Abortion barrier likely 'historical practice,' not law, says health minister

Nova Scotia's health minister says the province is addressing concerns about abortion access, adding it appears the need for women to get a referral from a family doctor is simply historical practice rather than law.

"There were concerns about how the process, particularly around referrals, takes place," Randy Delorey said in an interview Tuesday. "What we've seen thus far is there is no legislation or regulation that establishes it, so that means it's likely a case of it being historical practice."

Nova Scotia is the only province in Canada that requires women to obtain a referral before booking an abortion. Advocates call the referral requirement a barrier to access that creates lengthy delays for the time-sensitive procedure.

Delorey said he has asked staff at the Nova Scotia Health Authority and the Health Department to look into concerns and report back on how to improve access.

"Without knowing what, if any, clinical rationale exists for the referral, it's hard for me to take a position on it," he said in his first interview on the topic. "That's part of what I'm asking for: Why does it exist and is it something they recommend changing. From what I see, it appears to be historical practice."

Some women feel shamed and punished

If the need for a referral is indeed convention rather than law, Delorey said the hurdles to make changes "wouldn't be as large."

The health minister had earlier issued a statement calling abortion access in the province "out of step" with current practices after The Canadian Press reported on the barriers, with women requiring a referral for a surgical abortion, lengthy wait times for the time-sensitive procedure and no provincial coverage for medical abortions using pills.

Several women interviewed described feeling shamed and punished by the process.

Dr. Lianne Yoshida, medical co-director of the Termination of Pregnancy Unit at the QEII hospital in Halifax, said provincial health officials have asked her to put together recommendations to improve abortion access.

But she said waiving the referral requirement is only the first step.

"Women should be able to book one appointment and have an ultrasound and blood work done on the same day as an abortion," Yoshida said. "The day of the appointment, she would arrive, get her blood work drawn and ultrasound done, which would confirm the gestational age, and then she could have the surgical procedure. It would all happen in one visit."

Some women wait months

Women in the province must now book an appointment with a family doctor for a referral and then have a dating ultrasound scan and a blood test — three separate appointments — before they can schedule an abortion.

The process has left many women in Nova Scotia waiting months to obtain an abortion, a delay abortion advocates called "unconscionable."

The lengthy waiting period also forces women to have later-term abortions, something a medical ethicist said is unjust, more risky and more expensive.

In 2016, the Halifax clinic performed 1,592 abortions, a number that includes out-of-province patients. Some Prince Edward Island women came to Halifax for the procedure before P.E.I. started offering in-province abortions in early 2017.

Yoshida said her recommendations would not only improve abortion access in Nova Scotia — they would save the province money.

Proposals under review

While reducing the number of appointments overall and cutting health care costs, she said the abortion clinic would require more resources, including a toll-free number, a full-time, trained clerk to answer the phone as well as an ultrasound machine.

"Part of my proposal, and the way it's done in other hospital-based clinics in Ontario, for example, is to have an ultrasound machine in the clinic," Yoshida said. "Once a day, an ultrasound technician can come to the clinic for an hour to scan all the patients for that day, rather than booking separate appointments and sending all the patients to radiology."

A bedside ultrasound machine would also assist doctors during procedures, such as confirming when an early abortion is complete, she said.

Delorey said he would examine any recommendations that come forward.

Yoshida said her proposal will include ways of integrating the abortion pill Mifegymiso into the clinic's scope of practice.

Delorey said the province has not yet made a decision on whether to offer universal coverage of the drug, a two-step combination using mifepristone and misoprostol that is now covered in five provinces.

"We're still evaluating it through a process for assessing drug coverage within the province. It's still under review."