THE STATE OF ABORTION EDUCATION IN MEDICAL SCHOOLS
It has been 25 years since the Supreme Court struck down Canada’s abortion law in 1988, but medical schools in this country are still wary about giving the subject sufficient weight in the classroom according to a feature article by Danielle Groen in the latest issue of Chatelaine.
The medical students interviewed who are interested in abortion care admit they’re nervous about bringing it up with faculty members because they don’t know where they stand on the issue. The statistics on schools that actually include abortion in their medical curriculum are very telling of how many schools avoid the subject altogether:
“Because there is no standardized curriculum for any medical discipline, by the mid-2000s, only half of Canada’s 17 medical schools offered some discussion about first-trimester surgical-abortion techniques. A recent study published in the journal Contraception found that in a third of schools, abortion isn’t raised in mandatory lectures at all.”
These statistics are quite troubling considering that 31% of Canadian women under the age of 45 have terminated a pregnancy, which means every physician will encounter a patient who is seeking an abortion or has had one.
The need for abortion providers is great, and all physicians should have a basic understanding of the procedure. Women living outside of urban centres are at a great disservice because of the uneven distrubution of trained providers: “While Quebec has 46 abortion facilities, the Prairies combined have eight. Prince Edward Island has no provider at all.”
Unfortunately, medical schools are doing little to normalize this safe and legal medical procedure:
“Medical schools as institutions are not typically brave. And it shouldn’t require any bravery, because abortion is a legal medical procedure that is clearly within their purview” says Dr. Mei-Ling Wiedmeyer, a Vancouver-based family physician.
Groups of motivated students have taken it upon themselves to fix these misguided educational priorities. Medical Students for Choice, founded in the U.S. in 1993, and holding chapters in 10 of Canada’s 17 schools, has been at the frontlines of a push for curriculum reform.
Groen also talks to Jillian Bardsley, a medical student who served as Co-President on the Toronto Chapter of Medical Students for Choice, and contributed to the new collection, One Kind Word: Women Share Their Abortion Stories. Bardsley and fellow co-president Anjali Kulkarni organized meetings with school faculty and referred to more substantial lectures at other medical schools including Wester University, which offers a two-hour pre-clerkship lecture on the medical and surgical aspects of abortion. In 2013, the school introduced a 1 hour lecture on the basics of aboriton counselling in its second-year obstetrics and gynaecology unit.
In One Kind Word, Bardsley discusses the links between barriers to abortion access and trained providers:
“It concerns me that first trimester surgical abortion techniques are discussed in only half of Canada’s medical schools. We must make an effort to train new providers and expand the practice of nurse practitioners and midwives. Unfortunately there are many bogus ‘health information sites’ and so-called ‘pregnancy crisis centres’ that intentionally misinform women as to the complications of abortion. If medical trainees aren’t taught that abortion does not cause breast cancer, infertility, or depression and that the procedure is quick and relatively painless, women will be forced to make decisions without being fully and truthfully informed.”
With the pending approval of mifepristone by Health Canada — an abortion pill called “essential medicine” by the World Health Organization and widely used in Europe — family doctors will be at the centre of abortion care in Canada. The approval of mifepristone would remove barriers for women in remote areas who cannot access abortion clinics. Medical schools need to be at the front lines of this trend towards medication abortion and help guide future physicians and the national conversation around this essential area of healthcare.
HOW THE GOP IS UNDOING ROE V. WADE.
A recently published article in Essence magazine by Zerlina Maxwell outlines the insidious strategies the Republican House is using to prevent women from accessing safe and legal abortion.
It has been four decades since the landmark Supreme Court decision in Roe v. Wade, but abortion rights are still not guaranteed for women in the U.S. Since the 2014 elections gave Republicans control of two-thirds of state legislative chambers, opponents of safe and legal abortion procedures are targeting providers in a new and aggressive way. The New Right’s anti-choice strategy has slowly evolved from trying to dissuade women from seeking abortions to attacking providers directly. By pushing unnecessarily restrictive legislation under the guise of “protection,” anti-abortion groups are making it economically impossible for independent abortion clinics to remain open.
As 2015 begins, congressional Republicans have already tried to introduce a sweeping ban on abortions after 20 weeks of gestation (H.R. 36). It was only when President Obama threatened to veto the bill that it was shelved. The House is also trying to pass bills that would ban the use of tax dollars for abortion, target funding for groups like Planned Parenthood, and require abortion providers to have hospital admitting privileges.
