Saturday, May 31, 2014

Letter to the Editor: Abortion status quo not working

The Guardian published a letter to the editor I co-authored with Dr. Colleen MacQuarrie, about the current status of abortion care access in Prince Edward Island in New Brunswick, Canada:

P.E.I.’s current policy of forcing women to travel out of province to obtain the abortion care they need is fraught with barriers, which actually harm women. Women’s groups in P.E.I. have been fighting to change this inequitable policy, and last year Health P.E.I. formed a working group to develop a proposal to establish a termination service in P.E.I. However, even though this plan would benefit women in P.E.I., save money for the province, and correct a long-standing unjust policy, it has not moved forward.

This week, Premier Robert Ghiz said in a statement that the, “Government has indicated that there is no desire to broaden the current abortion services; therefore, it would not make sense for Health P.E.I. to put resources into a proposal that is not in line with government policy.”

But the current “government policy” on abortion is unjustifiable. It not only harms women, it flies in the face of the Canadian Charter of Rights and Freedoms, specifically sections 2 (freedom of conscience) and 7 (protection of life, liberty, and security). Since 1988, the Supreme Court of Canada has recognized that access to abortion is fundamental to women’s right to health and to health care, and protected by the Charter.

 P.E.I. is the only province where abortion care is not provided in-province. In order for Island women to obtain a publicly-funded abortion, they must first get a doctor’s referral and travel to a hospital in Halifax, which more than 100 women did last year. And even though the province may pay for the physician and hospital costs for women traveling to Halifax, it doesn’t pay for other costs such as travel expenses, child care, and lost wages. These additional costs can present major barriers for women in P.E.I. and would be lowered or eliminated completely if abortion care was available on the Island.

Additionally, another 50 or so women traveled to Fredericton last year and paid out-of-pocket for their care at a private clinic, often because the wait was too long in Halifax or they were unable to obtain a referral. However, this clinic is closing in July due to lack of funding, and this will further stress the health care system and negatively impact women in both Halifax and P.E.I.

Contrary to recent statements by Premier Ghiz, the status quo is not working for these women who have to travel out of province to access medical care that would be available locally if they lived in any other province in the country.

Ghiz has also compared abortion to other medical procedures that Islanders must travel to obtain. However, these are generally services that are done by specialists that couldn’t be supported in a small community, which is not the case for abortion care. Abortion is one of the safest and most commonly provided medical procedures in Canada. P.E.I. has always had the facilities, equipment, skills, and resources to provide abortion care and there is no credible reason why this simple 10 minute procedure is not offered locally—indeed it was up until 1986. The proposal developed by Health P.E.I. would use existing hospital facilities and the National Abortion Federation has identified at least three physicians who are willing to come to P.E.I. to provide the care.

Resource allocation decisions like this that carry health risks need to be based on evidence. And there is no scientific evidence that forcing women to travel improves their health. In fact, research from UPEI shows that restricted access to abortion care promotes unsafe abortion. Some women in P.E.I. have attempted dangerous methods to try to induce an abortion when they haven’t been able to navigate the barriers to obtain one out of province.

Restricting women’s access to abortion care doesn’t make the need disappear. Abortion is a present and enduring part of Island women’s medical needs. Without access to local safe surgical abortion options, women’s safety and health are at risk.

For too many years, we have been told that abortions aren’t available in P.E.I. because there isn’t a doctor willing to provide this care or that it would be too expensive. But that simply is no longer true.

It’s time the provincial government comes into compliance with the law, and ensures that women have local access to this constitutionally protected and medically necessary care. Women in P.E.I. deserve the same care and respect as women in other provinces when it comes to their ability to access the abortion care they need.

*Dr. Colleen MacQuarrie is an Associate Professor in the Psychology Department at UPEI.

Monday, April 28, 2014

On Abortion, New Brunswick Must Change

This weekend, the Telegraph-Journal in New Brunswick published my op-ed on the closing of the province's sole freestanding abortion clinic and NAF member, the Morgentaler Clinic in Fredericton:

For far too long, women in New Brunswick have been denied the same care and respect as women in other provinces when it comes to their ability to access the abortion care they need.
The government in New Brunswick has a clear duty to meet the health care needs of women in the province, including their reproductive health care needs.

