Access to abortion unequal in Saskatchewan
|Montreal Gazette 05 Jun 2015 at 07:02|
Alack of self-referral to abortion services in Saskatoon also causes hardship for women in northern Saskatchewan, say two doctors working in the north...
Saskatchewan doctors should have the right to refuse to refer a woman seeking an abortion, says the president of the Saskatchewan Pro-Life Association...
When it comes to the issue of access to abortion in Saskatoon, silence speaks volumes.
Saskatoon is one of the most difficult places in Canada to get an abortion, leaving women to navigate a political maze, advocates say.
Along with a Halifax hospital, Saskatoon is the second-last Canadian site where a woman can’t simply make a call to set up the procedure — she needs a doctor’s blessing.
Regina’s clinic is a better model for patients, say several advocates familiar with the system.
Among them is Janelle (not her real name), a 38-year-old mother who had an abortion at Saskatoon City Hospital two years ago.
“I found that the number of steps it took to make the appointment happen was stressful,” she said.
The bureaucracy involved in setting up the abortion left Janelle feeling frustrated.
“I was feeling like, ‘Come on, let’s just get this over with so I can move on.’ Once I had made that decision, I wanted it to happen as quickly as possible. I didn’t want to have to think about it for another week and a half before it actually happened,” Janelle said.
Once a woman is referred to a gynecologist or family doctor who will do the procedure, the system is inefficient and disjointed, she said.
Janelle’s doctor scheduled an ultrasound and referred her to a gynecologist. It was left up to her to call the women’s clinic at City Hospital to find an opening for the surgery.
Janelle said she called for a couple of days in a row, and was told each time, “No, sorry. Call again tomorrow.”
It took three consecutive days of trying to get in.
Although the surgical procedure to end pregnancy is available in hospitals in both Saskatoon and Regina, a family doctor is the gatekeeper for most women in Saskatoon who want the publicly-insured service.
That gatekeeper is unnecessary, and doesn’t meet the standard of care across the country, said Vicki Saporta, president and CEO of the National Abortion Federation Canada.
“(A doctor’s referral is) an extra step that isn’t, and shouldn’t be necessary for a woman to access the care she needs,” Saporta said.
Saskatoon family doctor Brian Fern has performed pregnancy terminations for more than 40 years and is one of the few family doctors left who perform surgical procedures.
He’s heard more stories than he can count from women who say other doctors refused to refer them to a colleague so they could have an abortion, he said.
“It’s a breach of what I think are professional ethics.”
That ethical question — whether a doctor must send a patient to another doctor who can arrange an abortion if they don’t agree with it — is a topic of discussion right now before the College of Physicians and Surgeons of Saskatchewan.
One stop in Regina
In Regina, women can call the Women’s Health Centre directly to book an ultrasound, schedule a consultation with a gynecologist and get a procedure date. All of the appointments happen at the General Hospital, and often on the same day.
The Regina centre, which recently marked its 20th anniversary, was established with the aim of removing barriers to abortion, Regina Qu’Appelle Health Region spokeswoman Lisa Thomson said.
“When women are calling and referring themselves, we are better able to assess that it is their choice for the service, and it further allows us to gather the important private information directly from the patients themselves,” Thomson said.
The ability to self-refer matters because some physicians morally opposed to abortion will intentionally stall or refuse to refer women to an abortion doctor, says Evelyn Reisner, executive director of Sexual Health Centre Saskatoon.
“Doctors will say, ‘If you choose to do an abortion, you can’t be my patient anymore,’ or ‘That’s murder; I can’t support you murdering your baby,’ ” Reisner said.
The doctor may not know where to send a woman who wants an abortion, said support worker and options counsellor Linzi Williamson, who has also worked at the Sexual Health Centre.
By the time some women find the clinic, it’s too late to get an abortion in Saskatoon and they’re distressed by the runaround.
“Not that I wasn’t sensitive with everybody, but I would just have to take extra care of them. They would often be crying, feel very cheated and abused,” Williamson said.
One woman threatened suicide after her family doctor told her he no longer wanted her as a patient.
“She was just so upset about the whole thing, because she wanted to access this service, and was made to feel ashamed, and like she was an evil person for doing that,” Williamson said.
