Augmenter les points de services d’avortement doit inclure des cliniques, Justice Reproductive NB/Expansion of abortion services must include clinics, Reproductive Justice NB

Le premier article: Avortement: bientôt dans un hôpital près de chez vousAcadie Nouvelle, le 9 janvier 2017 par Pascal Raiche-Nogue

English version below is courtesy of RJNB volunteers.

Abortions: coming soon to a hospital near you? Acadie Nouvelle January 9th, 2017, by Pascal Raiche-Nogue

Abortion practice may become present in more hospitals within the province, according to Brian Gallant.

Currently, abortion service in the public health system is limited to Bathurst and Moncton. The procedure is offered at CHU Dumont, The Moncton Hospital,  and at the Chaleur Regional Hospital.

Even if abortion access has improved in the province throughout these past few years, thanks to the changes that have been made by the liberals, the procedure is not offered in any hospital in the North-West or South-West regions.

According to the Premier, this could change. That’s what he suggested Friday afternoon in an editorial meeting with Acadie Nouvelle when asked if he had any intention of improving abortion access (by ensuring that it’s being offered in the North-West and South-West for example).

“We are in the process of initiating proceedings to see what more we can do on that front. There is nothing that I can say for certain at the moment, but I can tell you that there are discussions regarding how we can extend abortion services throughout the province.”

Upon being asked if he’s working to improve abortion access in the public health system or in the private sector, Brian Gallant was unequivocal.

“ For us it’s important to offer access to treatment through the public healthcare system. That’s what we do for every other procedure, so our aim is to try to offer that for this procedure as well.”

Those that want the government to fund the voluntary terminations of pregnancies that are performed at Clinic 554 in Fredericton, a private institution, should remain patient.

Brian Gallant was careful not to divulge any details regarding how many more hospitals would be able to perform abortions in the near future, whether or not he had talked with hospital and health networks, and where those discussions may have taken place.

“ Surely you can imagine that when you want to develop a policy like this, every partner is in on the discussion. I am not willing to mention who is saying what right now.”

He indicated that the government is collaborating with it’s partners in the health system to determine what changes could be made and in which regions to improve access.

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La réponse de Justice Reproductive NB

Le 11 janvier, 2016
English version follows courtesy of RJNB volunteers.

POUR DIFFUSION IMMÉDIATE: Augmenter les points de services d’avortement doit inclure des cliniques, Justice Reproductive NB

Fredericton, NB. Justice Reproductive NB (JRNB) se félicite de la déclaration du Premier Ministre du Nouveau-Brunswick Brian Gallant, citée dans l’Acadie Nouvelle le 9 janvier 2017, que la province planifie d’accroître les services d’avortements.

Les Libéraux de Gallant ont fait campagne sur une promesse d’enlever toutes les barrières à l’avortement, mais des barrières considérables demeurent. JRNB espère que cette annonce signifie que les avortements pratiqués dans les cliniques, dont ceux dans la Clinique 554 de Fredericton, vont enfin être couverts par l’Assurance-maladie provinciale.

«Nous sommes heureuses et heureux d’entendre que le Premier Ministre Gallant compte augmenter les points de services d’avortements dans la province, mais nous voulons lui rappeler qu’avec un simple trait de plume, il pourrait financer ces services dans les cliniques, dont la Clinique 554 de Fredericton, et les étendre dans toutes les communautés à travers la province,» dit Allison Webster, co-porte-parole de JRNB.

La Clinique 554 est une pratique familiale offrant une gamme complète de services qui a aidé des centaines de personnes à travers le Nouveau-Brunswick à accéder aux services d’avortement depuis qu’elle a ouvert ses portes en janvier 2015. Malgré que tous les autres services médicaux offerts à la Clinique 554 soient couverts par l’Assurance-maladie, les patients.es sont forcés de payer de leur propre poche pour obtenir des avortements en raison d’une législation anti-choix provinciale qui nie le financement lorsqu’un avortement est pratiqué à l’extérieur d’un hôpital. En effet, la Clinique 554 est la seule clinique médicale communautaire au Canada où les services d’avortements ne sont pas couverts par le gouvernement provincial.

