New abortion pill policy in northern Manitoba an important step, but access still limited: advocates

Destiny Werstroh squinted over her steering wheel, peering through the thick wall of a January snowstorm at what she could see of Highway 6 unfolding ahead.

In about eight hours, it would lead her and her boyfriend from their home in Thompson, Man., to the Women's Health Clinic in Winnipeg, where Werstroh would end her pregnancy.

Months earlier, on a chilly August morning, Khrystyna Massan was with her mom and infant daughter on the same journey — though this one began in Gillam, Man., roughly 12 hours from the destination. She was nervous and sick, wishing she could have afforded to go sooner.

Both women arrived at the decision with confidence — each already had a young daughter, and knew having another child wasn't the right choice for them — but that didn't mean the choice was easy.

Though the abortion was free, the four-day trip to Winnipeg was expensive. Werstroh, a single mom, estimates it set her back around $1,500, between paying for gas, food and a place to stay. Massan, who at the time worked a few hours a week cleaning at a local daycare, says her costs were closer to $2,000. 

But it was their only option.

When Massan, now 25, looked into ending her pregnancy, she wasn't told about medication abortion — also known as Mifegymiso, a two-drug combination that ends a pregnancy.

Werstroh, now 26, said when she inquired, health-care staff told her the procedure — which involves taking medication at home, but could require care in a clinic or hospital depending on the outcome — was not an option in her community.

"It was just rough the whole way around. I wasn't really offered any support," Werstroh said of her 2019 experience.

While the province started covering the cost of medication abortion last September, barriers still exist in many communities.

It's a problem addressed by a new policy shaped by community members in the Northern Health Region. Those guidelines, introduced in July, underline two points: practitioners who don't want to prescribe Mifegymiso must refer patients to someone who will, and those who provide it need to be trained.

The rules are meant "to protect the health of women within the Northern Health Region," a spokesperson said.

There are now at least four people in The Pas, Man., and two in Thompson trained to provide medication abortion, they said. Nurses in the region are also getting education on supporting and caring for those patients.

The policy is an important step in improving access, said Dr. Nadin Gilroy, the medical director of the Women's Health Clinic's abortion program. It signals to patients and providers that they have the health region's support — whether that's in deciding to have a medication abortion or incorporating the procedure into their practice.

People 'shamed and denied services'

The move followed calls for change from people like Emily Pruder, an abortion doula in Thompson who supports people considering ending their pregnancy.

"There were people being told, 'No, we can't help you, sorry. You need to figure it out yourself,' said Pruder, 27. "Basically, people [were] being shamed and denied services."

She and Massan joined a group of community members the health region consulted to create the new policy. When it was finally implemented close to a year later, it felt like a huge win, Massan said.

"I told everyone — every woman I know — about it," she said.

But there are still barriers to access in the north, particularly in places where patients have to travel because no one in their community is trained to prescribe Mifegymiso.

And for people who can't afford that trip, or to take time off work or arrange for child care, it can be the difference between ending a pregnancy and carrying it to term, said Gilroy.

"Those are very hard things to have to decide based on logistics … in a sense, not decide, but have that decision made for you," Gilroy said. "I hope that everybody would agree that that is wrong."

Barriers across Manitoba

Gilroy said the policy is a proactive step that she hopes will inspire other health regions in Manitoba. While barriers to abortion may be most pronounced in northern and rural areas, they exist all over the province, she said.

For instance, the Southern Health region, which covers a chunk of southeastern Manitoba including Portage la Prairie and Steinbach, does not offer abortion services and has no plan to do so, said a spokesperson for the health region.

And despite the new policy in the north, stigma still exists across the region in both obvious and subtle ways, Pruder said, pointing to a local church organizing a screening of Unplanned, an anti-abortion film, last year. 

Massan, a member of Fox Lake Cree Nation, said it can also be difficult for people in those kinds of small communities to access abortion.

"It's not easy to just go to the hospital and ask," she said.

Even in Winnipeg, people usually have to make an appointment with someone they don't know to end their pregnancy, Gilroy said.

"Even a woman in the city should have the right to have her abortion taken care of by her family physician or nurse practitioner with whom she has a relationship and feels comfortable with," she said. "The more normalized it can become as just one part of medicine and one part of health care, the better."

And that doesn't just come from a broadened understanding about the technical aspects of the procedure, she said. With statistics suggesting roughly one in three women will have an abortion before age 45, people also need to start thinking of it as something that has likely touched someone they know.

"We just need to start to normalize it by talking about it and by not hiding," Gilroy said, "and by not kind of feeding into that stigma by kind of, you know, talking about it only in whispers."