[ Medical Students for Choice ] May 2007 http://www.ms4c.org/update/MSFCUpdateMay2007.pdf Rural Access to Abortion Services in Canada by Patricia La Rue and Jessica Shaw Canadian women face many barriers when trying to exercise their reproductive choice. These barriers are made most severe for rural women because they are often the most vulnerable. In 2006, a Canadians for Choice researcher called all 791 general hospitals in the country posing as a pregnant woman looking for abortion services. She noted both the availability of the service and the reactions of hospital staff members when she asked about abortion services. The findings of her research were published in Reality Check: A close look at accessing abortion services in Canadian hospitals. According to the findings of Reality Check, approximately one in six Canadian hospitals offer abortion services. Services are poorly dispersed throughout the country. The majority of providers are located in urban areas, within 90 miles of the American border. If you exclude the province of Quebec, where abortion services are organized so that there is at least one provider per region, approximately 12% of hospitals providing abortion services are located in rural areas. This is low considering 20% of the country's population lives in rural areas. The travel needed to reach the closest provider is one of the biggest barriers limiting women's access to abortion services. In some cases, travel time to the closest provider can amount to more than 20 hours. The fact that a woman has to travel outside of her area of residence often implies a loss of confidentiality because she will often have to explain her absence from school or work to members of her family or community. Very few of the hospitals offering services in rural areas provide abortions after 12 weeks. The wait time for an abortion in rural areas can reach four weeks. By the time a woman realises she is pregnant, makes her decision and gets an appointment, she might already be past the gestational limit set by her local hospital provider and have to travel. Having to travel to get an abortion can amount to a large sum not only because of transportation and accommodation costs, but also because of other indirect costs. These indirect costs include, but are not limited to, having to take time off work, arranging for elder or childcare, and arranging for someone else to accompany the woman who is terminating her pregnancy. Since most women are required to have preliminary and follow-up consultations, and these are not always available in their region, they are often required to make several trips to the provider's office or hospital. Women unable to afford these may be at risk of attempting to self-induce an abortion or be forced to carry an unwanted pregnancy to term. Judgmental or misinformed staff act as gatekeepers to a woman's access to information about abortion services. Reality Check reveals that 41% of hospitals that actually provide abortion services had staff members answer the phone who did not know if abortions were offered or where to refer the woman for more information. If a staff member is unaware of the policies and services at their own hospital, it is quite likely that they are also unaware of the abortion policies and services at neighbouring hospitals. Women who live in rural areas are especially vulnerable to the detrimental outcome of speaking with an unknowledgeable staff member because, for many, their local hospital is the only regional source of healthcare. In bigger cities, there exist standalone clinics or sexual health centres that can give information. However, in rural areas, if a hospital is unable to help her with a medical need, there is nowhere else for her to turn. Hospital employees can make deliberate attempts to block a woman's access to abortion services by refusing to talk about abortion or by providing bad referrals leading to anti-choice organizations, to facilities that are not healthcare providers, and to contacts that do not even exist. Women calling about abortion services are often hung-up on, laughed at, and told many myths and inaccuracies about the procedure. Throughout the course of our study, a staff member at a rural hospital answered the phone, 'hospital switchboard' but after the researcher told her she was looking for abortion services, she said, 'I'm sorry, we're a lumber company' and hung up. At another rural hospital, our researcher was given the number to an in-patient psychiatric hospital and told that there was no way anyone at a 'normal' hospital would want to talk about something like abortion. The nurse suggested she should admit herself to the psych hospital until she could 'figure things out'. At yet another hospital, the researcher was advised to take the Emergency Contraception pill to 'cure' her 10-weeks pregnancy. Other staff members limit women's ability to access services by withholding relevant information about the steps to take in order to make an appointment. This can be especially damaging for women who live in poverty and/or isolation and need specific details in order to arrange for the financial and logistical components that ensure the procedure is done. While some parts of the country have hospitals and clinics where a woman may self-refer for an abortion, many rural areas have no place that will offer an abortion without a referral from a family doctor. Of the hospitals providing abortion in rural areas, all but two require a doctor's referral. If a woman's doctor is anti-choice, her path to accessing safe and timely abortion care is often blocked. Some hospitals give the option of going to the emergency room for a referral but none can guarantee the doctor on duty will support a woman's right to choose. Work remains to be done so women living in rural areas can exercise their reproductive choice and access accurate information about abortion services. After all, a choice that cannot be exercised in a safe, accessible and affordable manner is no choice at all. Click here to see media coverage in French