Nova Scotia’s insistence that only hospitals can perform ultrasounds on women who are seeking an abortion is increasing wait times for the procedure, women’s health advocates say.
Those advocates are urging the province to abandon that policy and to allow ultrasounds to be performed at an abortion clinic, as is the case in several other provinces.
Dating ultrasounds are often performed before women are prescribed the abortion pill Mifegymiso or are scheduled for a surgical termination of pregnancy. These ultrasounds can typically be done by health professionals at an abortion clinic. But in Nova Scotia, these ultrasounds are only performed in a hospital by a radiologist, which can result in waits of days or weeks.
The Nova Scotia Women’s Choice Clinic is about to acquire an ultrasound machine, but the province’s only health authority will not allow that machine to be used for dating purposes, which could help speed up access to abortions.
Neither Nova Scotia’s health ministry nor the health authority will explain the decision to limit ultrasound procedures to hospitals, and to exclude the ultrasound machine at the province’s only clinic with abortion services.
Lianne Yoshida, the medical co-director of the Nova Scotia Women’s Choice Clinic, said the practice of sending women to the hospital for ultrasounds is the last major hurdle to abortion access in the province and that no one within the health-care system has been able to explain this rule. “I don’t actually have the answers to this,” she said. “I don’t also know whose decision it is to change it. I haven’t been given that answer either.”
Abortion access has been a problem for many years in parts of Canada, particularly the Atlantic provinces. Until this year in Nova Scotia, women needed a referral from a doctor to receive an abortion, a hurdle that women’s health advocates said caused unnecessary delays. Some of these access barriers were recently outlined in an essay by The Globe and Mail’s Jessica Leeder, who described her attempt to obtain a drug-induced abortion in Nova Scotia.
When asked about the ultrasound issue, the province’s health department directed questions to the Nova Scotia Health Authority, which declined to answer repeated questions about the requirement for radiologists to conduct pregnancy ultrasounds.
Dr. Yoshida said her ultimate goal is to be able to use an ultrasound machine within the clinic to provide timely, efficient care to women. For the moment, the clinic’s ultrasound machine is instead being used as an aid to health professionals during surgical procedures, said Sharon Hartling, manager of ultrasound for the health authority’s central zone.
Robyn MacQuarrie, an obstetrician and gynecologist in Nova Scotia, said in the context of the broader health-care system, waiting two weeks for an ultrasound should not be considered a barrier to accessing an abortion.
“You can’t say we’re going to privilege this over all other things,” she said. “It needs to be in the context of ultrasounds are done for a variety of things, not just abortions.”
Dr. MacQuarrie said women in the province do face obstacles, such as a lack of awareness around the availability of the abortion pill and geographical challenges that require some women to travel for hours to get an abortion. But she said waiting for an ultrasound is part of the reality of a stretched health-care system.
Ellen Wiebe, medical director of Vancouver’s Willow Women’s Clinic and clinical professor at the University of British Columbia, said that while waiting does not necessarily pose a risk to a woman’s physical health, it can cause her to experience unwanted symptoms that can be “traumatizing,” including nausea, vomiting and distress over the fact the pregnancy is developing. The delays can also have an effect on the type of treatment a woman receives. For instance, the abortion pill Mifegymiso can only be prescribed when a woman is nine weeks pregnant or less.
“I would say that waiting more than a week is not acceptable,” Dr. Wiebe said. “It is an unnecessary barrier.”
A Health Canada spokeswoman said while ultrasounds are recommended before women receive prescriptions for Mifegymiso, decisions about health-care delivery are ultimately between doctors and patients. According to the Society of Obstetricians and Gynaecologists of Canada’s induced abortion guidelines, ultrasounds are recommended when the gestational age is in question, if the pregnancy is possibly ectopic – or developing outside the uterus – and in all cases of second trimester abortions.
“It’s safe to go ahead with a medical or surgical abortion without an ultrasound. It is not required,” Dr. Wiebe said.
She added radiologists don’t have to perform pregnancy ultrasounds, which can be quickly and safely performed by on-site health professionals in other provinces.
Frédérique Chabot, director of health promotion with Action Canada for Sexual Health and Rights, said it doesn’t make sense to have women seeking abortions wait for an ultrasound at the hospital when it can quickly and easily be done in a clinic setting. The fact that this doesn’t happen is one of the many barriers to access women face for abortion services across Canada, she said.
“Depending on where we are locating or what we have in our bank accounts, the access is quite different,” Ms. Chabot said. “I think a lot of people in Canada don’t realize that.”
For instance, women in rural areas may have to travel to an urban centre in order to visit an abortion clinic. In some cases, provinces don’t fund the cost of the abortion pill, leaving women with no choice but to pay a few hundred dollars out of pocket for the drug.