N.S. now only province that requires doctor’s referral for abortion: Advocates
HALIFAX — Five years ago, Melanie Mackenzie got pregnant. Her birth control had failed, and the then 29-year-old knew she didn’t want to have a baby. She wanted an abortion.
“I found out I was pregnant almost immediately. You just get that feeling,” the Halifax resident said in an interview. “I hadn’t even missed a period yet.”
After taking a positive home pregnancy test, Mackenzie went to her family doctor — Nova Scotia is the only province in Canada where women must obtain a physician’s referral before making an abortion appointment.
“I said flat out ‘I’m pregnant and I don’t want to be. I want an abortion.’ ”
Mackenzie was told there was a waiting period, and was sent for a battery of tests including blood work and an ultrasound. It took two months for her to finally obtain 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.”
Advocates say Nova Scotia is now one of the most difficult provinces in the country in which to access abortion, with women requiring a referral for a surgical abortion, lengthy wait times for the timesensitive procedure and no provincial coverage for medical abortions using pills.
The province also has no private or freestanding abortion clinics located outside of a hospital. Halifax’s Morgentaler clinic, where women had to pay out-of-pocket, closed in 2003.
The Termination of Pregnancy Unit at Halifax’s QEII Health Sciences Centre — 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.
With few doctors prescribing the abortion pill Mifegymiso — and no universal coverage of the costly medication in the province — women seeking to terminate early pregnancies are forced to wait.
“Nova Scotia is one of the worst places in Canada to get an abortion. The situation for abortion access is extremely grim,” said Darrah Teitel, public affairs officer for Action Canada for Sexual Health and Rights.
After her blood work came back positive, 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 Canada, abortion care is a patchwork of widely differing degrees of accessibility and options depending on the province and region. Abortion access is largely provided in big urban centres, leaving women in small communities or rural areas footing the bill for travel and accommodation.
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.
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.
Women in Nova Scotia still require a referral and tests before obtaining an appointment for an abortion.
“We do require our patients to get referred to our clinic,” Lianne Yoshida, medical co-director of the QEII’s Termination of Pregnancy Unit, said in an interview. “It’s been identified as a barrier and it’s an issue we’re working on. The issue of referral and ultrasound does delay a woman’s ability to see us.”
It also may be unconstitutional, Teitel said.
She said the provincial 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.
In addition to the referral rule, it’s unclear whether delays are exacerbated by a policy enforcing a wait time, restrictions on early abortions or simply a lack of sufficient resources.
While Yoshida said there are surgical issues with abortions performed too early, she said that tends to be around four weeks gestational age.
Still, a receptionist reached at the QEII clinic said abortions are not scheduled before eight weeks — something confirmed in multiple interviews.