Advocates slam lack of surgical abortion services in Fraser Health hospitals

While the NDP government insists it is “taking steps to improve access to abortion services” in B.C., advocates and health-care providers say they’ve seen little evidence of that in the past four years.

In the wake of the U.S. Supreme Court decision that overturned the constitutional right to abortion, Premier John Horgan and Grace Lore, the parliamentary secretary for Gender Equity, issued a joint statement condemning the “injustice” of the decision and emphasizing the B.C. government’s support for abortion services.

“We are taking steps to provide safe and accessible abortion services, including providing universal, no-cost access to medical abortions in B.C. as of January 2018,” they said in June.

While the NDP government acknowledges there is “more to do” to improve abortion access in B.C., it’s typically “northern and rural areas” highlighted as lacking services.

But abortion-rights advocates are raising awareness about a hole in the province’s services: the fact that hospitals in one of B.C.’s largest urban centres, Fraser Health, do not currently provide surgical abortions.

“Surrey is the fastest growing community in Canada … and yet Surrey Memorial doesn’t have abortion providers,” said Michelle Fortin, the executive director of Options for Sexual Health. “The reality is in this province we currently have a government that identifies as feminist but we have an entire health authority — Fraser Health — [that] does not have a single hospital that provides abortions.”

Health Minister Adrian Dix was in Surrey yesterday to announce another step toward building a second hospital but would not confirm whether surgical abortion will be among the services provided.

“It is our expectation that women will have the right to choose to make their own decisions around abortion and that services that are needed will be provided,” he said.

Fraser Health did not directly respond to questions about whether its hospitals provide surgical abortions, telling BC Today, “emergency abortions are performed at hospitals in every region of the province.”

“For people in Fraser Health, there are multiple Lower Mainland options nearby that provide abortions,” the authority said, adding that people who need help travelling to those clinics can access travel assistance through the province.

Abortion access in B.C. is “better than most” other provinces, according to Joyce Arthur, executive director of the Abortion Rights Coalition of Canada. Nationwide, just one-in-six hospitals offer abortion services.

Arthur credits NDP governments in B.C. from the 1990s with laying a strong foundation to “ensure access” to abortion services, including introducing regulations requiring certain hospitals to provide abortions.

“The idea was to ensure there was a point of access in every region in B.C.,” said Arthur. “I don’t think it was ever enforced and it still may not be to this day.”

The current regulation, last updated in 2017, lists Surrey Memorial Hospital, along with three other hospitals in the Fraser Health region.

“I think there’s been some attrition — in some cases, it might be the hospital lost their doctor,” said Arthur, adding that hospitals can offer surgical abortions without being included in the regulation.

Access to surgical abortion access outside of urban centres in southern B.C. is limited — 40 per cent of the province’s abortion providers are in the Vancouver Coastal Health region, per Fortin.

“We need to consider the barriers for folks that don’t have a car,” she said.

Most British Columbians living outside of Metro Vancouver, Victoria or Kelowna would have to drive for hours to get one and for those needing an abortion in the later stage of pregnancy, Vancouver is the only option.

“Once you get past [about] 14 weeks, then you need to come to Vancouver for your procedure,” said Dr. Ruth Habte, an obstetrics and gynecology resident at the University of British Columbia. “The procedures that take [place] up to 24 [weeks] and six [days], those only happen at BC Women’s Hospital — anyone in the province who is needing that service has to come down to Vancouver.”

Dix has also stressed the “very significant improvement” no-cost medical abortions — via the abortion pill Mifegymiso, which is fully covered in B.C. — has made to abortion access across the province.

But when pressed on specific actions his ministry has taken on surgical abortions since announcing coverage of Mifegymiso in January 2018, the minister offered no examples — instead reiterating the importance of Mifegymiso.

“What it’s meant is profound change in the nature of the provision of abortion services in our province such that we’ve seen a significant decline in the number of surgical abortions because women have access everywhere to Mifegymiso,” Dix said in response to a question from BC Today yesterday.

Dix’s ministry did not provide any specifics on efforts to increase access to surgical abortion last week and Lore was not available for an interview on the subject.

