This article, first published in The Pigeon, is the first in a two-part series about Clinic 554 and health care in New Brunswick.
Clinic 554, New Brunswick’s only independent abortion clinic, is closing next month.
In the Greater Toronto Area, there are nine locations where someone can access abortion services. In the entire province of New Brunswick, there are only four.
Come September, that number could shrink to three, worsening the already poor access to abortion care in the province.
Clinic 554, New Brunswick’s only independent clinic that offers abortions—as well as family medicine, trans-inclusive care, and contraception counselling—is set to close permanently at the end of September. Advocates for the Fredericton clinic, as well as former patients, are urging the provincial government to save it, but the Progressive Conservative leadership hasn’t budged.
New Brunswick Premier Blaine Higgs spoke at an anti-choice rally in 2017 and told protesters that he “shared” their convictions. He has repeatedly shown his unwillingness to change provincial legislation to allow clinical abortions under Medicare. However, according to the Canada Health Act, abortions should be covered regardless if it is provided in a clinic or hospital.
To many supporters of the clinic, it seems like the chances of saving Clinic 554 are slim. Still, advocates for abortion access in the province are continuing to demand change.
Tasia Alexopoulos is the social media coordinator and a New Brunswick spokesperson for the Abortion Rights Coalition of Canada (ARCC). She says that Clinic 554’s closure demonstrates the provincial government’s disregard for the health of its residents.
“It’s really scary that the government is willing to place so many people at risk and close a clinic in a province that really needs this clinic for general health care, as well as abortions,” Alexopoulos said in an interview with The Pigeon.
“New Brunswickers deserve to have health care that they’re entitled to. And it’s such a simple fix.”
Currently, New Brunswick residents can access abortion services in three different hospitals—two in Moncton, and one in Bathurst—and have their procedure paid for by Medicare.
Meanwhile, Clinic 554 is the only independent clinic that offers abortion services. In New Brunswick, out-of-hospital abortions are not covered through the province’s health plan. This is because of Regulation 84-20, Schedule 2 (a.1) of the provincial Medical Services Payment Act, which states that “abortion, unless the abortion is performed in a hospital facility approved by the jurisdiction in which the hospital facility is located,” is not covered by Medicare.
As a result, patients who have abortions at Clinic 554 must pay for their care out of pocket. Depending on the stage of pregnancy a patient is in, they could be asked to pay between $700 and $850 for an abortion.
The province’s size, however, means many would-be patients are unable to travel to a hospital for provincially-covered care, making paying for an abortion at Clinic 554 often more accessible.
“New Brunswick […] is quite a big province,” Alexopoulos said. “Some folks [are] traveling hours to get to a hospital.”
Alexopoulos says the regulation is based on outdated opinions about the essential nature of abortions.
“[If an abortion] doesn’t take place in the hospital, then [legislation says] it’s not technically medically necessary,” she explained. “Of course, in 2020, we don’t use words like elective or medically necessary when we talk about abortion.”
Without the regulation, clinics like Clinic 554 would be able to rely on the provincial government to fund abortion services through Medicare, removing barriers for both patients and abortion providers. Alexopoulos said if the provincial government wanted to, it could repeal the regulation.
“It’s such a simple thing to repeal,” she said. “It doesn’t need to be legislated. It can be repealed with the stroke of a pen.”
“If Clinic 554 is able to fund their services through Medicare, they won’t have to close. It’s really the simplest solution.”
In January 2019, Kristen Parkhill was 24 years old, living in Fredericton while she completed her undergraduate degree. When she found out she was pregnant, she knew it wasn’t the right time to have a baby.
“I didn’t think it was fair to myself or my partner—or a baby—to bring [a child] into a situation where I didn’t really have any individual stability,” Parkhill said. “So, I had to make that really tough decision [to have an abortion].”
She was quickly able to schedule an appointment at Clinic 554.
On the day of her appointment, Parkhill recalls being the only person in the clinic waiting room who had a support person with them.
“It [was] a terrifying experience, and I couldn’t imagine how isolating that feels when you’re doing that alone,” she said. “It just broke my heart.”
During her appointment, Parkhill learned that she’d actually had a miscarriage a few days prior. Although she didn’t need an abortion, the staff at Clinic 554 booked Parkhill for further tests to monitor her health in the weeks after her miscarriage.
Parkhill says that Dr. Adrian Edgar—who owns and operates Clinic 554 with his partner—was supportive throughout the process, and communicated all of her lab results to her personally.
“Dr. Edgar would call me multiple times a week to check in on me,” she said. “He was an incredible doctor.”
“For him to have to lose his practice […] because he’s not getting the proper funding [is] just a huge loss in so many different ways.”
Seeing the recent developments in Clinic 554’s already-precarious status encouraged Parkhill to speak out about her own experiences accessing abortion services. She said it felt important to show her support for Dr. Edgar’s work.
