Access to abortion disjointed, uneven in province, doctors say
When Dr. Sally Mahood was young, her mother was one of the only people who could help women get an abortion in Saskatchewan.
At that time, Canadian law required a board of hospital staff — usually entirely men — to individually approve a patient's decision to terminate pregnancy.
Mahood said her mother, a Saskatoon psychiatrist, was one of few sympathetic ears. Years later, Mahood became an advocate for reproductive rights, and then a doctor at the Regina Women's Centre. Much has changed, but Mahood said access to abortion in Saskatchewan is still far from where it needs to be.
“I don't think it's the lack of providers,” Mahood said. “I think it's the lack of initiative on the part of the provincial government and the health authority to recognize this is such an important service.”
After reports the U.S. Supreme Court could quash that country's guarantee to abortion services, politicians on this side of the border, including Saskatchewan, rushed to assure the public there was no legal challenge to abortion in Canada. Minister for Women Laura Ross said there is no barrier to accessing abortion in the province.
Doctors and advocates say access to abortion in Saskatchewan is still disjointed and uneven, with no apparent political will to make it easier.
Dr. Leane Pask has long believed in comprehensive reproductive health care, up to and including terminating pregnancy, so the Saskatoon family doctor received training to provide surgical abortion for up to 14 weeks gestation.
However, in Saskatoon, Pask said she can only operate up to 12 weeks — not because of the training, but because that's the standard for the city.
Saskatoon and Regina are generally the only two places in Saskatchewan where patients can get a surgical abortion, but the systems they use are completely different.
In Regina, anyone can visit the Women's Centre and make an appointment for a surgery up to 14 weeks gestation, and 18 in some cases.
In Saskatoon, though, the Saskatchewan Health Authority says doctors only provide surgeries up to 12 weeks — 14 in rare cases. And there is no central intake, meaning patients have to find a doctor who will refer them, first.
Pask said that little step can actually be a gigantic hurdle. There is no public hub for where to find such information, often leaving patients trying to chase leads on Google. The result is that patients are sometimes directed toward crisis pregnancy centres, which aim to persuade them against terminating a pregnancy.
“Even as somebody who does this and knows the different access points, even me, it takes three or four phone calls to get an appointment for a surgeon with a patient,” Pask said, adding that it almost feels clandestine.
“It always feels shady and underground in a way that you have to go into this secret world to access care.”
Angie Kells started the Saskatoon Abortion Support Network in 2018 with the explicit aim of helping people who want abortions get them. She said she hears from plenty of people who just can't find the right resource.
In a few rare cases, Kells has driven patients from smaller towns to the big city to get the service, which in and of itself is a remark on the barriers to access in the province.
“The folks that we're helping are literally reaching out to a stranger on the internet to ask for help.”
Because Saskatoon requires a referral, patients from out of town might need to make two separate trips to get the procedure. Ile-ala-crosse family physician Dr. Darcie Mcgonigle said that can mean two full days of travel for a procedure that takes as little as 10 minutes. Sometimes patients share cabs or other transport with other patients in the community.
“That's a huge barrier for people: time, money and loss of anonymity,” Mcgonigle said.
The Starphoenix got no response when it requested an interview with provincial Health Minister Paul Merriman.
In 2019, Saskatchewan began universally covering the abortion pill mifegymiso, which can terminate a pregnancy up to nine weeks gestation.
Mahood said more people in rural and remote areas are able to access it — a positive step — but it's not a substitute for available surgical services.
“I can give you a million reasons why women couldn't choose that option and would still need surgical abortion,” she said, adding that the people affected most by the barriers to getting an abortion are often those who are poor, don't have transportation or are otherwise vulnerable.
“It is women who are otherwise marginalized who get caught up in all these accessibility difficulties.”
The Starphoenix requested an interview with a Saskatchewan Health Authority official on why abortion services are so different in the two major cities, and why they aren't offered elsewhere.
The SHA responded with an unattributed statement, saying the “vast majority” of surgically-induced abortions happen in Saskatoon and Regina “where a full range of reproductive and counseling support services are available.” The statement said there are no plans to expand services outside of acute care settings.
The reason services are offered in different time frames is related to the needs of providers, it added.
Mahood said she doesn't think that's true. She believes there are plenty of doctors capable of providing the service in other cities across the province.
“There are many procedures in Saskatchewan that you can get in any urban community. This is more common than breast cancer, more common than heart attacks. One in three women in Canada needs an abortion in their lifetime,” Mahood said.
She doesn't think legal access to abortion in Canada is threatened as it is in the United States, but she also believes there isn't any political will in Saskatchewan to make it more accessible than it is today, she said.
Mcgonigle said if abortion were another health service, the status quo would not be accepted.
“(The SHA) do big programs and make sure that people have access to that care. They don't do this for abortion services.”
This is more common than breast cancer, more common than heart attacks. One in three women in Canada needs an abortion in their lifetime.