How PEI Became One Of The Most Accessible Places For Women’s Health Care In Canada

Within 10 months, PEI went from having no abortion services on the island to offering self-referral. What can the province teach the rest of the country?

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PEI Abortion Access-big brick building with three flagpoles outside

Summerside City Hall. This PEI town will host the permanent home of Women’s Wellness Program and Sexual Health Services, opening in spring 2020. (Photo, iStock)

When Courtney Cudmore learned she was pregnant in 2015, she knew immediately what she would do. At 31 years old, the Charlottetown restaurant worker was already a mother of two, and her then-fiancée had taken a job out of province. She was overwhelmed and scared, and she wanted desperately not to be pregnant. Cudmore saw a doctor at a walk-in clinic, who she says told her he had a religious objection to abortion. After she pleaded with him, he reluctantly gave her a prescription for a medical abortion. She tried several pharmacies before finding one that would fill it.

“There was no way I could bring another child into the equation. What was I going to do? How was I going to feed it? Clothe it? Find room for it?” she wrote at the time on Facebook.

On a Wednesday afternoon, Cudmore took her first pill, and the second five hours later. But after some light cramping and bleeding, Cudmore says things just stopped.

Worried that something was wrong, she went to the emergency department in Charlottetown. After giving a urine sample, Cudmore says the triage nurse told her to speak up if her condition noticeably worsened. She sat in the waiting room for nearly five hours, while her cramping, bleeding and pain returned, until finally, the doctor on duty refused to treat her without performing an examination. She says the hospital staff told her she was still pregnant, but they were “not comfortable” dealing with the “situation.”

Instead, Cudmore was told she could travel more than three hours to Halifax, to have a dilation and curettage (D&C), a process that would open up her cervix and remove any tissue that hadn’t passed with the pills. “I felt betrayed by our health-care system,” Cudmore says. “If you have a natural miscarriage, they do a D&C on you. So why wasn’t that something that was done for me?”

Cudmore could have quietly gone home or travelled to Halifax to have the procedure. Instead, she got angry. She went public, writing a post on Facebook that soon went viral, calling out the provincial health-care system, then-Health Minister Doug Currie and everyone who opposed her ability to choose what happened to her body.

She eventually found a family doctor to perform the D&C, but Cudmore’s story became a flashpoint for women on Prince Edward Island. Her Facebook post was the first attack in a reinvigorated war that had been fought for more than 30 years, since abortion services were banned across Prince Edward Island. After Cudmore spoke out, a wave of protest spread throughout the island, and activists succeeded in not just bringing abortion services back to PEI, but in making the province one of the most accessible places for women’s health care in Canada.

While reproductive rights and sexual health funding are being restricted and cut back in the United States, pro-choice activists across Canada have had a string of successes over the last few years. In 2015, New Brunswick struck down its restrictive “two doctor” regulation. This spring, Health Canada did away with the mandatory ultrasound requirement for a prescription to Mifegymiso, the medical abortion pill, and Saskatchewan became the final province to cover the cost of the pill. But none of these advances matches the sheer breadth of what happened on Prince Edward Island.

Within a span of 10 months, PEI went from having no abortion services on the island to offering self-referral. How did this seemingly impossible reversal happen, and what can the province teach the rest of the country? The answer lies in the power of activism, and the willingness to innovate.

Speaking out to effect change

Abortions on Prince Edward Island stopped being performed in 1982. The last abortion was performed at secular Prince County Hospital, just before the Queen Elizabeth Hospital opened in Charlottetown, and the Protestant and Catholic health-care systems merged. As a condition of the merger, the Catholic church demanded that abortion services discontinue.

Colleen MacQuarrie, a psychology professor at the University of Prince Edward Island, recalls how political parties would run one Protestant candidate and one Catholic candidate in each riding—a practice that continued into the mid 1990s. “That’s part of the story here of how abortion was able to be banned. It was a collusion of church and state in which women’s bodily autonomy was constantly under scrutiny.”

There were some advancements, like when the government of PEI quietly introduced an option in the 1990s that allowed a patient to be referred to a hospital in Halifax, if the abortion was deemed medically necessary by two doctors.

But in March of 2016, then-Premier Wade MacLauchlan announced that abortion services would finally return to the island. Soon after, the Women’s Wellness Program and Sexual Health Services (WPP) rolled out. In January of 2017, the first abortions were performed on Prince Edward Island in 35 years. The permanent physical space for the WPP is under construction in Summerside, estimated to open in the spring of 2020. Until then, doctors at the Prince County Hospital in Summerside can perform surgical abortions, while doctors across the province can prescribe Mifegymiso.

