Of all Canadian provinces and territories, Nova Scotia is widely considered as having one of the worst state of affairs regarding abortion accessibility and accommodation[1] [2]. Many women and girls in Nova Scotia must face institutional emotional, physical, political, and financial barriers to acquiring an abortion. These problems include but are not limited to lack of healthcare coverage, location inaccessibility, elongated wait times [3], and misogynistic and discriminatory political barriers. With a problematic historical foundation, a current state of inaccessibility, and prejudicial institutional practices, women seeking abortion services in Nova Scotia face not only personal barriers in their healthcare circles, but must confront a larger social and political problem in women's reproductive healthcare in Nova Scotia.
In Nova Scotia, women seeking to have an abortion are required to go through a series of approval stages and wait times before gaining access to the procedure. These procedures have been critiqued as poorly organized, aribtrary, at discriminatory, and at times leading to bodily harm[1].
In order for a women to gain approval to have an abortion in Nova Scotia, she must first acquire a physician's referral for the procedure[4]. Nova Scotia is the only province in Canada which requires patient's to have a referral for an abortion [5]. This referral requirement was politically critiqued by Nova Scotia's Health Minister Delorey in August 2017 as not a legal requirement, but rather an old social historical practice that has become ingrained in the procedural system: "What we've seen thus far is there is no legislation or regulation that establishes it, so that means it's likely a case of it being historical practice"[6]. Unfortunately this understanding that there is no legal requirement for the referral system has led to little to no political action but rather a practice of apathy towards system reform, as Delorey articulates: "Without knowing what, if any clinical rationale exists for the referral, it's hard for me to take a position on it"[6].
From the perspective of women who have previously sought abortion services in Nova Scotia, this referral requirement can also result in physician-patient discrimination, where physicians either refuse to provide the referral or make their patients endure a series of invasive interview style appointments before providing the referral. In an anonymous interview, a women described her experience with attempting to acquire a referral to the Canadian Press: "One women told the Canadian Press she had four appointments with her family doctor before she obtained a referral for an abortion. Her doctor quizzed her on her knowledge of the fetus and sent her to a psychologist before finally agreeing to refer her"[1].
The referral requirements in Nova Scotia not only pose institutionalized barriers to women seeking abortion services, they have also been discussed as a constitutional violation of rights. As articulated by Lianne Yoshida, co-director of the QEII hospital abortion centre "said the provincial rule requiring a physician's referral is at odds with the Supreme Court's 1988 R. Morgentaler decision"[1].
In order to receive an abortion, women in Nova Scotia are required to schedule a series of appointments including a referral, blood test and an ultrasound, before her actual abortion appointment [7]. An issue with these appointments beyond the unnecessary separation of them into multiple visits, is the often excessive wait times between them, which can often put women in precarious situations due to the time sensitive nature of an abortion procedure.
As Kayleigh Trace, a Halifax based sex educator and author describes in her telling of her own abortion experience: "I had to wait about 2 weeks in between my first appointment and this second appointment. The point of getting the blood work and ultra sound is to tell exactly how far along you are, and to make sure there aren't any complications (for instance, is the pregnancy in utero or ectopic)"[8]. This last detail regarding whether the pregnancy is ectopic is important to note, as ectopic pregnancies can be very dangerous for women as they can lead to fatal internal bleeding[9]. This appointment procedure is also therefore somewhat dangerous, as making women wait several weeks before the appointment to determine if her pregnancy is ectopic can place the women in a potentially harmful situation.
Another associated issue with the separation of appointments into several visits with weeks between them, is that women in rural areas must travel into areas like Halifax each time, as often these appointments must happen in hospital. This is due to the lack of sexual health centres equipped to perform these procedures or doctors willing to provide referrals for the services - this need for travel also extends to women from other maritime provinces where abortion services are even more limited[10]. Women from other maritime provinces needing to travel into Nova Scotia for aboriton services not only burdens them financially and socially, but also burdens the province with accommodating them as their own provinces refuse to provide them with adequate care.
Perhaps one of the largest issues with abortion accessibility in Nova Scotia, when compared with the policies and procedures of other provinces, is that women are made to wait until they are a minimum of eight weeks pregnant before they are allowed to acquire an abortion[1]. As articulated by Kayleigh Trace, this rule is likely not due to medical requirements (as other provinces do not have this requirement), but rather "a symptom of Nova Scotia only having four hospitals that will perform abortions"[8]. The requirement to make women endure a first trimester pregnancy due to administrative issues and lack of provincial resources, indicates a systemic and institutional issue with the procedures in place to provide women with abortion services. As articulated by Vancouver based abortion advocate Joyce Arthur when discussing wait times for abortion in Nova Scotia with the Canadian Press, "It's unconscionable the province would let that go on. Waiting a month or two for an abortion is hell [...] It traumatic and damaging to women and violates the spirit of the 1988 Mogentaler decision and likely violates constitutional rights"[3]. Above all, one of the most institutionalized political and social barriers preventing activists from proving the need for a reduction in wait times and a removal of the 8 week regulation, is the fact that "Nova Scotia does not appear to keep statistics on how long it takes women to obtain an abortion after referral"[1]- an archival procedures that seems as if it should be ethically and socially required by the provincial government.