Improving access to the abortion pill while not ensuring surgical abortions are readily accessible means the province is “still denying people choice,” according to Fortin.

Mifegymiso is “wonderful” for those who choose and are able to use it, but it’s not always an appropriate or viable option, Fortin said.

“I think that’s a bit of a red herring to say, ‘Hey, we’ve increased access for people in rural and remote communities’ [by covering Mifegymiso],” she told BC Today. “The reality is with medication abortion, the use of an ultrasound to make sure of the date is also important, and many small communities don’t even have an ultrasound machine.”

Mifegymiso is an option up until “about 10 weeks” from the start of a pregnancy, according to Habte. The earlier a person can get the medication, the more likely it is to be effective without complications.

However, access to the abortion pill does not guarantee a surgical abortion will not be needed.

“If someone has failed a medical abortion, they can try the pill one more time, but if it doesn’t work, then they ultimately need a surgical abortion,” Habte said. “People deserve to have choice.”

Habte would like to see B.C. allow Mifegymiso to be delivered by mail once prescribed by a doctor or nurse practitioner.

“To my knowledge that is not available here, people still have to go to a pharmacy,” she said. “That could be a bit of a deterrent for people in really rural locations where maybe they know the pharmacist.”

While B.C.’s coverage of Mifegymiso “should be applauded,” Habte said she has not heard of any changes to improve access to surgical abortion under the NDP.

Access to medical abortion has had a dramatic impact on the demand for surgical abortion in B.C., according to the health ministry, which reported 8,205 courses of Mifegymiso were dispensed last year at a cost of $2.53 million under B.C. pharmacare.

That same year, 5,916 surgical abortions were performed in B.C., per the ministry — a more than 40 per cent drop from the 10,100 surgical abortions performed the year before Mifegymiso coverage rolled out.

Fortin, Habte and Arthur all identified specific steps the government could take to improve abortion care — and expressed frustration the NDP has yet to make good on its 2020 election promise to make prescription contraception free.

“I’m getting a little tired of waiting for the actual rollout,” Fortin said. “You can’t have a conversation about abortion without thinking about the things that impact a person’s need for an abortion and the very first one is, if people have access to reliable contraception, that is free, they’re more likely to choose it.”

Free prescription contraception “would vastly reduce the number of abortions and would save our government a lot of money,” according to Habte, who is also a campaign co-ordinator for Access BC.

“[Access BC has] been lobbying for like three years now and it’s still not in place,” Arthur said. “I have heard it’s coming finally, but we can’t understand why it takes so long — why is this not a priority that they couldn’t do earlier?”

Dix has committed to fulfilling the campaign promise by the end of the government’s term.

Fortin wants to see the province push and support family doctors to provide abortion care — “If you’re a family doc, there should be an expectation that this is a part of your practice” — and consider expanding Mifegymiso prescribing powers to certified midwives and advanced certified practice nurses with input from their professional college.

B.C. could also crack down on hospitals that don’t provide abortion services.

“If you’re a publicly funded hospital, you should have to provide abortions,” she said.

In addition to ensuring surgical abortion options in Surrey, Habte sees a need for “a hub in the north where they’re able to provide more consistent surgical options,” especially after the 14-week mark of pregnancy.

Arthur wants to see B.C. return to where it once was on the cutting edge of reproductive rights  when it passed the first “bubble zone” law in 1995 which restricted protests near abortion providers .

The Supreme Court of Canada upheld a legal challenge to the law in 2008.

But facilities that provide abortions have to apply for protection under the law “and as a result, even today, only three facilities actually have protection under the bubble zone,” Arthur said. Until B.C.’s most recent bubble zone law — which created a 10-metre zone of protection around hospitals, schools and vaccination clinics and took effect last year — no hospitals benefitted from that protection.

Efforts to improve or expand the first bubble zone law under the current government have stalled, Arthur said, calling the NDP’s lack of action on the issue “disappointing.”

“I’m just not convinced that the NDP government now is as concerned or committed to women’s rights as they say they are,” Arthur told BC Today.

Editor’s note: This article has been updated to include a response from Fraser Health.