En novembre 2014, le gouvernement Gallant a enlevé quelques barrières imposés par la Loi sur le paiement des services médicaux de la province (84-20), spécifiquement qu’un avortement financé par l’Assurance-maladie exigeait l’approbation de deux médecins et devait être offert par un OB-GYN. Par la suite, le gouvernement a augmenté les services d’avortement à l’Hôpital de Moncton, un deuxième lieu dans une ville qui offrait déjà des services d’avortements. Le gouvernement Gallant n’a encore enlevé le dernier obstacle qui se trouve dans l’Annexe 2 (a.1) du Règlement 84-20, qui rend seulement accessibles les avortements pratiqués dans un hôpital. Cet obstacle oblige plusieurs personnes incapables d’accéder aux services dans un hôpital à payer de leur propre poche les services d’une clinique.

Il y a plusieurs raisons pour lesquelles les personnes préféèrent obtenir un avortement dans une clinique. Les services dans les hôpitaux peuvent impliquer des longs temps d’attente. En raison des temps d’attentes prolongés, plusieurs gens se sont retrouvés trop loin dans la gestation pour pouvoir avoir un avortement dans un hôpital. Les hôpitaux nécessitent souvent deux rendez-vous avant que l’avortement puisse être obtenu. Cela implique des défis d’organisation de transport, de la garde d’enfants ou une absence du travail ou de l’école. La Clinique 554 ne nécessite qu’une visite. De plus, certaines personnes craignent le manque de confidentialité et d’anonymat dans les hôpitaux. Toutes les travailleuses et travailleurs des établissements hospitaliers ne sont pas pro-choix. Cela rend les patientes et patients vulnérables au stigma, à la honte ou aux jugements. Par contre, toute personne qui travaille dans une clinique y est car elle veut soutenir le patient ou la patiente.

Si notre système de soins santé veut rester à jour, accessible, abordable et offrir des services de qualité en toute sécurité à la population, le Nouveau-Brunswick doit développer des politiques et programmes fondés sur les données et sur les meilleures pratiques. Les meilleures pratiques encouragent le financement des services d’avortement à l’extérieur des hôpitaux et dans différents milieux de la santé, incluant des cliniques médicales autonomes[1][2]. Les avortements pratiqués dans les communautés, près du domicile de la personne sont les plus sécuritaires. En finançant les avortements pratiqués dans les cliniques, le réseau de la santé élargit ses services de santé médicaux essentiels dans la province sans réaménager les hôpitaux.

«La Clinique 554 fournit des services de santé essentiels reconnus par Santé Canada et ces services, dont les avortements, devraient être couverts par l’Assurance-maladie comme ailleurs au Canada,» dit Webster. Il y a du soutien pour ce changement. David Coon, député de Fredericton-Sud, a présenté une pétition à l’Assemblée Législative à deux occasions en 2016 qui exigeait la couverture des services d’avortement par l’Assurance-maladie, commençant avec la Clinique 554.

[1] https://www.rcog.org.uk/globalassets/documents/guidelines/best-practice-papers/best-practice-paper-2.pdf

[2] http://www.arcc-cdac.ca/postionpapers/09-Hospitals-vs-Clinics.PDF

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JRNB demande une rencontre rapidement avec le Premier Ministre Gallant et le Ministre de la Santé Boudreau pour discuter de cette situation. Il est crucial que JRNB, groupe travaillant à promouvoir et à faire avancer les droits en santé reproductive pour toute personne habitant le Nouveau-Brunswick, ait l’occasion de discuter de cette avancée avec les élus.

reproductivejusticenb@gmail.com

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FOR IMMEDIATE RELEASE: Expansion of abortion services must include clinics, Reproductive Justice NB

January 11th, 2016.

Fredericton, NB. Reproductive Justice NB (RJNB) welcomes the statement made by New Brunswick Premier Brian Gallant on Jan. 9, 2017 as quoted in Acadie-Nouvelle that the province is planning to expand abortion services.

The Gallant Liberals campaigned on a promise to remove all barriers to abortion access however significant barriers still remain. RJNB hopes that this announcement will finally mean that abortion services provided in clinics, including Clinic 554 in Fredericton, will be covered by Medicare.

“We’re happy to hear that Premier Gallant is planning to expand abortion services in the province but we also want to remind him that with just the stroke of a pen he could fund services in clinics, like Clinic 554 in Fredericton, and expand these essential health care services to where they are needed across the province,” says Allison Webster, a spokesperson with RJNB.

