Skip to main content

Nova Scotia abortion referral rule ‘historical practice,’ not law: minister

Randy Delorey attends a briefing at the legislature in Halifax on April 19, 2016.

Andrew Vaughan/THE CANADIAN PRESS

Nova Scotia's health minister says the province is addressing concerns about abortion access, adding it appears the need for women to get a referral from a family doctor is simply historical practice rather than law.

"There were concerns about how the process, particularly around referrals, takes place," Randy Delorey said in an interview Tuesday. "What we've seen thus far is there is no legislation or regulation that establishes it, so that means it's likely a case of it being historical practice."

Nova Scotia is the only province in Canada that requires women to obtain a referral before booking an abortion. Advocates call the referral requirement a barrier to access that creates lengthy delays for the time-sensitive procedure.

Story continues below advertisement

Delorey said he has asked staff at the Nova Scotia Health Authority and the Health Department to look into concerns and report back on how to improve access.

"Without knowing what, if any, clinical rationale exists for the referral, it's hard for me to take a position on it," he said in his first interview on the topic. "That's part of what I'm asking for: Why does it exist and is it something they recommend changing. From what I see, it appears to be historical practice."

If the need for a referral is indeed convention rather than law, Delorey said the hurdles to make changes "wouldn't be as large."

The health minister had earlier issued a statement calling abortion access in the province "out of step" with current practices after The Canadian Press reported on the barriers, with women requiring a referral for a surgical abortion, lengthy wait times for the time-sensitive procedure and no provincial coverage for medical abortions using pills.

Several women interviewed described feeling shamed and punished by the process.

Dr. Lianne Yoshida, medical co-director of the Termination of Pregnancy Unit at the QEII hospital in Halifax, said provincial health officials have asked her to put together recommendations to improve abortion access.

But she said waiving the referral requirement is only the first step.

Story continues below advertisement

"Women should be able to book one appointment and have an ultrasound and blood work done on the same day as an abortion," Yoshida said. "The day of the appointment, she would arrive, get her blood work drawn and ultrasound done, which would confirm the gestational age, and then she could have the surgical procedure. It would all happen in one visit."

Women in the province must now book an appointment with a family doctor for a referral and then have a dating ultrasound scan and a blood test – three separate appointments – before they can schedule an abortion.

The process has left many women in Nova Scotia waiting months to obtain an abortion, a delay abortion advocates called "unconscionable."

The lengthy waiting period also forces women to have later-term abortions, something a medical ethicist said is unjust, more risky and more expensive.

In 2016, the Halifax clinic performed 1,592 abortions, a number that includes out-of-province patients. Some Prince Edward Island women came to Halifax for the procedure before P.E.I. started offering in-province abortions in early 2017.

Yoshida said her recommendations would not only improve abortion access in Nova Scotia – they would save the province money.

Story continues below advertisement

While reducing the number of appointments overall and cutting health care costs, she said the abortion clinic would require more resources, including a toll-free number, a full-time, trained clerk to answer the phone as well as an ultrasound machine.

"Part of my proposal, and the way it's done in other hospital-based clinics in Ontario, for example, is to have an ultrasound machine in the clinic," Yoshida said. "Once a day, an ultrasound technician can come to the clinic for an hour to scan all the patients for that day, rather than booking separate appointments and sending all the patients to radiology."

A bedside ultrasound machine would also assist doctors during procedures, such as confirming when an early abortion is complete, she said.

Delorey said he would examine any recommendations that come forward.

Yoshida said her proposal will include ways of integrating the abortion pill Mifegymiso into the clinic's scope of practice.

Delorey said the province has not yet made a decision on whether to offer universal coverage of the drug, a two-step combination using mifepristone and misoprostol that is now covered in five provinces.

"We're still evaluating it through a process for assessing drug coverage within the province. It's still under review."

Report an error
Comments

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff. Non-subscribers can read and sort comments but will not be able to engage with them in any way. Click here to subscribe.

If you would like to write a letter to the editor, please forward it to letters@globeandmail.com. Readers can also interact with The Globe on Facebook and Twitter .

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff. Non-subscribers can read and sort comments but will not be able to engage with them in any way. Click here to subscribe.

If you would like to write a letter to the editor, please forward it to letters@globeandmail.com. Readers can also interact with The Globe on Facebook and Twitter .

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff.

We aim to create a safe and valuable space for discussion and debate. That means:

  • Treat others as you wish to be treated
  • Criticize ideas, not people
  • Stay on topic
  • Avoid the use of toxic and offensive language
  • Flag bad behaviour

Comments that violate our community guidelines will be removed.

If your comment doesn't appear immediately it has been sent to a member of our moderation team for review

Read our community guidelines here

Discussion loading…

Due to technical reasons, we have temporarily removed commenting from our articles. We hope to have this fixed soon. Thank you for your patience. If you are looking to give feedback on our new site, please send it along to feedback@globeandmail.com. If you want to write a letter to the editor, please forward to letters@globeandmail.com.