NB abortion access a work in progress one year after policy change

A year after the New Brunswick government lifted the final legal limits on access to surgical abortion, there have been no real changes in where the service is available.

Three hospitals in the two cities are still serving, but no clinics outside hospitals have taken advantage of the regulatory change effective November 7, 2024.

According to Health Minister John Dornan, doctors who were prepared a year ago to introduce it into their practices in communities are “less interested” than before.

“It’s up to the individual practitioners,” he said.

“They haven’t stepped up to say ‘we want to start doing this,’ and so if they do, we’re ready to be able to support it, but the community of physicians doing this hasn’t asked us for it yet.”

Reproductive health researcher Martha Paynter, who is part of the New Brunswick Abortion Care Network, says that’s no surprise.

“We did not expect that a new clinic would be built there immediately,” he said. “Demand for procedural abortions is falling year over year, and the resources it would take to open a freestanding clinic would be significant.”

Just days after being sworn in last fall, Premier Susan Holt repealed a section of a provincial regulation that said Medicare could only fund surgical abortions in hospitals.

This marked the end of a long political battle that centered on Clinic 554, a practice in downtown Fredericton that lobbied Medicare for abortions performed there.

“We believe abortion is health care and everyone deserves access to the care they need, when and where they need it,” Holt said in last year’s announcement, where he blocked a cabinet order repealing the ban.

But he also said that surgical abortion “will not become (more) accessible tomorrow” as a result of the change.

Both Dornan and Paynter said the main reason doctors do not add this service to their clinics is the increased use of abortion medication.

The province funds Mifegymiso, a combination of two pills that any doctor or nurse practitioner can prescribe that terminates pregnancy and is less intrusive than surgery.

The province funded 724 claims for prescriptions in 2020-21, a number that increased from 1,224 last year.

This year the number is poised to exceed 1,300.

“Year after year, we’re seeing these shares go up, go up, go up, and the abortion rates aren’t even going up,” Paynter said.

“We know this from national data. So we can assume that more and more people are choosing medication abortion.”

That means the hassle of accessing a physical facility has become increasingly obsolete, Paynter said, pointing to a primary care clinic in downtown Fredericton, where several doctors and nurse practitioners prescribe Mifegymiso.

They can also write it virtually.

“The terrain has changed a lot,” Painter said. However, questions remain.

Mifegymiso is not prescribed after the ninth week of pregnancy, and patients who need a surgical abortion must still travel to the only hospitals offering abortion in Bathurst and Moncton, which Dornan says can represent a barrier.

Paynter said there is a lack of data on how many patients have to travel and how long it takes, and whether delays are being minimized.

“We think we’ve improved things but we really need that data … to be able to answer this accurately.”

Some patients who have misinformation about the service, or who do not know how to access the service, may wait too long and be forced to travel outside the province toward the end of their pregnancy.

The minister said he was confident that many people did not understand the nuances of the different options.

“They wouldn’t know where to turn,” he said.

Dornan said a promised toll-free phone line will launch “very soon” dedicated to providing patients with more information about their options and how to navigate the system.

He will also look at whether more data can be provided on travel to Moncton and Bathurst.

He said his “gut feeling” is that travel remains a barrier for some patients, and he urged advocacy groups to refer people to the department or doctors they might not otherwise hear about.

Dornan also said that universal contraceptive coverage, which was promised in the 2024 Liberal throne speech, would occur whether or not a pharmacare agreement was signed with the federal government.