Sex & Consequences
In Canada we don’t have abortion laws, for the same reason we don’t have appendectomy laws. When Canadians need healthcare, they make decisions with their care providers and we keep politicians out of it. The word is a medical term that means the end of a pregnancy before the fetus can survive outside the uterus. Miscarriage is a spontaneous abortion and when a patient chooses to end their pregnancy we call it a therapeutic abortion.
One in three women will choose to end a pregnancy at some point in her life. We don’t have good data for transgender and non-binary people yet. 60% of those people already have a child and are making the best decision they can for their family. 8% are teenagers and 57% are in their twenties.
90% of abortions are done in the first trimester. There’s always online outrage about “late-term abortions” which is often misinformed and misplaced. Most abortions over 12 weeks are done for severe fetal anomalies and the rest are for people who are so compromised by poverty or trauma that they can’t access care earlier.
Before 1969, to access an abortion you had to stand before a panel of 3 doctors and persuade them that it was medically necessary. The driver of policy change in this nation was Dr. Henry Morgentaler, a survivor of Dachau concentration camp who immigrated to Canada, went to medical school in Montreal, and opened his first clinic in 1969 providing birth control (even to unmarried women!), vasectomies, and abortions. He opened 20 clinics across Canada and went to the Supreme Court twice in 1975 and 1988 to defend reproductive choice. In 1975 the court ruled that danger to women due to an unwanted pregnancy was “not immediate” and he was imprisoned for 10 months. In 1988 he was able to use the newly enacted Charter of Rights and Freedoms to argue that keeping abortion illegal denied women the right to life, liberty and security of the person.
When I was a medical trainee I arranged to train with Dr. Garson Romalis in Vancouver. He was an observant Jewish man who felt called to provide abortion care and train medical students to offer comprehensive reproductive health care. In 1994 someone fired a high-powered rifle through his kitchen window and he was severely injured. This made him even more determined to ensure abortion remained accessible in Canada. Three Canadian physicians were shot in the 1990s: Dr. Romalis, Dr. Hugh Short in Ancaster, and Dr. Jack Fainmain in Winnipeg. Dr. Barnett Slepian in Amherst New York was murdered in 1998 for his work to keep reproductive choice open for all who needed it.
In the year 2000, three months before I was booked to work with him, he was stabbed in the parking garage of his clinic. By the time I was ready to fly to BC he was back at work. He was an extraordinarily kind man who welcomed me to Seder at his home and showed compassion to everyone he encountered. He died in 2014 at age 77 after a brief illness. People in Canada have control over their reproductive lives because of the dedication of healthcare providers who risked their own safety and freedom.
The landscape of abortion care has changed since I trained 25 years ago. Back in those days, most people had surgical abortions. Nowadays about half of abortions are medical abortions. The abortion pill is called mifepristone and it was approved in Europe in 1988. In Canada we had to wait until 2015 for approval.To access abortion care in Canada start with choiceconnect.ca to find the nearest abortion provider. The medication and procedure are covered by OHIP, but some clinics also charge a small admin fee.
The biggest hurdle to medical abortion is that an ultrasound is usually required, to date the pregnancy and make sure it’s not an ectopic pregnancy. If you’re near an abortion clinic, they will bring you in for a visit where they do the ultrasound, talk about what to expect, and give you the medication to take home. If you live in an area with fewer services you might need to visit a walk-in clinic to get your ultrasound and use a service like womensclinic.ca which offers medical abortions over the phone up to 11 weeks 6 days.
Mifepristone works by blocking progesterone which causes an early pregnancy to stop growing and detach from the uterine wall. Two days later, misoprostol is given to cause cramping within 30 minutes to 4 hours which will push out the gestational sac. Some spotting or bleeding may continue over the next couple of weeks. A blood test is done a week or two later at your local lab to ensure the procedure was successful, and the clinic follows up with a phone call to review the results. The most common side effects are mild stomach-upset, fever, and diarrhea after the misoprostol. You’ll get medications to help with pain and nausea. If you’re in the unlucky 3% where pregnancy is not terminated by the medication, they’ll go ahead with a D&C to empty the uterus.
If you opt for surgical abortion it can usually all be done in a single visit to the clinic. They’ll do ultrasound and, depending on the clinic, start an IV to give pain medications or sedation. A flexible tube is inserted through the cervix and gentle suction is used to empty the uterus. The procedure takes 5-15 minutes, afterwards you hang out in the recovery room, then you’ll need someone to drive you home. The complication rate is 1.5 per 1000 procedures, compared to the severe complication rate of pregnancy which is 13.8 per 1000. Most people can return to normal activities 1-2 days after the procedure. I worked at a clinic once where the recovery room had huge windows overlooking the Rocky Mountains. It was a good reminder that today’s problems will be washed away in the sands of time.