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Inadequate Abortion Access for Northern Communities

May 4 2022 - By Michaela Parenteau, Edited by Sabrina Flack

Michaela Parenteau is an Indigenous Registered Nurse currently completing her Masters in Public Health. She works for Indigenous Services Canada providing reproductive and perinatal care to members of her community. She is currently fulfulling her practicum placement with the Northern Birthwork Collective.

“It is estimated that approximately 1 in 3 Canadians have an abortion in [their] lifetime” (Dunn & Cook, 2014).

Canada, unlike other countries, has legalized abortion procedures across the nation. Without legalization of this medical practice, abortions are not able to safely occur, and pregnant people lack the ability to make important choices involving their body. The legalization of both medical and surgical abortion has allowed physicians to practice these treatment options legitimately allowing pregnant people the opportunity to reclaim their body rights. Legalization of abortion has allowed for pregnant people to seek safe and quality care, supports the right of choice and improves holistic wellbeing.

Without the legalization of abortion in Canada, pregnant people may choose to turn to the “black market” and participate in “back-alley procedures” to discontinue a pregnancy (SOGC, 2019). Where legal abortion services are not available, pregnant people wishing to access abortion care may opt to undergo procedures that are dangerous, performed in risky environments without access to sterile medical equipment, timely interventions and life-saving medications. These unsafe procedures performed by unregistered practitioners could render the person sterile, could result in failed abortion, uncontrolled bleeding, or even death of the pregnant person (United Nations, 2022). Abortion care should not be criminalized or driven underground when we can legally provide quality and safe care options.

Despite the legalization of abortion in Canada and available options of care across the country, abortion is not equally accessible for all pregnant people. For those that reside in Canada’s remote northern communities, the continuation of inequities hinders the ability to access timely care and access to quality abortion services.

Types of Abortions:

A medical abortion is the most common treatment option as it is less invasive and can be completed with the least amount of risk for the pregnant person. Medical abortions can only be completed up to 9 weeks from the first day of the last menstrual period and may need to be confirmed by ultrasound. Medications are given to stop pregnancy hormones, allow for products to pass through the cervix and help with any experienced pain or cramping (GNWT).

A surgical abortion is more invasive and can be done in Canada until 24 weeks. Medication is given to help soften the cervix, and an IV is put in place to give medications to help with pain and relaxation. A speculum is inserted into the vagina to visualize the cervix, freezing is applied and a tube with suction is inserted into the uterus. The procedure takes between 10-20 minutes and requires someone to pick up the client after the procedure (GNWT).

For those residing in remote northern communities, travel to a larger centre such as Yellowknife may be required as there may not be access to definitive ultrasounds if needed. Small remote communities in Nunavut and Northwest Territories sometimes have access to midwives and medication abortion care which often allows the person to remain in their community. However, for Indigenous peoples who reside in northern communities in provinces such as Ontario, abortion care is not permitted in federally operating nursing stations and medical evacuation to a larger centre to access abortion care is required.

Unequal Abortion Access

Canadians would be naive to believe that everyone can access barrier free abortion care. For those pregnant people residing in northern and remote communities, often the only option available is to travel hundreds of kilometers by plane to access these services. For some, leaving home and responsibilities of other children, employment obligations or school to choose what is best for them is not feasible.

For some, accessing abortion care is not as simple as calling the local clinic and discretely scheduling an appointment. In the NWT and western Nunavut, we are fortunate to have the NOW program. The NOW program has a 1-800 number that anyone can call to confidentially arrange for their care. For pregnant Indigenous people living in many other Northern communities, they must book an appointment at the community nursing station or clinic, be assessed by one of the community health nurses, consult with the community physician, await a referral to an out of community specialist, arrange for travel to the accepting facility, be flown to a city with abortion care services (sometimes without support of an escort), undergo the abortion procedure by unfamiliar health care providers and then be housed in an unfamiliar hostel or boarding home for the duration of the treatment. While waiting for the products to pass, heavy cramping and bleeding is common. Surfacing emotions such as grief and sadness may be experienced. Many people would wish to endure the following days post procedure privately, and discretely. However, for some northern Indigenous persons this simply is not an option. Boarding homes often only offer shared double occupancy rooms and communal bathrooms. In the NWT, the NOW Program will offer options to ensure privacy during a medical abortion to those who are travelling to Yellowknife from remote communities for the procedure. They are likely to offer the patient a hotel room or use of one of the rooms at the obstetrical unit.

Abortion is a highly controversial topic, and confidentiality of the pregnant person is of utmost importance. Often in community nursing stations, these medical procedures can be difficult to organize discretely which causes hesitation with clients as they lack trust in the medical system. The choice of abortion is not always supported by family, community members or health care professionals. Sometimes access to options is difficult to arrange, and sometimes escorts for abortion care is not supported. Once in the city, the person may attend the procedural appointment alone and then return to the boarding home where little support exists. A follow up appointment is sometimes booked or recommended by the abortion clinic in a few weeks. Mental health services to provide support during the grieving process is generally not facilitated, and the person returns home without having appropriate support after having experienced an invasive and at times traumatic procedure.

Canada as a whole has failed in ensuring abortion care is equitably accessible by all. Not only is care out of reach, but distant accommodations are inadequate and holistic support following abortion is unavailable. Understanding the relationships between Indigenous people and the injustices related to the national birth evacuation policy, systemic racism and discrimination, absenteeism of informed consent, colonialism in medical models, it is apparent that abortion care services follow a similar negative trend. Access to abortion care continues to be inequitable for Indigenous peoples and reproductive justice gaps are prevalent in current services.

How birthworkers and doulas can support abortions

Birthworkers and doulas can support people who are accessing abortions by checking in with them pre abortion, escorting people to abortion appointments, and supporting them after the abortion. Their presence can be to provide emotional support, listen without judgement or to offer distraction by playing games or having light conversation. Sitting in silence and solidarity is also a valid form of support if that is what the person needs. Additionally, logistical support can be provided to ensure people get to and from their appointments safely.

Birthworkers play an important role in advocacy for reproductive justice and rights. Ensuring that people have dignified, safe and respectful abortions is a big part of this.

Safe, equitable abortion access and support is a human right.

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