The panicked calls about accessing abortions during the COVID-19 pandemic started coming in to the Action Canada for Sexual Health and Rights hotline last week, and they haven’t stopped. “People are worried they won’t be able to get to their appointments, or that they won’t be able to even schedule appointments because they’re in quarantine,” says Frédérique Chabot, director of health promotion for the reproductive rights non-profit. “There’s a lot of anxiety.”
Understandably so. In a country where access to abortion — a legal, medical service — is already hit or miss, the potential closure of clinics and the scaling back of services is another looming barrier. And while Canadians likely won’t ever face a situation like women in Ohio or Texas — where anti-choice politicians are using COVID-19 as a completely transparent ruse to stop or indefinitely “postpone” abortions — there’s a very real concern that reproductive healthcare is going to slip down the priority list as the pandemic deepens and resources are stretched thin. “We can’t treat abortion as if this isn’t as urgent as COVID-19,” says Chabot. “It’s so time-sensitive and has such huge consequences, not like other elective surgeries.”
After all, it’s not like you can just put off the procedure until the pandemic clears up. Mifegymiso, the two-part abortion pill, which was approved for use in Canada in 2017, is theoretically the most widely available method (even though many doctors or nurse practitioners in Canada still refuse to prescribe it). But it can only be taken up to 10 weeks in a pregnancy. After that, you’ll need a surgical abortion, and that’s where things start to get dicey during COVID-19.
Here's why: While abortions have been considered a medical service in Canada for decades, the uneven patchwork of access that already exists across the country — just try getting an abortion in most rural areas or small communities — is going to be exacerbated as hospitals and clinics enact social-distancing measures like spreading out appointments; as doctors are pulled in different directions; and as the number of doctors and nurse practitioners who have to go into quarantine themselves inevitably grows. (One Canadian clinic has already had to temporarily close because its sole doctor was exposed to the virus.)
That’s why Action Canada and the National Abortion Foundation have put out a joint call to the federal government to affirm publicly that abortion is an essential healthcare service during this pandemic and to extend the medical abortion limit from 10 weeks to 12 weeks.
Meanwhile, clinics across the country are hustling to put new protocols in place so they can keep their doors open. “Health-care providers are rallying at a very fast pace to make sure they still have the ability to provide abortion care,” says Chabot. This means using old-school menstrual period-dating methods to date a pregnancy whenever possible instead of sending women to get lab test or ultrasounds; not allowing support people into appointments; and doing pre- and post-procedure counselling on the phone.
But what about patients who have been infected or exposed to COVID-19 and can’t wait the recommended two-week incubation period to ensure they’re not contagious? Two weeks, after all, can make the difference between a medical or surgical abortion, or even push you past the point in your pregnancy when the doctors in your respective province or territory preforms abortion. Jill Doctoroff, the Canadian director of the National Abortion Federation, says clinics are dealing with this scenario on a case-by-case basis as they simultaneously try to contain COVID-19’s spread, protect staff and patients, and still treat these patients. “Health-care professionals need to weigh the risks,” she says. “If they were in a situation where seeing the patient means that the facility has to shut down, that’s a concern.”
Also at risk is the small percentage of women who have abortions after 24 week — usually due to severe fetal abnormalities or serious risks to the mother’s health. There are no facilities in Canada who do them; patients are usually sent to specialized clinics in the U.S.
It’s not yet clear if travelling for an abortion would be considered one of the “necessary” reasons people are allowed to cross the now-closed U.S.-Canadian border, but even if that wasn’t an official barrier, practically speaking, it’s already nearly impossible. Doctoroff says NAF has already worked with at least one woman who couldn’t get to her American appointment after her flight and hotel were cancelled. (They were able to find a Canadian provider to help.) “Pathways for care are being created,” Chabot says.
Here’s hoping they’re being created quickly.
Visit Choiceconnect.ca for a searchable database of abortion providers or phone the Action Canada access line: 1-888-642-2725.
COVID-19 has been declared a global pandemic. Go to the Public Health Agency of Canada website for the latest information on symptoms, prevention, and other resources.