“We will never see anybody without access,” says Rachelle Pike, program manager of the WWP. “That’s what I’d like for the folks to know. ‘I live in wherever, I’m not going to be able to get to Summerside.’ Reach out. We’ll figure it out.”

As the WWP has grown, it has also started to offer STI testing, general sexual health care and education, pre and post-natal care (including mental health), and other services for men, women, trans and LGBTQ+ patients. But Pike says the lingering stigma on the island means people do not make themselves publicly available. “I’m purposely the spokesperson. You’ll never see the physician, you’ll never hear a name, you’ll never know social workers or nurses. No.”

Despite the concerns, Pike says she is already considering ways the WWP can expand across the province and is looking into ways of incorporating services like tele-health. “I think we are changing lives, and I think we are making a difference, and I’m very proud.”

Finding your team

This radical change in women’s health care would not have happened were it just Courtney Cudmore sharing her story on social media. Hundreds of women have fought for improvements since the 1980s.

But Cudmore’s gave way to another, more influential public outcry. Activist Becka Viau started a blog called The Sovereign Uterus, which attracted immediate attention. Dozens of women wrote in, some anonymously, to talk about what life without access was like. One woman, Sally, wrote of being devastated when she was denied treatment. “I had no idea that doctors could refuse medical support like that.” Marian wrote of helping former students travel for the procedure. “Their choices were to drive to either Maine or to Montreal, costing them up to $1,000—money they did not have. We scraped up the money and I kept their kids while they hit the road for a service that could have taken 30 minutes at a local hospital.” More than 40 women spoke about paying hundreds of dollars, taking time off of work, and convincing doctors that an abortion was a medical necessity for their lives.

One of those women was Moe Chandler. Chandler was 19 when she learned she was pregnant, and soon after, started thinking of ways to induce her own miscarriage, since she didn’t think she could get an abortion on the island. She thought about taking pills and wondered if there was something she could drink. Eventually, her thoughts grew darker. She wondered about throwing herself down the stairs, trying to figure out if she or the fetus would survive. “If I walk out in front of this transfer truck, would it kill me, or would it just end the pregnancy? Would it be enough to do that? If I go to the hospital and the pregnancy doesn’t end, they’re going to hospitalize me, and I’ll be forced to give birth.”

In her blog entry, Chandler described how scared she was to tell anyone what she was going through. “This is PEI, it’s small, someone would know me. There’d be a paper trail. It would haunt me… I’d never know who might find out.” She eventually made it to Halifax for the abortion but didn’t speak of it until years later. While the memory of that experience is traumatic for Chandler, she says she decided to speak publicly to ensure access stays open.

“We put so much work into this. So much was put on the line. And the concept that it could all be overturned,” Chandler says, “there just aren’t words for it.”

PEI abortion access-Prince Edward Island Premier Wade MacLauchlan speaking into a microphone
Prince Edward Island Premier Wade MacLauchlan announced his will not fight a legal challenge launched by the group Abortion Access Now in the Supreme Court of P.E.I. in Charlottetown on Thursday, March 31, 2016. (Photo, The Canadian Press/John Morris)

Since starting The Sovereign Uterus, Viau has become a target for anti-choice activists. The artist says she regularly gets death threats. The morning we met in Charlottetown, she picked several notes off of her car, her yard, and the front step of her office.

“We know you work here, murderer.” “Ms. Viau, a life is a life.” The notes are such a part of her life that Viau reviews stranger danger techniques with her children before sending them to daycare.

“‘You might have an accident.’ What does that mean? Are you going to cut my brakes? Are you going to push me down, trip me accidentally?” Viau says. “It’s so vague and scary.”

Still, Viau won’t consider backing down. She says abortion was brought back to PEI in part because people like her fought for it, and they continue to fight to expand and improve access. When the pressure becomes too much, Viau remembers all the people who have spoken out over the years.

“This kind of fight takes a lot of time and a lot of effort,” Viau says.

Colleen MacQuarrie thinks the power of the collective is the best lesson that PEI could teach other provinces. “If we are asked to take a step backward, we actually link our arms together and take two steps forward. Never step back.”