Clinic 554 is a full-service family practice that has helped hundreds of people across New Brunswick and the Maritimes access abortion services since it opened in January 2015. While all other medical services provided at Clinic 554 are paid for by Medicare,  patients are forced to pay out-of-pocket for abortions thanks to some unique anti-choice legislation in New Brunswick that denies Medicare funding if an abortion is performed outside a hospital setting. As a result, Clinic 554 is the only community-based medical practice in Canada where abortion services are not covered by the provincial government.

In November 2014, the Gallant government lifted some of the restrictions imposed by the province’s Medical Services Payment Act (84-20), namely that a Medicare-funded abortion required the approval of two doctors and had to be performed by an OB-GYN. It later limited the expansion of abortion services to one new site in a city that already provides abortion services, the Moncton City Hospital. The Gallant government has not yet removed the final restriction in Schedule 2 (a.1) of Regulation 84.20, which makes abortions eligible for medicare coverage only if performed in a hospital facility. This barrier forces many New Brunswickers who are unable to access services at a hospital to pay out-of-pocket at a clinic.

There are many reasons why patients may prefer to have an abortion in a clinic. Hospitals services may involve long wait times. Several patients have found themselves too far along to have a hospital-based abortion by the time they reach the top of the list. Hospitals often require two appointments before an abortion can be performed. This increases the barriers for people who have to arrange transportation, childcare and days off work or school. Only one visit is required at Clinic 554. Further, some patients fear the lack of privacy in hospitals. Not all hospital staff are pro-choice. This leaves patients vulnerable to stigma, being shamed, or being treated unfairly. In contrast, everyone who works at a clinic is there because they want to support the patient.

If our health care is to remain up to date, safe, accessible and affordable, New Brunswick must develop policies and programs that are evidence-based and follow best practice guidelines. Best practice guidelines for abortion services consistently encourage the provision and funding of abortion care outside of hospitals and in a wide range of health care settings,including free-standing clinics [1][2]. The sooner and closer to home that abortions are performed, the safer they are. By funding clinic-based abortion services, the network of health care settings providing this essential medical service would be greatly expanded in this province without the expense of retrofitting of hospital wards.

“Clinic 554 provides essential health care services recognized by Health Canada and these services, including abortions, should be covered through Medicare, like everywhere else in Canada,” says Webster. There is public support for the change. Fredericton South MLA David Coon presented a petition in the New Brunswick Legislative Assembly on two occasions in 2016 that called for the abortion services in clinics to be covered by Medicare, starting with Clinic 554.

[1] https://www.rcog.org.uk/globalassets/documents/guidelines/best-practice-papers/best-practice-paper-2.pdf

[2] http://www.arcc-cdac.ca/postionpapers/09-Hospitals-vs-Clinics.PDF

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RJNB requests a meeting with Premier Gallant and Health Minister Boudreau as soon as possible to discuss this matter. It is crucial that RJNB, as a key stakeholder working to advance the reproductive health of all New Brunswickers, have the opportunity to discuss this exciting development with our elected officials.

reproductivejusticenb@gmail.com

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Le deuxième article:  Exclusif – Avortements: le réseau Horizon n’a fait qu’absorber une partie de la clientèle de Vitalité. Acadie Nouvelle, mercredi 11 janvier 2018, par ANTHONY DOIRON

English version below courtesy of RJNB volunteers.

Abortions-Exclusive: The Horizon network only absorbed some of the Vitalité clientele

According to statistics obtained exclusively by the Acadie Nouvelle, in 2016 twice as many women have resorted to the voluntary termination of a pregnancy in the English health system compared to Vitalité.

In 2014, 495 people received the procedure at hospitals within the francophone health network.

In 2016, the number of abortions was 213. Comparatively, the anglophone health network carried out 740 abortions in 2016.

In July of 2015, the Horizon health network opened its first point of service for the voluntary terminations of pregnancies at the Moncton Hospital. However, Dr. Georges-L.-Dumont UHC already provided the service in the same region.

Vitalité indicated that the resources at Dr. Georges-L.-Dumont UHC were sufficient to meet demands.

By doubling access to abortion services in the South-East, the anglophone network only absorbed a portion of the hospital traffic that the francophone network already had, further restricting accessibility in the South-West.