Anti-choicers claim increased wait times and measures that require providers to be licensed as freestanding surgical outpatient facilities will better protect women, but these standards are the most threatening to abortion clinics which cannot afford renovations that would cost some clinics more than $1 million.
Federal statistics shows that abortion is one of the safest medical procedures in the U.S. David Grimes, former chief of abortion surveillance at the Center for Disease Control and Prevention, and a leading research and abortion provider says “Anyone who talks about the dangers of abortion is just blowing smoke…These kinds of regulations do nothing to advance women’s health. All they do is drive up the cost of care and cause women to delay, which drives up the risks.”
The women who are put at most risk by these laws are economically disadvantaged women and women of colour. According to the Guttmacher Instittue, “Black women have consistently had the highest rate of abortion compared to other women. Thirty-seven percent of abortions are obtained by Black women, compared to 33 percent by White women and 22 percent by Latina women.” Many women cannot afford to put their jobs on hold and travel far distances, endure waiting periods, and pay for an abortion out of pocket. This is why challenges to abortion access resonate so clearly with communities of colour. A recent report from the Center for Reproductive Rights and Ibis Reproductive Health shows that states with the most abortion restrictions also have some of the worst indicators for women’s health.
Reproductive health is an integral component of comprehensive health care, which is a basic right for every individual. Roe will be meaningless if Republicans continue to hack away at it and make the well-being of women dependent on their zip code.
“CANDA’S ABORTION PROBLEM” AND REPRODUCTIVE JUSTICE NEW BRUNSWICK
Cynthia Spring’s in-depth piece for GUTS Magazine discusses the uneven state of abortion access in Canada from the 1970s to the present day. Spring lays out how the national conversation around abortion access changed when news of the Fredericton Morgentaler clinic’s forced closure broke on July 31, 2014. For more than twenty years, the New Brunswick government refused to provide provincial funding while the clinic was performing over 60 percent of the province’s abortions.
In Spring’s piece, Moncton activist Beth Lyons explains how the clinic’s closure presented an opportunity for change:
“With the clinic closing there was no longer this band-aid solution, and it was no longer possible to say: ‘It’s too bad that folks can’t get publicly funded abortions with self-referral, but at least we have the Morgentaler clinic.”
A change in provincial power came during last fall’s elections when the Liberal party led by Brian Gallant, who openly expressed his pro-choice leanings, beat the Progressive Conservatives. Four months after the Morgenatlier clinic closure, Gallant announced that his Liberal government would amend Regulation 84-20 that required a patient to get two referrals from physicians in order to receive a fully covered abortion in one of the province’s two hospitals authorized to perform the procedure. The two-referral requirement has been removed from the Medical Services Payment Act, but private clinics are not funded, nor are hospitals required to provide abortions. Gallant’s failure to expand women’s access to healthcare means this amendment really just offers the bare minimum in reproductive health care.
Activists in New Brunswick have a different vision of adequate support and timely care for women that the current health system is lacking. On January 16, 2015, it was announced that a new health centre would be opening in the former Fredericton Morgentaler clinic, made possible from the funds raised by Reproductive Justice New Brunswick and Fredericton Youth Feminists’ incredibly successful kickstarter campaign.
Clinic 554 will offer publicly funded health services such as contraception and pregnancy options such as emergency IUDs, prenatal care, and abortions not covered by medicare. The clinic will also treat people who do not have a family doctor and provide services for the LGBTQ community. Without provincial funding, visitors at Clinic 554 will have to pay up to $800 for abortion services. Hospitals in Bathurst and Moncton are currently the only facilities that perform abortions, which means some women will still have to drive three to four hours depending on where they live in the province.
Wendy Robbins, a long-time advocate for improving access to abortion in New Brunswick, describes the new rules a “partial victory.”
“It’s an achievement to get back to Square 1. It is an achievement to catch up to the 1980s. It is a very muted Hallelujah,” said Robbins.
The fight for access in New Brunswick has shifted towards having medicare fund abortions in other settings outside of hospitals such as private clinics and doctors’ offices. The province’s restrictions go against trends in medicine, such as expansion in the use of telemedicine (i.e. virtual consultation with a physician by video), that help women in rural areas gain access to early abortion care.