A small island makes big changes

PEI is small. Only about 156,000 people call the province home, and you can drive from the western tip of Prince Edward Island to the eastern shore in about three hours. Now that the WWP offers services at five hospitals and clinics across the province, as well as general workshops and educational community outreach, almost everyone has access to care.

There are still some barriers for people without transportation, but the WWP works with doctors at smaller offices to also prescribe Mifegymiso or refer patients to the WWP program. A social worker specializing in mental health travels across the province to meet with rural patients. For patients in other parts of the Atlantic provinces, access to a physician is much harder to come by—and it could get even more difficult.

New Brunswick may see their only clinic that offers abortion outside of a hospital close because the province won’t fun abortions performed there. Clinic 554 in Fredericton does not receive government funding for abortions, which Adrian Edgar, medical director of the clinic, says is a violation of the federal Canada Health Act. Instead, the New Brunswick government only offers the service in two cities, Moncton and Bathurst, both in eastern parts of the province.

After surviving on charitable donations for abortion services, Edgar announced in October that Clinic 554 had been put up for sale, and his 3,000 patients would likely soon be without a family doctor. “I didn’t predict our government would continue to act illegally to withhold healthcare from my patients. I honestly thought they must not have known what they were doing. But they do know,” Edgar said in a Facebook statement. The whole process is baffling to him. “Our current health minister in New Brunswick is by trade a lawyer, and he’s acting illegally. How can anyone make sense of that?”

Edgar’s hope is that the federal government will pressure the province of New Brunswick to repeal the regulation that denies funding for Clinic 554, but that doesn’t help them in the short term, and the building is still up for sale now.

“I just have to hope that whoever is entrusted with defending the Canada Health Act would take that seriously,” Edgar says. “I’m hopeful. You can’t be involved in this kind of work without being a hopeful person.”

Newfoundland and Labrador have similar issues, with a clinic in St. John’s and another two in Central Newfoundland and in Corner Brook, each open just one day a month. Patients in other parts of the province face long drives to get to the capital city, or even a flight when the winter ice make the roads and ferry routes impassable. In Nova Scotia’s Cape Breton region, there are no physicians in the area who offer surgical abortions and few who offer medical.

Halifax-based registered nurse Martha Paynter says physicians and nurses should be trained to do these procedures, because there’s no technical reason for the hospitals to deny these services. “Anywhere that can handle an incomplete miscarriage should be able to do this procedure. And nearly everywhere can have a prescriber of medical abortion,” Paynter said. “For practitioners in reproductive health, this is not hard. This is not a unique skill.”

Joyce Arthur, executive director of the Abortion Rights Coalition of Canada, thinks access can be expanded. PEI has shown jurisdictions that having providers across a region is ideal, but it can still be improved. “Let’s be practical here and look at how huge Canada is.” Arthur proposes having medical abortions prescribed over the phone, with the prescription for Mifegymiso called into a patient’s local pharmacy without the need for a formal doctor appointment. “Why not do it by telemedicine?”

PEI abortion access-women hold signs bearing pro-choice message
Women take part in a protest as pro-choice demonstrators rally at the New Brunswick legislature in Fredericton (Photo, The Canadian Press/David Smith)

Take them to court

Ultimately, the social pressure and national spotlight on Prince Edward Island wasn’t enough for the government to change their policies. Activists had to sue the government.

Nasha Nijhawan is a litigator from a boutique firm in Halifax. Along with her partners, she worked on this case for more than a year, trying to figure out why exactly the government could get away with not providing abortion. After hundreds of hours of work, Nijhawan and her partners served the government with a detailed draft pleading their case: why the government was acting unconstitutionally and how they planned to fight it.

Surprisingly, it worked.

Nijhawan watched, shocked, as Wade MacLauchlan announced that the province would not be fighting this battle in court. He told reporters at a press conference that the legal advice they received was that they would not win the case, and so, they were not going to waste the time.

“I remember when we got the decision, lying down on the floor and thinking, ‘okay ,well this validates all of my life choices until this point,’” Nijhawan recalls. “If I do nothing else in my life, the fact that there will be an abortion clinic in Summerside is enough.”

Threat of legal action may be what spurs the official change of regulations and policies. But individuals standing up for their beliefs also has a big role to play. While Courtney Cudmore was belittled by some, and held up as an icon by others, she says she would happily do it all again.

“People think PEI is just a small little province, but when we combine our voices great things happen and we are heard.”