We didn't get to a lot of the questions during the webinar, so here are the responses:
The major opponents to progress on this issue seem to be right-wing religions. Is this true? How do you engage them?
The anti-choice movement in Canada are often connected to religious groups, but we know that religion and faith of any kind are not incompatible with working towards sexual and reproductive health and rights. We work to make sure that anti-choice beliefs and activism don't end up rolling back rights at the provincial/territorial and federal level, while also working to increase education and public awareness on the benefit of programs, laws, and policies that ensure access to comprehensive sexuality education and the full spectrum of reproductive and sexual health care.
This awareness raising work is important because, in conjunction with the (very organized) work of a vocal minority like the anti-choice movement, what holds us back in making the progress we must make to ensure equitable access to abortion care in Canada is the fact that abortion is still treated as a political hot potato. We must raise the political will to address historical gaps in access and we can do that by making it clear that it is unacceptable to the Canadian public that people still see their right to this very common medical procedure denied.
I am aware that at least 2 catholic hospitals refuse to provide abortion. These hospitals also provide health care to vulnerable populations, who face barriers seeking care elsewhere?
What work has been done, or can be done, to ensure hospitals uphold patients rights?
Only one hospital in six provides abortion care in Canada. This is unacceptable. As your question highlights, some of the hospitals who do not offer this service are serving vulnerable populations and some are the only hospitals serving large catchments, effectively making people having to travel on their own dime to access a hospital or a clinic where that care is available. While it is not the case in every hospital that does not offer abortion, in some instances, we see institutions exercising 'institutional' conscientious objection.
What Action Canada has done on this issue has been to engage international treaty monitoring bodies and other human rights monitoring organizations to support them in offering constructive recommendations to the federal government of Canada to address conscientious objection and ensure they play a leadership role and hold provinces and territories accountable in addressing barriers to reproductive health care.
For example, Action Canada made a submission to the UN Committee for the Elimination of Discrimination Against Women making the case for conscientious objection to be identified as a major barrier to abortion in Canada. We have also supported many individual people who have connected with us through our Access Line program in lodging complaints against health professionals and institutional gate keepers which has informed our advocacy and policy work.
It is important for us to continue to raise the profile of the barriers faced by many Canadians when seeking an abortion to make it a priority for governments, health authorities, medical schools and institutions to move on an issue that many see as either 'resolved' or carrying 'reputational risks' because of abortion stigma. It is with the help of the public and health care providers that we can continue to hold our leaders to account on this issue.
In many countries around the world nurses and midwives can provide early medical abortion and WHO supports this. What work has been done, or can be done, to promote an expansion of nurses scope of practice to provide medical abortion?
Especially for nursing stations in First Nations communities where people often need to fly, travel and leave children and family obligations to obtain an abortion.
On November 7th 2017, we achieved a significant step forward in ensuring access to medical abortion in Canada. As part of the January 2015 approval process for Mifegymiso, Health Canada had recommended unnecessarily strict conditions for use of the abortion pill. These restrictions were standing in the way of realizing the drug’s potential for better access to abortion care in Canada. But in response to the tireless work of health care advocates (including Action Canada for Sexual Health and Rights) Health Canada removed all of the restrictions that complicated access to the abortion pill. Up until then, Mifegymiso was more regulated than controlled substances in Canada, despite decades worth of evidence from its use in over 60 countries proving how safe and effective this medication is (including the studies you allude to looking at the provision of medical abortion by various health care professionals). Mifegymiso now has federal regulations similar to other prescription drugs. One of the important change that took place was how the language in their product monograph was changed to “health professional” from “physician” only. This change allows for appropriate prescribing and dispensing by pharmacists, nurse practitioners, midwifery groups, etc.
The reason why this matters is exactly what you point out. In many communities, health care is mainly provided by nurses, and the model of care used by midwives also enhances access for many populations. In 2017, the Canadian Nurses Association shared their position on Nurse Practitioners prescribing Mifegymiso and what this could mean for individual access across Canada. The College of Nurses of Ontario was the first nursing governing body to support their Nurse Practitioners to prescribe Mifegymiso. The College of Nurses of the Yukon followed suite immediately to support independent Mifegymiso prescribing by Nurse Practitioners. By 2018, nurse practitioners in Saskatchewan were allowed to prescribe Mifegymiso, making it the 8th province where NPs are supported in prescribing Mifegymiso. Midwives from across Canada are also working in concert to examine how to expand their scope of practice in different provinces to allow for medical abortion care to be part of it. Nurse practitioners and midwives will continue to be key actors in ensuring the successful take up of medical abortion as a way to expand access to abortion in Canada.