There is a blatant correlation:

Number of Abortions by Region of Patient’s Origin

Vitalité Health Network

Region/Year

2014

2015

2016*

Moncton/South-East

197

142

65

Fundy/Saint-John

100

86

29

Fredericton

83

65

24

North-West

22

13

11

Restigouche

16

13

17

Bathurst

62

54

48

Acadian Peninsula

0

0

0

Miramichi

13

18

18

Other (not specified)

2

2

1

TOTAL

495

393

213

*From January 1st to September 30th

Horizon Health Network

Region/Year

2014

2015

2016**

Moncton

0

51

151

Saint-John

0

35

84

Fredericton

0

20

67

North of the province

0

6

15

PEI

0

59

137

Other (not specified)

0

Undetermined

16

Elsewhere in Canada

0

0

0

TOTAL

0

171

470

**From July 1st to September 31st

The number of patients in Fredericton, Saint-John, and Moncton who have requested an abortion at Vitalité has decreased by 59, 71, and 142 every year respectively since 2014. The number of patients that requested the service at Horizon increased by  67, 84, 151 every year over the same period.

In addition, Horizon served 137 patients in PEI in 2016. That represents nearly one third of the total, or 29.15%

The demand for abortion services is is strong in the South-West of the province (Fredericton and Saint-John). In 2016 alone, 204 people received the procedure from the two networks combined. In 2015, it was 206.

These statistics support those who argued that that Horizon’s decision did not help access to reproductive rights.

In May of 2015, the Globe and Mail released a series of email exchanges between Horizon CEO John McGarry and his colleagues. In an email dated December 1st 2014, Brenda Kinney, executive director of the Saint John Hospital Network, suggested that the Saint John Regional Hospital offer the procedure.

In a subsequent email, John McGarry said he preferred the Moncton Hospital, explaining that the strong Irish Catholic presence in the Saint-John area would create risks and costs to ensure the safety of the staff and patients.

The CEO then rectified his remarks in an interview with the Acadie Nouvelle, specifying that this reality would not motivate the final decision. When asked if Horizon would consider offering this service in one of the hospitals in the South-West, he indicated that he wanted to wait longer before reassessing the situation.

Horizon says there’s no change in sight

Despite what Brian Gallant suggested in an editorial meeting at the Acadie Nouvelle last week, the Horizon health network does not intend to extend it’s abortion services to its establishments in the South-West, at least not for the moment.

We asked for an interview with John McGarry in light of these new statistics on the provenance of the patients, but the health network simply emitted a statement via email.

“We currently have the capacity and resources to meet the needs of our Moncton clinics […] Managing access and cost was our main reason for providing this service at a single location- the Moncton Hospital” said Senior Media Advisor Stephanie Neilson-Levesque

“The site was designated to perform 600 of these procedures annually” she continues.

As for the patients in Prince Edward Island, the councilor recalled that the government was planning a possible service.

“We will continue to work with PEI Health by accommodating patient requests from Prince Edward Island.”

The feminist group says Horizon must reassess its approach

The exclusive statistiques obtained by the Acadie Nouvelle are in no way surprising to the general director of the Regroupement féministe du Nouveau-Brunswick.

“This clearly demonstrates the need for this service in Saint-John and Fredericton, but we must not forget other more rural areas. There is no offer of this service in the North-West either.” says Nelly Dennene.

“Availability is not synonymous with accessibility,” says the young woman,”the socioeconomic status of patients must be brought to the forefront of political considerations.”

“Some people do not have a car or simply cannot afford to drive for 1 ½ hours. These people are not counted in these statistics and it’s difficult to put an exact number on them. Horizon must expand its service elsewhere.”

The same goes for Reproductive Justice New Brunswick. Allison Webster, spokesperson, asks Horizon health network to re-evaluate its service offer in light of these new statistics.

“With these statistics, no one can deny the high demand in the South-West.”

“This is a politicized issue,” she says, “hence the source of the barriers between accessibility and women.”

“There are external factors at play. The stigma surrounding the procedure discourages people from using their right to ask for it.The government and the network know that it is easy to sweep this issue under the rug. We must denounce it.”

However, the young woman remains hopeful.

“I hope that the government and the Horizon health network will come to their senses and realize why the issue of accessibility, real accessibility, is important. People have the right to have access to this procedure when they need it.”