New Brunswick is already infamous for its significant restrictions on access to abortion. The barriers faced by patients are rising higher as New Brunswick faces the reality of COVID-19. Travel, child care, financial cost, and hospital requirements have long been recognized as barriers to accessing abortion. With the added burden of a pandemic, these challenges are only worsening, putting patients and providers at risk.
In response to the COVID crisis, public health officials have declared a state of emergency and New Brunswickers are staying home, avoiding hospitals for non-essential reasons, and limiting unnecessary travel. However, because abortions are funded only in three hospitals in two cities in New Brunswick, pregnant patients are still required to travel long distances, often on public transit, to access care.
Social distancing and the shuttering of daycares to all but essential workers has put added burden on patients trying to find childcare for the day they have the procedure. The cost of travelling to another city, paying for accommodation, or paying out of pocket for an abortion at Clinic 554 in Fredericton, is even more challenging as workers are facing layoffs due to COVID-19.
Patients who access surgical abortion at Clinic 554 in Fredericton – the only non-hospital provider of abortion in NB – pay up to $850 for a procedure. This is because of the persistence of Regulation 84.20 of the Medical Services Payment Act, which restricts funding of abortions to those provided in hospital.
The three hospitals in New Brunswick that do provide surgical abortions will only care for a patient who is up to 13 weeks six days pregnant. Patients are often beyond this limit when they seek abortion care, and in the current environment of COVID – where some people are being required to self-isolate for 14 days – they may literally have been unable to access care until they were beyond the hospitals’ limits. Clinic 554 has received numerous referrals from the hospitals for patients beyond the gestational age limit. These patients are now being forced to pay for their care.
Providing abortions outside of hospitals, in community-based clinics such as Clinic 554, has long been recommended by organizations such as the World Health Organization and the National Abortion Federation, as well as Canada’s own federal Minister of Health. One reason for this is to limit the risk to patients of developing a hospital-acquired infection.
In response to COVID, hospitals have implemented severe restrictions on visitors and are encouraging patients to stay away for non-essential reasons. However, current regulations are forcing pregnant patients seeking abortion to access care at hospitals, or else pay out-of-pocket for the procedure. Patients and health care workers are deeply concerned about the risk of unnecessarily exposing themselves to the virus in hospitals.
Public health officials are tracking the possible surge of critically ill COVID patients expected to hit hospitals and possibly overwhelm capacity, and staff are preparing for the worst. Surgeries have been cancelled except for those deemed essential: fortunately abortion has been deemed an essential procedure.
However, physicians such as Dr. Edgar – the medical director at Clinic 554 – are concerned about the unnecessary use of hospital space and supplies for a procedure that can be performed safely in a clinic. “As the COVID-19 pandemic surges, our hospitals will need every space available and more and more surgeries will be delayed or cancelled,” says Dr Edgar, “As a result, more and more pregnant patients will have nowhere else to go for abortions but Clinic 554.”
Advocates are deeply concerned about the injustice and safety risk created by the current situation. “Patients are being forced to choose: either pay out of pocket for the procedure at Clinic 554, or step foot in a hospital and endure the risk of exposing themselves to hospital-acquired infection,” says Jessi Taylor, spokesperson for Reproductive Justice NB (RJNB), an advocacy group working to improve access to reproductive health care in NB. “The government has made sweeping changes in response to COVID in so many other areas, why are they not making changes to protect the health and safety of our patients around abortion?”
Taylor is also deeply concerned about access to abortion were Clinic 554 to close. The Clinic announced in October 2019 that the building was up for sale, due to financial instability resulting in large part from the restrictions on funding of abortion in NB. “We are seeing an increase in patients accessing care at Clinic 554 during the COVID crisis,” says Taylor, also active on the Save Clinic 554 campaign. “Where will these patients go if the Clinic closes?”
In their guidelines for abortion care during COVID, the National Abortion Federation acknowledged the increased risk of maternal morbidity, gender-based violence, unintended pregnancy, and long-term impacts on mental and physical health during crisis times, as reproductive health care is often deprioritized.
Advocates state that if the government removed Schedule 2 (a.1) of Regulation 84.20 of the Medical Services Payment act, they could institute a funding system for community based abortions, such as those provided at Clinic 554. Dr Edgar has been advocating for years around this issue, and he reached out to the Department of Health and Emergency Operations Committee (EOC) again in light of the COVID crisis. However, in response to his request for the NB government to change the regulations, the EOC replied that “abortion access is not an issue of focus at this time.”
The COVID crisis has shown us that the status quo must change: the ‘usual’ ways of life have been turned on their head in weeks. Persistent gaps in accessing abortion care are growing wider, at the expense of patients and our health care system.