Saskatchewan became the last province in Canada to bring in universal coverage for the abortion pill and two years later the province is finally paying doctors who provide it.
On Oct. 1, the province started offering a billing code for physicians who offer Mifegymiso, which terminates early pregnancy up to nine weeks.
Previously, only doctors who performed surgical abortions were directly compensated, but those who prescribed the pill had to bill it as counselling or a consultation, which deterred them from taking on work that could require hours.
“Now that it can be billed properly, and physicians can be compensated for the amount of time that it takes, we’re hoping it will increase the number of physicians all over the province who are willing to offer that service to patients who need it,” said Dr. Carla Holinaty, a family doctor based in Saskatoon.
She said the goal is to make it easier for women who want to end their pregnancies, especially for those living in rural or remote areas.
Holinaty said sometimes patients have to travel a great distance to an urban centre to get a prescription for the pill, often taking a day or two off work and incurring travel, child care and accommodation expenses.
“It makes it almost impossible for some women to be able to access termination of pregnancy if that’s what they want.”
Other challenges still exist for women who need to access sexual and reproductive health services in Saskatchewan.
“Even before the pandemic, information on how to obtain services was often shrouded in secrecy and shame in the province and there was already a critical lack of care providers … able to provide abortions,” said Heather Hale, executive director of the Saskatoon Sexual Health clinic.
Surgical abortions are only available in Saskatoon and Regina, so there’s a geographic barrier for women who live elsewhere, which is exacerbated by the lack of transportation options, said Hale.
“That means if you have money in your bank account, sure you have access to abortion. But if you don’t, then good luck,” said Frédérique Chabot, director of health promotion at Action Canada for Sexual Health and Rights.
And surgical abortion access remains inconsistent. In Regina, surgical abortions are performed up to 18 weeks and six days, and no doctor’s referral is needed. In Saskatoon, women can get an abortion up to 12 weeks but need a doctor’s referral.
“That extra step of having to get a referral contributes to individuals struggling to meet that timeline,” Hale said.
She said women who don’t meet the timelines have to travel out of the province and bear the expenses.
“Sexual health is stigmatized, wildly stigmatized, and that often means its deprioritized in health systems, and by governments and funding bodies,” Chabot said.
Sexual and reproductive health has become undervalued even more during the pandemic, she said.
As Saskatchewan deals with record COVID-19 hospitalizations, it has reduced services at its hospital-run Women’s Health Centre in Regina and at sexual health clinics.
A spokesperson for the Saskatchewan Health Authority would not disclose what services are being reduced but did say surgical abortions continue to be a priority.
“When there’s a public health crisis like COVID-19, sexual and reproductive health needs don’t go away, they often get more urgent,” Chabot said.
“When we take away more resources, and prioritize one crisis over another, we find communities that suddenly don’t have educational programs or followups, don’t have specialists who can help people make sexual health plans, (places to) get tested for (sexually transmitted infections), or support for people who test positive for STIs.”
Hales said sexual health is in a crisis in Saskatchewan.
“That’s looking at STI infection. Rates of HIV are very high. We have a syphilis outbreak that’s happening, and we also have the highest provincial rate of adolescent pregnancy, and high provincial rates of sexual violence,” she said.
“All of those pieces together really create challenges and impacts on individuals’ health.”