A graphical overview of the rural abortion situation in Canada, by Thomas Van Ryzewyk for VICE Canada.
Getting an abortion in Ontario is fairly easy. Unless you accidentally walk into a crisis pregnancy centre, no one will interrogate you or try to talk you out of it. I could book an appointment, the government would pay for the procedure, and no one would have to know. That's why it's so odd that outside of Ontario, trying to get an abortion is such a tedious, frustrating process.
A recent study done by researchers at UBC examined the barriers women face that prevent them from getting abortions. They surveyed abortion providers across British Columbia, asking about their experiences, their future intentions, and the occupational challenges they face day to day. They found that these barriers have become bigger and bigger over the past while: for women in rural communities, about 60 percent of abortion services provided in hospitals disappeared between 1995 and 2005.
Rural physicians working out of hospitals reported various barriers to provision, like operating room scheduling, logistical issues, high demand, professional isolation, and a lack of replacement providers. Many providers, two of whom I spoke with, felt the need to “fly under the radar” in their communities.
Many factors affect access to abortion in this country. Only licensed physicians can provide the service, and distances between rural communities and abortion service providers can be a massive physical and financial obstacle for women dealing with unwanted pregnancies. On top of this, abortion providers also face opposition from their own colleagues, making the situation even worse.
The study found that unlike abortion providers in urban areas who work out of purpose-specific clinics, rural providers mostly operate out of local hospitals, which comes with problems like lack of operating time for abortions, a likelihood of abortions being deferred for “urgent” non-abortion cases, and difficulties scheduling staff for the procedures, like nurses and anaesthesiologists, to accommodate those who don't want to be involved in abortion care.
“The anaesthetists…just don’t want to be in my room because they don’t get enough money per case and sometimes my case doesn’t run. I’m expendable. If there’s no anaesthetists… well, ‘It’s okay we’ll just pull the anaesthetist out of [participant]’s room’. So there’s a bit of a judgment call there on anaesthesia…there are people that have ideas about what they think is more important,” one participant told the researchers.
An abortion provider from a small city in the Cariboo District of BC, who spoke to me on the condition of anonymity, also told me about uncooperative anaesthetists. “We do a deep sedation, and there's often a challenge: several of the anaesthetists will not provide this service because they don't believe in abortion. They just won't. You have to scramble because you can't get the women in when you need to, which is frustrating,” she said.
Being an abortion provider in a rural area can be pretty lonely, with many being the only providers in their communities, serving very large geographic areas. Some say they feel overwhelmed by the demand and that they can't meet the community's requirements because they're so restricted by the facilities. Two participants felt like they always had to be available, and one actually stopped her surgical practice because he/she couldn't find another doctor to help her provide 24-hour availability for emergency care.
One participant describes the sheer volume as a potential reason to stop. “If it’s only me trying to see everyone, with no breaks and, you know, to feel like you can’t even take a week away because, either it’d pile up or people aren’t going to be able to be seen…The biggest barrier is just…keeping myself from getting burnt out, providing the services and feeling like I can’t do as much as I want to.”
Professional isolation is often coupled with social isolation—many rural abortion providers feel like they have to keep their work quiet. One particular provider told me how she feared for what her children could face if the community knew about her work, and another was afraid to go to church because she didn't want to be seen as a person with double standards where she “believed in a religion and all of its tenets… and then performed abortions.”
The abortion provider I spoke with from a small southern interior town in BC told me she's starting to resent having had to keep quiet about her work for the 20 or so years she's been practicing. She describes the difficulties of being the only one in her community to provide abortion services: “There are colleagues who are pro-choice who would never want to provide the service. I actually have a lot of colleagues in this town who are anti-choice, who actually put up obstructions for patients who are seeking abortions. They just don't offer referrals.”
She says abortion care is the work she finds most rewarding—even more rewarding than delivering people's babies—because that's where she receives the most appreciation from her patients. Her colleagues are the ones who give her the most flack, sometimes refusing to assist her in her obstetrical practice.
The study supports what we've heard anecdotally for years: access to abortion in rural Canada is awful. While yes, abortion providers themselves are struggling; women with unplanned pregnancies are the ones who ultimately suffer the biggest consequences. Dr. Wendy Norman, the UBC professor behind the research, explains: “Because there are so few rural communities that now have this service, often women are having to travel four or five hours to get it.” They have to get time off work, find someone to take care of the kids they may already have, and find money to pay to get to the abortion provider. “What about young girls with no money or anyone to turn to [who can] help them? Women whose lives—because of mental health and substance abuse problems—are too chaotic to solve the first problems let alone this one?” It's known that unplanned pregnancy rates among these marginalized populations and underage women are higher, explains Wendy.
In 2006, Canadians for Choice released a report called “Reality Check: a close look at accessing abortion services in Canadian hospitals.” A researcher called hospitals across the country to find out how easy it was to get an abortion and found the following: there are no abortion services in PEI, only 6% of hospitals in Alberta provide abortions, 4% do in Manitoba and New Brunswick, New Brunswick requires the approval of two physicians for an abortion to be provided, and 60% of non-providing hospitals in BC were unwilling to give the researcher further information or a referral to the researcher. And those are just the biggest findings.
The wait lists at some clinics are in the hundreds. In Kamloops, BC, for example, about 400 women need abortions but the doctor only does three abortions in the one-day a week she's actually there, because of a lack of support from the hospital. So what happens to all the women who are in the later stages of the eligibility period? Hard to believe that this still happens in Canada, but some of them are likely to take matters into their own hands or try to get an abortion outside the safety of a hospital.
“I think it starts with stigma and ends with stigma,” says Jeanette Doucet, a member of the Board of Directors at Canadians for Choice. “Women have to sneak around. It’s not like having a wart removed or like having your tonsils out. This stigma is hindering the ability of rural doctors who may well want to perform abortions in rural communities and preventing women from demanding them...[Doctors] care about their livelihoods, their place in the community, how their children are going to be treated.”
Many Canadians probably look at the craziness of the pro-life/pro-choice debate in the United States and scoff, knowing our choice to get an abortion is almost certainly safe. But even though abortions are not restricted by federal law, not every woman will get an abortion in a timely and safe way.
That's why research like Dr. Norman's is important—it sheds light on fixable problems. Women have fought for abortion rights for a long time in this country, and while we've had some big victories recently, it's important to remember that it's still an uphill battle. Until doctors are able to provide this safe, time-sensitive, and essential service without having to jump through hoops, the abortion issue in Canada is far from being resolved.