N.S. now only province that requires a doctor’s referral for abortion: advocates

Advocates say Nova Scotia is now one of the most difficult provinces in the country in which to access an abortion.

Darrah Teitel, public affairs officer for Action Canada for Sexual Health and Rights, said the “extremely grim” situation may be unconstitutional.

It is the only province that requires a referral for a surgical abortion, and there are lengthy wait times for the time-sensitive procedure and no provincial coverage for medical abortions using pills.

Lianne Yoshida, medical co-director of the termination of pregnancy unit at the QEII Health Sciences Centre in Halifax, said it is recognized as a problem.

She said she doesn’t believe politics are behind the barriers, so much as that it is ”the way it’s always been,” and officials are working on it.

Nova Scotia once had the region’s least restrictive abortion access, but both New Brunswick and Prince Edward Island have changed their policies in the last three years.

Some women interviewed for this story said they were referred for an abortion by a family doctor without delay, but others describe having to “jump through hoops” to get a referral. Wait times tended to be four to six weeks, a delay they described as “agonizing” and “cruel.”

One woman told The Canadian Press she had four appointments with her family doctor before she obtained a referral for an abortion. Her doctor quizzed her on her knowledge of the fetus and sent her to a psychologist before finally agreeing to refer her.

Another woman, Melanie Mackenzie, said it took her two months to obtain an abortion when she got pregnant five years ago.

Mackenzie was told there was a waiting period, and was sent for a battery of tests including blood work and an ultrasound before obtaining an abortion at nearly 12 weeks pregnant.

“It was the worst two months of my life,” she said. ”The whole thing felt like a punishment.”

Mackenzie recalled the nurse congratulating her on the pregnancy in front of other patients.

“I never regretted my decision to have an abortion,” she said. “But it felt like that waiting period and all those tests were to shame me, to make me feel like an irresponsible slut, to punish me. It felt like it was a price I had to pay to obtain an abortion in a country where my right to choose is legally protected.”

In 2014, New Brunswick lifted the so-called two-doctor rule requiring two physicians to certify an abortion as medically necessary.

Abortions became available in P.E.I. for the first time earlier this year. Women on the Island can call a toll-free number to make an appointment without the need for a referral.

Teitel said the Nova Scotia rule requiring a physician’s referral is at odds with the Supreme Court’s 1988 R v. Morgentaler decision. Evidence presented during the trial showed that the unnecessary wait times involved in physician referrals were creating unsafe conditions for women, Teitel said.

“These delays are still being forced on women in Nova Scotia, and there is no earthly reason why abortions cannot be granted upon self-referral, as in the rest of the country,” she said.

Nova Scotia does not appear to keep statistics on how long it takes women to obtain an abortion after a referral.

The QEII — where more than 85 per cent of the province’s abortions are performed — will only book appointments for women who are at least eight weeks pregnant.

Meanwhile, a new method has emerged that would give Nova Scotia women another option in early pregnancy. Mifegymiso, an alternative to surgical abortion, is an abortion pill that can be used to terminate a pregnancy of up to 49 days.

Advocates say the two-step process using the drugs mifepristone and misoprosto could increase access, provide women with more choices and shorten wait times.

The Society of Obstetricians and Gynaecologists of Canada says 171 physicians and pharmacists in Nova Scotia have either registered for or taken a training course on Mifegymiso.

Alberta, Manitoba, Ontario, Quebec and New Brunswick have said they would provide some coverage for the drug. A Health Department spokeswoman said the Nova Scotia government is looking at coverage for Mifegymiso, but a decision has not yet been made.

Meanwhile, it’s unclear why women in Nova Scotia must obtain a referral.

Health spokeswoman Sarah Levy MacLeod confirmed that a referral and an ultrasound are required before an abortion can be booked, but she referred questions on the policy to the Nova Scotia Health Authority.

The health authority referred questions to the co-director of the termination of pregnancy unit — the same doctor, Lianne Yoshida, who called the need for a referral a barrier to access that needs to be addressed.

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