Martha Paynter reports on the current state of access to abortion and comprehensive reproductive health services in Prince Edward Island.
“It’s ingrained in the health care system now”
That’s the assessment of the current state of abortion care in Prince Edward Island (PEI), from the provincial manager of the Women’s Wellness Program. Operating since January 2017, it’s come a long way and so has PEI.
In 1982 the Prince Edward Island Hospital and the Charlottetown Hospital merged, and a new heavily anti-choice hospital Board of Directors formed. It became policy that the new Queen Elizabeth Hospital would never permit abortion procedures. For 35 years patients were required to travel two to four hours to the hospitals in Moncton, or Halifax, or the Morgentaler Clinic/Clinic 554 in Fredericton. They faced expensive delays, mountains of paperwork, and unhelpful reactions from the Island’s emergency department clinicians when and if they had follow-up questions or complications.
In 2015, a team of activists, Abortion Access now PEI (ANNPEI), supported by the Women’s Legal Education Action Fund (LEAF) and pro-bono counsel from the boutique feminist litigation firm Nijhawan McMillan crafted a case against the Province. Launched in January 2016, the constitutional challenge never made it to court: Wade MacLauchlan’s Liberals admitted they could not win against AANPEI, and announced they would open an Island abortion clinic within a year.
As former chair of LEAF Halifax, I fought hard for policy change in PEI. As an abortion care provider and researcher, this past week I finally got a chance to tour the PEI abortion clinic facilities and meet with their staff.
The Women’s Wellness Program now operates five days a week in both Charlottetown and Summerside. In the former, the clinic space is on the third floor of The Mount / Sisters of St Martha, a multi-purpose office building with continuing care and child care under the same roof. In Summerside at the Prince County Hospital, the clinic has a freshly-renovated suite on the main floor, with art on the walls, brand new equipment and furniture, and three procedure rooms.
Since Women’s Wellness Program opened, they’ve performed 900 abortions. Last year there were 135 medication abortions and 105 aspiration procedures. Medication abortion (mifepristone) was only made widely available in Canada in 2017 and it’s still unusual in Canada for medication abortion to be more common than aspiration. Greater popularity of medication abortion in PEI puts the Province more in line with European countries that have had broad mifepristone access for years.
To meet the demand for aspiration abortion, the Summerside clinic does procedures three days a month. The gestational cut-off for aspiration procedures on PEI is 12 weeks, 6 days. The gestational cut off at Clinic 554 and Halifax’s NS Women’s Choice Clinic is 15 weeks 6 days. Beyond that, patients must travel out of Atlantic Canada.
When they’re not doing abortion procedures, the clinic does everything else a sexual and reproductive health service should do: sexually transmitted and blood-borne infection testing and treatment; contraception counselling and prescriptions; IUD insertions; pap tests and LEEP procedures; gender affirming care; prenatal education and care; basic infertility work-ups and referrals; menopause support; and a lot of maternal mental health care, including counselling for miscarriage, stillbirth and infant loss.
The interdisciplinary clinic team includes four registered nurses, three administrative staff, one social worker, one full-time nurse practitioner, and three physicians. Patients self-refer (via phone or email) and the clinic also does its own bloodwork, cutting down on extra appointments and hoops patients have to jump through. Two nurses staff a 24/7/365 toll-free line to text and talk with patients who have questions, like “Is this much bleeding too much bleeding?” or “I took another pregnancy test, why is it still positive?” The nurse-line cuts down on the inconvenience and expense of unnecessary emergency room visits, and boosts patient confidence and trust.
Women’s Wellness Program distributes mifepristone for free to all its patients. The clinic also covers the cost of intra-uterine devices (IUDs) for any patient who wants one and lacks insurance coverage. IUDs, one of the most effective forms of contraception available, which last for five years, cost over $400 out-of-pocket. Access to this highly reliable and reversible form of birth control can change a person’s life.
To foster better public understanding of sexual and reproductive health, the Women’s Wellness Program presents in libraries, junior highs, community organizations, and provides reproductive health care for people at the provincial jail. Their team is expanding soon to increase reproductive mental health services.
When we started the legal fight, we could not have imagined the comprehensive and compassionate abortion and reproductive health services that would grow and flourish on PEI. Now is the time for care providers across Canada to learn from the best practices in place on the Island.