When is an Abortion “Medically Necessary”?

Shannon Stettner, an historian of abortion, argues that pregnant women should be the ones to determine whether an abortion is “medically necessary” for them.

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Recently, the Fredericton Morgentaler clinic announced it would be closing in July of this year. The scheduled closure follows a 20-year struggle, including a 12-year legal battle, with the province over the funding of abortions. Because New Brunswick has refused to fund abortions performed at the clinic, women have paid for their own procedures, with Dr. Henry Morgentaler covering the remainder of the costs prior to his death last year.

In 2012 (the last year for which there are available statistics), there were 442 abortions in New Brunswick hospitals and 616 abortions at the Fredericton Morgentaler clinic. Thus, the clinic’s closure will severely limit access to abortions for women in New Brunswick and neighbouring provinces (especially PEI). The increasing lack of access to safe, legal, and funded abortion in New Brunswick is intolerable.

Pioneer Women's Memorial, Melbourne.  John Torcasio

Pioneer Women’s Memorial, Royal Botanic Gardens, Melbourne. John Torcasio

According to the Canada Health Act, every Canadian is to have “timely access to all medically necessary health services regardless of his or her ability to pay for those services.” But, who defines what is medically necessary?

If you live in New Brunswick and want an abortion, the Medical Services Payment Act determines that two doctors must “certify in writing that the abortion was medically required.” Only then can you access abortion at one of two provincial hospitals. In this way, the provincial government, the medical profession, and individual physicians in New Brunswick limit women’s timely access to abortion services.

Over the years, there has been much debate about whether abortions are medically necessary.  Opponents either argue that no abortions are medically necessary, or only those that are done to save the life of the pregnant woman.  Others, like myself, who fully support a woman’s right to access abortion services, believe that when a woman decides she needs an abortion – for whatever reason – it is a medically necessary procedure.  Personally, I don’t need to like another woman’s reason(s) for choosing to terminate a pregnancy – I don’t even want to know her reason(s).  I trust that she has made the decision that is best for her (and her family).

Before the law on abortion was liberalized in 1969, many of the ways women chose to rid themselves of unwanted pregnancies were dangerous, resulting in unnecessary complications and even, at times, death. Since 1988, when the 1969 abortion law was overturned, and an increasing number of private abortion clinics opened in Canada, many of those with pro-choice leanings thought the issue of access to abortion was more or less resolved. Those of us who remained active in the pro-choice and reproductive justice movements knew, however, that access to abortion remained a challenge in places like Northern Canada, PEI, and New Brunswick.  But did we truly understand how such challenges affected the women in these parts of Canada?

A recent study by Dr. Colleen MacQuarrie and colleagues at University of Prince Edward Island has documented women’s experiences with unplanned and unwanted pregnancies on the island and helped to shed light on how the lack of access to abortion services affects these women.  Many pregnant women travel great distances to New Brunswick or Nova Scotia to access abortion services there.  Other pregnant women, who are not quite sure how to navigate the system, instead entertain ideas of self-harm.  As one woman recalls, “I wasn’t having a baby. Um, I wasn’t. So if it got to a point where it looked like that was probably happening…I think the ways that I tried to induce [a miscarriage] probably would have gotten more risky to my health…and then…suicide probably would have been a viable option at the end…”

Repeatedly, in my research into the ideas and feelings of women on abortion in Canada, the word “desperate” is used by women to describe how they felt about being pregnant when they did not want to be.  For me, this is the point where the abortion issue begins and ends.  When a woman is so desperate not to be pregnant that she has thoughts of self-harm, her abortion is, unquestionably, medically necessary.  Canadian doctors, politicians, and the public have a responsibility to ensure that pregnant women – our sisters, our mothers, our daughters, ourselves – have access to safe, legal, and timely abortion procedures that do not marginalize, judge, or humiliate women.  More importantly, no woman should have to reach the point of desperation as a prerequisite to accessing abortion. Instead, we should recognize and respect that when a woman wants an abortion, it is a medically necessary procedure.

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Shannon Stettner is an historian who teaches at the University of Waterloo and York University. She is the Canadian manuscripts editor for the Canadian Bulletin of Medical History.  @slstettner

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