In a few days, Nunavut is about to experience a small revolution in terms of gynecological services, particularly with regard to abortions.
As of August 15, the time to obtain a surgical abortion at the Qikiqtani General Hospital in Iqaluit will increase from 13 to 18 weeks of pregnancy. This change is part of an overall improvement desired by the Ministry of Health, which envisages the establishment of a complete obstetrics and gynecology service in the establishment.
This program will alleviate wait times and reduce the need for patients to travel south to access these servicessaid a statement from the ministry.
This new range of services is also a way to strengthen the territory’s health system.
Iqaluit’s situation is enviable in terms of access to surgical abortion, because for people residing in other communities in Nunavut, long journeys are commonplace.
In fact, women in the Qikiqtani region who want to have access to a surgical abortion must take a flight to Iqaluit. Those who live in the Kitikmeot region depend on the Stanton Territorial Hospital in Yellowknife, while those who come from Kivalliq must travel to Winnipeg.
Therapeutic abortions, using the drug Mifegymiso, are available in Iqaluit, Cambridge Bay and Rankin Inlet up to 10 weeks of pregnancy.
In the Northwest Territories, surgical abortions are only available through the Northern Options for Women (NOW) program and can be performed in Yellowknife or Inuvik only.
The drug Mifegymiso is distributed on a case-by-case basis and depends on the precise situation of the women who need it, as well as the availability of the provider.
In the Yukon as in Nunavut, surgical abortions are only available in the capital, at the Whitehorse General Hospital. Although Mifegymiso can be obtained in Dawson and Watson Lake, most medical abortions also take place in Whitehorse, says Claire Robson, a spokeswoman for the Yukon government.
In all three territories, travel for surgical abortions is covered by territorial programs or the federal First Nations and Inuit Non-Insured Health Benefits program.
While these trips are theoretically accessible, they can cause a lot of stress.
Some women, even if they don’t want to be pregnant, leave their house to go away and leave their children, which makes them feel like they have no choice.argues Dr. Madeleine Cole, a family physician in Nunavut.
Problems also exist in communities where the Mifegymiso pill is available in pharmacies. According to Asa Mason, director of the Council on the Status of Women in the Yukon, the notion of confidentiality can be undermined in particular.
” You know everybody or you’re tied to half the town, and go to that space [la pharmacie] to take the abortion pill is still not the safest thing socially. »
There is also, in the Yukon, the anxiety of having to miss work and losing paydays, she says:
There is nothing from a legislative standpoint that protects your right to paid time off to get that particular medical procedure.
Lack of follow-up, lack of staff
According to Dr. Cole, the fact that it is not possible to obtain therapeutic abortions in some communities is linked to the inability to make appointments for follow-up care. She adds that in very rare cases, heavy bleeding caused by the pill may require blood transfusions, as well as ultrasounds or blood tests to make sure the abortion worked.
These services are beyond the reach of most community health care centers in Nunavut.
For Dr. Stefanie Buchanan, a family physician for more than 20 years and co-director of the Yukon Sexual Health Clinic in Whitehorse, the lack of availability of the service in rural areas can also be explained by a lack of medical follow-up. Some women do not necessarily know for how long, on a specific day, they have been pregnant, which complicates access to therapeutic abortion.
It is difficult to access precise dating in some of the small communitiesshe says.
The shortage of health personnel, exacerbated in the North, is another explanation.
” We are dealing with the closing of nursing stations, and it is not safe not to have access to emergency care in this context. »
Asa Mason believes that infrastructure issues add to these barriers. The lack of a public transport network can, for example, make it difficult to travel to a place where a patient can undergo the procedure or receive the abortion pill.
While it may seem from the outside that access is there, she says, I think it’s more a myriad of factors that determine or limit access to abortion.
An ever-present stigma
Last year, there were 208 surgical abortions in the Northwest Territories, and 53 therapeutic abortions were performed.
In the Yukon, since 2017, 556 abortions have been recorded in the territory, 62% of which are surgical in nature.
Nunavut has 60 to 80 surgical abortions performed in Iqaluit each year. Therapeutic abortions number between 30 and 40.
The number of abortions is stable from year to year and the stigma surrounding the procedure also seems not to change too much.
As proof, the staff who manage the program NOWdid not want to speak for this article, informed us the spokesman of the ministry of Health, David Maguire, in particular for reasons of confidentiality and respect for the private life of the patients.
There are also concerns about your name being tied to a service provider [d’avortement]as well as risks of negative reactions or security problems [principalement liés au risque de harcèlement en ligne]he says in an email.
Dr. Buchanan also regrets that the people who provide access to this type of service must be discreet, especially in the more so-called communities.
pro-lifealthough it is a common procedure, she adds.
It’s always a fear… Well, it’s not something you can discuss at a party.
With information from Jackie McKay