In Nova Scotia there are no clinics that provide abortions, and the only places that provide abortion services are hospitals[1]. One such hospital located in Halifax, the Queen Elizabeth II, is an example of how these facilities can be improperly equipped to provide adequate care to patients. The QEII abortion centre does not have the needed ultrasound machine to verify pregnancies, and according to Dr. Lianne Yoshida of the hospital, they are "looking at getting a private donation or fundraising it"[2], even though the machine would only cost $50,000[2] for the province to purchase. Another barrier preventing the hospital from providing adequate care includes a lack of a dedicated abortion help phone number, or staff for it[6]. Because of the lack of resources at the QEII, the day women come in for their procedure can be extremely uncomfortable and unnecessarily long. The hospital is unable to book specific appointment times, and as such, as Kayleigh Trace describes from her experience "you must be at the hospital at 6:30 in the morning [...] you just show up and wait along with the other people having an abortion that day" [8].
Women in Nova Scotia face a wall of anti-choice networks and individuals when seeking access to abortion appointments. In Halifax, public transit often features anti-choice advertisements, often put up by deceptive organizations which seek to lure women in with names that seem supportive such as "Open Door Women's Care Centre"[11]. A major reason these ads are able to be placed in the first place, is because, as described by Tiffany Chase of the Halifax municipality, "third-party contractor Pattison Outdoor is ultimately in charge of what ads go on municipal transit"[11].
There are a vast amount of bureaucratic layers in the Nova Scotia socio-cultural sphere working against women seeking abortion, such as outdated regulations, public advertising and anti-abortion groups picketing with and delivering graphic anti-choice imagery (for example a series of 2014 unsolicited pamphlets delivered to Halifax homes featuring graphic images of aborted fetuses[12]). These are all examples of how, as Joyce Arthur articulates "women are at risk of having to deal with anti-choice gatekeepers who will delay access even further or shame women and treat them inappropriately and unprofessionally"[3]. Furthermore, because there are no dedicated clinics for abortion procedures, those providing care for abortion patients in hospital are unaware or improperly trained on appropriate and supportive behaviours. For example, in an interview describing her experience with accessing an abortion in Halifax, Melanie Mackenzie describes that when "her blood work came back positive, [she] recalled the nurse congratulating her on her pregnancy in front of other patients"[1].
In the Maritime provinces, each year, approximately one thousand women cannot gain access to an abortion[13] , and must finish their pregnancies. Some of the largest barriers causing this lack of accessibility, are the financial costs associated with lack of service coverage, and high travel expenses.
An issue facing many women in Nova Scotia, is the problem non-provincial coverage. While someone with an NS healthcard can obtain an abortion without out of pocket charges[7] (with the exception of the blood work, referral, and ultrasound appointments), women from other provinces must pay for their aboriton out of province before appealing to their provincial health system to re-imburse them for their expenses[7]. This is a large issue in Halifax and other areas of the province, as Nova Scotia is host to many large universities, and the student population makes up a substantial portion of the larger provincial population. For women in college seeking an abortion who are from outside of Nova Scotia, they would be charged approximately $1724.24[7]. For those who are not Canadian citizens, that price escalades to $1955.74[7]. For a young person away at school, this type of expense is often a hardship, if not impossible when carrying the burden of University expenses. However the option to go home from the east coast to receive an aboriton under home province coverage is often even more insurmountable, as described by Rachel Richard and Elizabeth Whitten of UNews: "The cost to patients to travel to their home province can exceed the cost of paying for the procedure out-of-pocket. It’s especially a hardship for students who live on a tight budget"[13].
As abortions in Nova Scotia are only performed in hospitals[1], and a series of spread out appointments are required prior to the procedure being authorized[4], women living outside of major city areas are at a large financial disadvantage when needing access to an abortion. What is worse, is that travel expenses are rarely if ever covered by insurance or provincial coverage, even when life-threatening complications are a result of the hospitals procedure[10]. In an anonymous interview, a women travelling to Halifax description of her own experience with the financial burden and inaccessibility:
Information from the Halifax Sexual Health Centre indicates for women traveling from rural areas "an abortion is usually a 2 to 3 day trip to Halifax"[7]. This type of financial burden and abandonment of women in rural communities seeking abortions indicates a failure of the Nova Scotia health system to uphold equitable access to a procedure that is the right of Canadian women to acquire.
