Government & Medicine

A procedure that dare not speak its name

Abortion access is coming under fire in the US.
What's going on in Canada?

By Susan Usher

On April 25, over 800,000 people marched on Capital Hill in Washington to protest the US government's law aimed at restricting access to abortion. The law in question, misleadingly entitled the Partial-Birth Abortion Ban of 2003, was passed last year and bans second trimester abortions. It has been condemned by the American College of Obstetricians and Gynecologists and countless other groups who call for its reversal.

Closer to home, Canada's legislators have been pretty quiet on the abortion issue for over a decade. In 1988, the Supreme Court ruled for abortion to be removed from the criminal code. In 1989, they ruled that the fetus was not considered a person with legal rights and that the potential father had no right to veto a woman's decision on abortion. In 1991, proposed legislation to recriminalize abortion was defeated by the Canadian Senate. Abortion has since been treated like any other medical procedure, governed by provincial and medical regulations.

"There's pretty much unrestricted access here," says one senior obstetrician/gynecologist at the McGill University Health Centre who prefers not to be named. "People call the clinic and can be seen within a week. It kind of rolls on, as it should, as part of medical care." Newly released 2003 figures from StatsCan and the Canadian Institute for Health Information (CIHI) support this statement, showing relatively stable national rates of 15.4 abortions per 1,000 women, compared to 15.5 in 1995 and 14.6 in 1990.

End of story, right? Not quite � and certainly not everywhere and perhaps not for long.

The abortion debate may have moved on from the courtrooms, but it exerts a growing influence on where, when and how women end unwanted pregnancies. According to a 2003 survey conducted by the Canadian Abortion Rights Action League (CARAL), the percentage of hospitals providing abortion services ranges from a high of 35% in Quebec to a low of zero in PEI. There are around 20% in Ontario and BC, less than 4% in Alberta, Saskatchewan and Manitoba; only two hospitals each in New Brunswick and Newfoundland and three in Nova Scotia perform abortions. Women in Canada's North need to travel to Whitehorse or to the South to get abortions.

In some places, elected hospital boards have decided to stop offering the service. CARAL found that of the 127 mergers between Catholic and non-Catholic hospitals from 1990 to 1998, about half resulted in the elimination of all or some reproductive health services.

As a result, over 40% of abortions are now performed in clinics, according to this year's CIHI data. "Clinics offer a very efficient service," says Dr Vita Senikas, Associate Vice President of the Society of Obstetricians and Gynecologists (SOGC). However, coverage of abortions provided in clinics is not available or complete in many provinces.

COUNT ME OUT
The greatest concern at the moment, however, is the possible decline in the number of doctors performing abortions � in 2000, BC health ministry statistics showed a 20% decline since 1994. That year was significant: Vancouver ob/gyn and abortionist Garson Romalis was shot and wounded by a sniper through his kitchen window. The next six years saw three further serious attacks on Canadian physicians who provided abortion. Most attacks occurred around November 11, adopted as a significant date by hard core anti-abortion groups.

For many doctors, things have never been the same since. "Unfortunately, security is an issue," says Dr Senikas. "The SOGC issues a warning to physicians a month before November 11 to remind them to keep up security precautions." Bullet proof glass is a common feature in abortion clinics and some doctors wear bullet proof vests. "Certainly," says Dr. Senikas, "there's no advertisement, even in the hospital, of any OR schedules that would allow someone to get hold of a list stating where and when these procedures are being performed." One doctor in Kingston, refuses to tell even his wife where he performs abortions.

The aura of danger and discretion may see young doctors decide that providing abortions is not an area they want to get into. Anecdotal estimates indicate that about 50% of residents today choose not to perform induced abortions. At a time when the retirement of one physician can eliminate abortion services for a whole region of women, access in Canada, despite legislative protection, cannot be taken for granted.