Dear Premier MacLauchlan and Minister Currie:
We write collectively today from an emergency meeting of the PEI Abortion Rights Network, held at the PEI Advisory Council on the Status of Women office on four hours' notice and attended by 25 concerned people. This is an open letter from the group.
We demand immediate action for local access to abortion care in Prince Edward Island. This care must include – but not be limited to – local access to surgical abortion in a Prince Edward Island hospital or hospitals. Immediate steps are necessary to safeguard women's health.
Yesterday, one woman told her story of being denied care to follow up a prescribed medication-based termination of pregnancy. It is our understanding that she was not offered medical procedures that would determine the status of her pregnancy or any human care or kindness. This is not the first story Prince Edward Island women have told about the terrible lack of follow-up medical care for women who are prescribed a medication-based abortion.
What has brought us together today is the fresh attention on this issue.
Lack of appropriate aftercare puts women's lives and health at risk and cannot be tolerated.
As a first principle, let it be stated that the best and most important back-up to a medication-based abortion is local access to safe, legal surgical abortion. All other steps and recommendations that follow are important as stop-gaps but would not replace local access.
We call on government to take the following actions:
- Enhancing communications and navigation of systems for abortion care
A very small number of doctors are aware of the protocols for a medication-based abortion. Only a half-dozen doctors are trained in the protocol. Lack of access to safe, surgical options has created intense pressure on doctors to provide this medical care. There is a veil of secrecy over access to medication-based care. This forces community-based advocates for reproductive rights to become gatekeepers for information and access to medical abortion. This is not acceptable.We call for immediate publication of online information about abortion services that directs people to a local, PEI-based phone number and email address where they are guaranteed confidential, non-judgmental service by a comprehensively well-informed person(s) who is able to provide information about options for abortion care and how to access them.
In the absence of adequate non-stigmatized follow-up care for medication abortions and in the absence of surgical abortion back-up if the protocol is unsuccessful, women require more information from Health PEI about what to expect from a medication abortion. Clear, illustrated print and online medical information is essential. It should be supported by a 24-hour on-call appropriately-trained information service, preferably a medical practitioner, available to answer women's questions during the process of a medication-based termination. This model functions well at facilities across the country, both hospital-based and free-standing facilities.
- Establishing a policy framework for medication-based abortions
As noted above, it is best practice to have surgical back-up to medication-based abortion. Lack of local surgical abortion in PEI hospitals or clinics limits access even to medication-based abortion care for Island women. Local access would improve uptake of the medication abortion protocol in lieu of surgical termination.In the Fall of of 2015, Health Canada is expected to make a ruling on Canadian access to a first-rate drug for medication-based abortion, mifepristone. This drug is widely used in Europe and other countries. It is far more reliably successful than the protocol currently available (methyltrexate and misoprostol) and can be administered up to nine weeks' gestation, rather than just seven.
In light of the current and possible future use of medications for abortion in PEI, we recommend that the Province of Prince Edward Island immediately set a comprehensive billing number for medication abortion. Billing numbers exist in British Columbia and Ontario to provide models for Prince Edward Island policy.
Additionally, when mifepristone is approved by Health Canada in 2015, we ask that it immediately be added to the provincial formulary.
It is important to note that while greater access to medication abortions will make a big difference for Prince Edward Island women, there will always be women who prefer surgical abortion care. A woman's preference for surgical care may relate to its high success rate, the certainty and finality of the surgical outcome, or the ability to plan around a specific date. Some women will always also require surgical abortion care, especially women who have gone past the gestational limit for medication abortions or women for whom a medication abortion would not be medically appropriate.
Local access to safe and legal surgical abortion remains crucial.
- Establishing local dedicated clinic days for women seeking abortion care
Last year, Health PEI made a business case for repatriating abortion care, including surgical abortion, to Prince Edward Island hospitals through a hospital-based clinic. The model presented in this report, with its clear case for the feasibility of local surgical abortion access in a local hospital, must be reconsidered as the next step for bringing abortion care back into the Prince Edward Island health system.If clinic days were to be established within a comprehensive women's health centre or a full-service sexual and reproductive health clinic, all the better, since the state of access to sexual and reproductive health care in Prince Edward Island is shameful, unacceptable, and must be acted on with the most urgent priority.
Women's health is at stake. The time to act is now.
Sincerely,
Representatives of the PEI Abortion Rights Network
