Nova Scotia is refusing to force its health authority to speed up access to abortion, declining to instruct officials to allow the province’s only abortion clinic to provide ultrasounds for women seeking to terminate pregnancies.
The government says it’s up to the Nova Scotia Health Authority (NSHA), which oversees day-to-day health-care delivery, to make any recommendations for changes to abortion services, including ultrasounds.
At issue is the fact that the Nova Scotia Women’s Choice Clinic, a surgical and medical abortion provider based in the QEII Health Sciences Centre in Halifax, is prohibited from performing dating ultrasounds to determine the gestational age of a fetus for women seeking abortions. Women must instead wait for an appointment at the hospital’s diagnostic imaging department, which can result in delays of days or weeks.
Even short delays can have consequences for women seeking abortions, as many will experience unwanted symptoms including nausea and vomiting. Delays also impact the type of care a women receives, as the abortion pill Mifegymiso can be prescribed only in the first nine weeks of a pregnancy. After that, a woman’s only option is a more invasive surgical abortion.
Despite repeated requests, the Nova Scotia Health Authority has not explained why the abortion clinic can’t perform ultrasounds or indicated if this is an official provincial policy. While they are not mandatory, dating ultrasounds are recommended before abortions and to rule out an ectopic pregnancy, one that is developing outside the uterus.
The abortion clinic is in the process of acquiring an ultrasound machine after a successful fundraising campaign. Medical co-director Lianne Yoshida said she doesn’t know why they won’t be able to use the machine for dating purposes and said it’s a problem that should be changed.
In an e-mailed statement, the Nova Scotia Department of Health and Wellness said the health authority is responsible for clinical health-service delivery, and that “when NSHA brings forward recommendations for changes to the system, we consider them.”
Department spokeswoman Tracy Barron was unable to explain what provincial policies would have to be changed or why the province couldn’t mandate improved access to ultrasounds at the abortion clinic.
In an e-mailed statement, NSHA spokeswoman Kristen Lipscombe said the hospital has timely ultrasound appointments available for women seeking abortions.
David Jackson, a spokesman for Nova Scotia Premier Stephen McNeil, declined to comment. Mr. Jackson said in an e-mail: “there is no question the Premier and government take issues around women’s health and access to services very seriously," but that the Nova Scotia Health Authority is better able to respond because it’s in charge of day-to-day health-care delivery.
The issue came to light in an essay by The Globe and Mail’s Jessica Leeder, who described her attempt to obtain a drug-induced abortion in Nova Scotia. In most larger centres in Canada, early abortions are easier to access, including in abortion clinics where dating ultrasounds can be readily obtained.
Martha Paynter, a Halifax-based nurse and women’s health advocate, said the province must be transparent about why the abortion clinic can’t perform dating ultrasounds.
“Where do we find this rule? What does the rule say? Why do we have this rule?” she asked. “We need answers to those questions.”
Dustin Costescu, a family planning specialist who authored Canada’s national guidelines on medical abortions using Mifegymiso, said the restrictions on ultrasounds are an unnecessary obstacle preventing women from accessing timely abortions.
“It’s frustrating for us to see these systemic barriers as the end reason why someone can’t access abortion,” said Dr. Costescu, who is also an assistant professor at McMaster University in Hamilton, Ont. “We can get doctors trained, we can get drugs in the pharmacies, we can tell people how to use it and women can’t access it.”