“I’ve never shared this story publicly, just because I really didn’t know how to,” she explained. “Because of everything happening right now with the government, and the clinic potentially being closed down […] I [decided] to speak up.”
“People need to hear why [patients] seek this type of care.”
Looking back on her experience, Parkhill remembers how lucky she felt to be able to access a local abortion clinic and afford the out-of-pocket cost of the procedure. Even simple things like living in Fredericton and having a supportive partner made it possible for her to have a barrier-free abortion.
“I came from one of the best-case scenarios in terms of my circumstances,” she said. “A lot of people don’t have cars, or they don’t have people they feel like they can talk to.”
“There’s no other choice for some people,” she said. “And the alternative is very dangerous.”
“I don’t think people understand that women will take matters into their own hands, and it’s not always a safe option.”
Michaela—who asked to be referred to by her first name—found out she was pregnant in December 2017. She was in her second year of studies at the University of New Brunswick in Fredericton, and she knew she didn’t want to continue her pregnancy.
“[When I found out I was pregnant] it finally hit me how depressed I was,” she said. “I wasn’t going to classes, I was sleeping all the time, I cut myself off from a lot of my friends […] If I [could] barely take care of myself, I don’t think I could get to a point to carry a baby.”
Michaela wasn’t sure where to get an abortion in Fredericton. After mistakenly visiting a church-run women’s centre where she was encouraged not to have an abortion, and to pursue adoption instead, Michaela found Clinic 554 online, and left staff a voicemail explaining her unwanted pregnancy.
They scheduled her for an appointment that Friday.
“I was just in shock of how simple and easy it all seemed to be,” Michaela remembered.
Compared to the church centre she’d visited, Michaela said the staff at Clinic 554 respected her choice to pursue an abortion.
“We had a small talk at the beginning [of my appointment] making sure it was the right choice,” she explained. “They just accepted that this was what I wanted, and instantly provided it, no questions asked.”
While Michaela was grateful there was an accessible option for abortion services in Fredericton, she had a hard time paying for the procedure. Even with financial help from her boyfriend’s parents, the up-front costs of an abortion were almost too much.
“I put most of it on my credit card,” she said. “I remember saying, ‘Okay, here’s some money in cash, then we’re going to put this much on my debit, and this much on my MasterCard.’ It was pretty obvious that I was struggling to pay for it.”
Despite the cost, Michaela was relieved she was able to get an abortion locally. Looking back, she doesn’t know if she would have been able to travel to a hospital for services if Clinic 554 hadn’t been around.
“That’s a really scary position to be in, especially if you’re a student who doesn’t have a transportation method to get you there,” she said. “It’s really discouraging knowing that your own province doesn’t support you.”
Losing Clinic 554 would negatively impact the thousands of patients in Fredericton who rely on it, not just those needing abortions. For those living outside of the city, though, visiting the clinic has never been an option.
Jessi Taylor, a spokesperson for Reproductive Justice New Brunswick’s “Save Clinic 554” campaign, told The Pigeon that saving Clinic 554 wouldn’t be the end of New Brunswick’s lack of health care accessibility. Instead, they say, inhabitants of the province will continue to suffer, unless similar services become available in other cities.
“Right now, we have a government that is hostile,” they said. “It’s hostile to people who are marginalized, hostile to women, to people who need abortion services of all genders, [and] hostile to trans and queer folks.”
In December 2019, federal Health Minister Patty Hajdu addressed New Brunswick’s lack of funding for out-of-hospital abortions in the House of Commons. She stated that because Regulation 84-20 created a distinction between clinical and hospital abortions, the provincial government was in violation of the Health Act.
In March 2020, the federal government penalized New Brunswick for violating the Canada Health act and withheld $140,216 of annual health transfer payments. However, these payments resumed during COVID-19 to ensure the province had adequate resources to address the pandemic.
A spokesperson for Hajdu later said that the Health Minister “will ensure that the New Brunswick government eliminates patient charges for abortion services outside of hospitals,” but did not provide a timeline.
Despite federal pressure, the provincial government of New Brunswick continues to maintain its refusal to “[fund] a private clinic.”
To most of the clinic’s patients, whose services are covered by Medicare, Clinic 554 is just like any other doctor’s office. Taylor said focusing only on the clinic’s abortion care ignores the 3,000 patients who use Clinic 554 for primary health services regularly.
“Usually when we think about private medical clinics, we’re thinking about […] for-profit medicine,” Taylor explained. “That’s really not what we’re talking about when we talk about Clinic 554, which is very much a family doctor’s office.”
“New Brunswick continues to break the Canada Health Act through their restriction of abortion services. We have the law on our side.”
Without legislation allowing independent clinics to operate with the same funding as hospitals, New Brunswick will continue to offer inequitable health care.
“One of the most important things you need to realize about health care in the province is that largely it is based on luck and privilege,” Taylor said.
“And luck and privilege is not a way to design a healthcare system.”
Tegwyn Hughes is Managing Editor of The Pigeon.