However, for nearly three decades, the powers that be in the province have been passing the buck and forcing many women to pay out of pocket for what should be, and would be, a publicly funded medical procedure anywhere else in the country.

Archaic and unsound policies in the Medical Services Payment Act - which require women to seek approval from two doctors and obtain an abortion from an obstetrician-gynecologist in a hospital in order to receive public funding - have forced half of the women who need abortion care each year in New Brunswick to pay out of pocket at the Morgentaler Clinic in Fredericton, the province's sole freestanding abortion clinic.

Many of these women struggle, and are unable to raise the funds to afford this care. The National Abortion Federation Canada has been operating a patient assistance fund since 2008 to help women in Canada who otherwise slip through the cracks, and the vast majority of the women we have funded have been from New Brunswick.

The clinic has also helped by discounting fees and doing all that they could to provide care for women regardless of their financial resources. But this system has proved financially unsustainable, and the clinic has announced it will be closing in July.

This closure will leave a real void for women, which the provincial government has a duty to fill. And that cannot happen without the repeal of the province's regulation 84-20 of the Medical Services Payment Act.

In virtually no other province are women subjected to such medically unnecessary and unfair policies. Across Canada, provinces and territories allow family doctors as well as obstetricians-gynecologists to provide funded abortion care. Additionally, abortion care is safely provided by outpatient clinics as well as hospitals.

And nowhere else in Canada is there a requirement that two doctors must approve and agree that an abortion is medically necessary to be eligible for coverage through a medical services payment plan. This requirement is in direct violation of the 1988 Supreme Court ruling in R v. Morgentaler, which eliminated the requirement for approval of abortions and ensured women, not a committee of doctors, had the freedom to make the decision to terminate a pregnancy. There is no justification for New Brunswick to stand alone in continuing to subject women to this unjustified, unconstitutional restriction.

The current system in New Brunswick is completely inadequate and unacceptable. If the government refuses to fund abortion care at private clinics, then it must develop a coordinated plan to make sure women's health care needs are fully addressed by the province's hospitals.
This includes expanding abortion care to other hospitals throughout the province and ensuring there is enough operating room time available to accommodate the actual number of women who need abortion care each year. Currently, women often encounter waiting times at the hospitals, which are now only seeing half of the women who need this care each year in New Brunswick.
Barriers to abortion access do not reduce the number of abortions, but rather force women to jeopardize their lives and health in order to terminate an unwanted pregnancy. The government in New Brunswick has an obligation to provide care for women in the province and it is long overdue that the provincial government fulfills this duty. Women should not be subject to pre-Morgentaler era policies that threaten their lives and health.

Tuesday, March 04, 2014

Kudos to Madison for creating buffer zone

Today, the Capital Times in Wisconsin posted my letter to the editor, applauding the Madison City Council on the passing of a 8-foot buffer zone around medical facilities:

Dear Editor: We applaud the Madison City Council for passing an ordinance that creates a roaming 8-foot buffer zone around patients who are within 160 feet of the entrance of a medical facility.

In a recent National Abortion Federation survey, 92 percent of clinics reported that they were concerned about the safety of their patients and employees in the areas approaching the clinic. Further, 90 percent of clinics reported that, within the past two years, patients entering the clinic have expressed concerns about their personal safety.
Buffer zones are critical in reducing threats and intimidation, and help ensure that patients are able to safely access the reproductive health care they need. They accomplish this while still protecting the free speech rights of abortion opponents.

Monday, March 03, 2014

Substandard Practitioner

The New Yorker posted a letter to the editor that I co-authored with NAF Board Chair Beverley Winikoff, in response to Eyal Press' article, A Botched Operation, and the substandard practices of Steve Brigham.
Throughout his career, Brigham has come under fire from state licensing boards, health departments, and the abortion-provider community. His case is not representative of the high standard of care offered by abortion providers in the U.S. If anything, his story demonstrates how important it is for women to have access to safe, legal, and affordable abortion care. State regulations have made it more difficult for women to obtain safe abortions. Regulations such as requiring providers to have hospital admitting privileges do nothing to improve patient safety, nor do they stop bad actors like Brigham. Instead, they make it more difficult for legitimate providers to remain open, and create opportunities for substandard providers to prey on vulnerable women.