In Saskatoon, women can get bookings for the necessary appointments by going to the Sexual Health Centre, or by finding one of the handful of family doctors who perform abortions. Many, though, will go to their family doctors and be referred to a gynecologist. All roads lead to a string of appointments in different parts of town.
Some out-of-town doctors also find Saskatoon’s system cumbersome. Ile-a-la-Crosse family doctor Darcie McGonigle said it sometimes takes her 45 minutes of calling back and forth to get her patient booked for the necessary appointments in the city.
She calls Regina’s one-stop model “far superior.”
“There’s someone there to not only support you in your decision, but also to help organize, logistically, the steps that you need to take,” McGonigle said. “To have everything in one fell swoop is much more ideal.”
For Janelle, the clock was ticking on her window of opportunity to have the procedure done in town.
Doctors in the Saskatoon Health Region will only do the procedure up to 11 weeks and six days of gestation. If the pregnancy is any further along, a doctor will refer the woman to Regina or out of the province.
The only exceptions are if there’s a significant health problem with the baby, or the mother’s life is at risk.
Gynecologists in Regina will do the procedure until just shy of 19 weeks.
Counsellors say its difficult to get Saskatoon women booked into the Regina clinic, and that most end up travelling to Alberta.
The prospect of travelling to Alberta for an abortion was looming large in Janelle’s mind as she tried to book her appointments.
Thirteen per cent of abortions paid for by the Saskatchewan government in the past five years happened outside the province. That adds up to nearly 1,400 Saskatchewan women who had abortions elsewhere, according to numbers provided by the health ministry. Ninety-four per cent of those out-of-province abortions happened in Alberta.
Many of the women compelled to travel are further along in their pregnancies.
Pregnant women in their second trimester make up 40 per cent of the people travelling outside Saskatchewan for an abortion.
How it is now and where it’s going
Obstetricians and gynecologists aren’t getting much feedback from patients who say they’re dissatisfied with the way things are now in Saskatoon, said Dr. John Thiel, interim academic head of obstetrics, gynecology, and reproductive services for the Saskatoon Health Region and University of Saskatchewan.
Thiel’s practice is based in Regina, and he is a former chair of the Regina women’s clinic. He has limited knowledge of how the process works in Saskatoon. However, when The StarPhoenix requested an interview, he was the only spokesman the health region was willing to put forward.
“Things are done differently (in the two cities), but I don’t think they’re done differently to the detriment of patient care,” Thiel said.
He has an appetite for change and improvement, he said.
“Perhaps what happened is, concerns like (Janelle’s) were lost in the noise of reducing surgical wait times, because that really did take a huge focus. Having dealt with that, maybe it’s time to turn to some other issues,” he said.
Thiel said he can’t understand why Saskatchewan has no free-standing abortion clinic like five other provinces do, including Manitoba.
The less-than-12-week limit on abortions in Saskatoon is due to a 20-year-old decision by doctors to pull the plug on second-trimester abortions.
The further along a pregnancy is, the more technically challenging it is to remove the fetus, Thiel said. Not all gynecologists have the specific skill set needed.
Although he didn’t have numbers, Thiel said the demand for second-trimester abortions is small.
“Because they weren’t really common events for later-stage pregnancies, it was felt that the most appropriate way, and the best way to do it for patient care and patient safety was to have one or two people doing procedures in one centre,” Thiel said.
According to health ministry data, 14 per cent of Saskatchewan women who had abortions in the last five years were in their second trimester.
It’s not unusual for medical procedures to be available in only one of Saskatchewan’s two major cities, Thiel said.
He said there’s also help for women who need to travel for the procedure, pointing to funds available from the National Abortion Federation and through some First Nations.
Although Thiel may be open to change, the Sexual Health Centre’s Reisner said altering a complex and disjointed system is daunting.
A group of health professionals, including some young doctors, are pushing for Saskatoon to adopt Regina’s model, Reisner said. She is not directly involved.
The potential political fallout makes change a no-fly zone, Reisner said.
“No one wants to touch it with a 10-foot pole. It’s complicated, messy, and just a political hot potato. The health region doesn’t want to do anything — it’s the ‘If it ain’t broke, why fix it?’ approach. (It’s a) ‘Women are getting abortions. What’s your problem?’ kind of attitude.”
Dr. Fern, who has performed thousands of abortions, said the absence of a one-stop shop in Saskatoon has the advantage of preventing women from making rash decisions.
“I felt that there wasn’t anything wrong with a system where the patient had some time to think about it,” he said.
Janelle said she feels grateful she was in a stable, supportive relationship when she had to make the decision.
“What if you were 17 and had to deal with telling your parents and telling your partner and have to figure out what to do? You’d probably have no idea how to go about accessing the services. It would be hard to deal with all that.”
Barriers pile up for women in the north
A lack of self-referral to abortion services in Saskatoon also causes hardship for women in northern Saskatchewan, say two doctors working in the north.
The fragmentation of services across the city amplifies the difficulty for women in remote and rural areas to access all the necessary appointments, they say.
“I don’t think it’s adequate. I don’t think it’s ideal service for people. It puts up barriers,” said Ile a la Crosse family doctor Dr. Darcie McGonigle.
To get an abortion in Saskatoon, women need to first visit the Sexual Health Centre or see a family doctor to get a referral to a gynecologist and to book an ultrasound appointment. These appointments happen at several places across the city. Doctors do surgical abortions at Saskatoon City Hospital.
When women refer themselves to Regina’s Women’s Health Centre, an initial consultation, ultrasound, any necessary blood work, and counselling are done in one place, and can often happen on the same day.
“To have everything in one fell swoop is much more ideal. Essentially, no woman in the north gets that service,” McGonigle said.
The disjointed system means women from the north must sometimes travel to Saskatoon as many as three times to see it through. That’s a 10-hour round trip from Ile a la Crosse. The travel is expensive, disruptive, and easily derailed if childcare plans fall through, or the woman can’t get a ride.
If her travel costs are covered, the cost of a support person travelling with her may not be.
“This is an issue for every single part of people’s medical care here,” McGonigle said.
There’s also the question of confidentiality.
Some northern communities run a taxi-like service to and from Saskatoon for medical appointments, McGonigle said. If there are other people in the car, they might ask, “What are you going down for?”
It would be better if women could have all their appointments back-to-back in one trip, said Dr. Johanna Kaiser, a family doctor in La Ronge.
“Confidentiality in a small community is a big issue.”
Although women can request travel funds from the National Abortion Federation, president and CEO Vicki Saporta said very few women from Saskatchewan have applied in the past.
Then, there’s the lack of followup after doctors refer patients to Saskatoon.
“We never hear what happens,” Kaiser said. “I don’t know if people make it down.”
Kaiser would like to see a central referral centre, where doctors could book women for all their appointments on one day, or consecutive days. She also wishes women could have access to abortions closer to home in Prince Albert, which is the surgical centre closest to La Ronge.
More comprehensive lab services in La Ronge would also allow doctors there to do more medical abortions, Kaiser said.
In a medical abortion, a doctor administers two drugs a few days apart in the early stages of pregnancy. Most women don’t need to go to hospital while the drugs do their work.
Both doctors said they are frustrated by the status quo.
“It’s a health care service, and it’s legal. It’s something that should be available to all women if they want it,” McGonigle said.
“The fact that there’s so many barriers before accessing it, it’s just not fair.”
Easy access is not the answer: Pro-lifers
Saskatchewan doctors should have the right to refuse to refer a woman seeking an abortion, says the president of the Saskatchewan Pro-Life Association.
“If they’re referring (a patient) to someone who will do an abortion, then they’re kind of being an advocate for abortion. A child dies. So they don’t want to be part of the death of that child,” said Colette Stang.
The body that regulates Saskatchewan doctors is considering a new policy that would require physicians to refer patients for services to which they object for reasons of conscience, or provide the services themselves if no other options are available.
When asked about differences in access to abortion services between Saskatoon and Regina, Stang said she supports equal access to medical procedures. However, she doesn’t think any abortion is “healthy and safe,” she said.
“Easy access just isn’t a healthy way to go ... I see way too many women who live with all sorts of grief because of their abortion.”
Although a woman may feel anxious waiting for an abortion, or getting the runaround to set one up, Stang believes some suffer even more after the fact.
“You want to make a quick decision, but it’s an uninformed decision.
That doesn’t necessarily mean that’s going to be in the best interest of your mental health for the long term,” Stang said.
The question of parental consent also resurfaced recently when Saskatchewan’s rural and remote health minister delivered a petition to the legislature demanding pregnant teens be required to get their parents’ permission to have an abortion.