Yukon woman shines light on the cracks in abortion access in the territory

A Yukon woman is raising the alarm about the cost and difficulty of accessing abortion medication in the territory.

Jane Doe says she had to seek an abortion through the emergency room, because the Opal clinic — the territory's only dedicated abortion services provider — is only open one day a week, for four hours. 

Jane Doe is a pseudonym. CBC is not disclosing her identity for personal safety reasons.

That day, she says, she was left waiting, watching other patients come and go, until a female doctor was on shift — even though she hadn't asked to be seen by a female doctor.

At the time, Doe was working in a rural community. She'd travelled to Whitehorse on the weekend seeking a medical abortion to end a pregnancy. She says the doctor advised her to go to the Opal Clinic. The receptionist and a nurse had made the same suggestion.  

"So for the third or fourth time that day, I said, 'I can't go to the Opal Clinic. I work full-time out of town. This is my only option,'" she said.

By the time Doe had received a prescription for the abortion pill Mifegymiso, the hospital pharmacy had closed. She had to get back to work the next day, so she went to a different pharmacy downtown. She says the pharmacist told her the abortion pill cost $300. 

"I broke down," said Doe. "I only had $250 in my bank account and I still needed to buy food and gas to get home."

Experts cast doubt on whether abortion pills are free

Cabinet communications said the Yukon government offers Mifegymiso to Yukoners at no cost.

But the government acknowledges free pills are only available through the Whitehorse hospital. 

Justine Fair, a physician who specializes in women's health at Whitehorse General, says the walk-in clinic and some private family doctors in town may choose to stock the abortion pill at their clinic. 

"What that means is that someone literally has to bring some of the pills from the hospital and store them at their clinic. But if they write a prescription and tell the patient to go to a pharmacy in town, they're going to be charged," Fair said.

CBC has independently verified the pill costs between $400 and $500 at Whitehorse pharmacies at the time of publication.  

Access in rural communities uncertain

The Yukon government says "medical abortions [are] available to patients at all health centres across the territory."

CBC confirmed 11 out of 13 rural health centres don't carry Mifegymiso. The other two did not respond by publication time. 

"What the health centres usually do is put a referral through to the Opal Clinic," said Fair.

For community members seeking an abortion, accessing the Opal Clinic means taking time off work, travelling to Whitehorse and finding overnight accommodation. Patients may be able to get their travel covered with a referral from their rural health centre, but there are barriers there as well. 

"In communities of, you know, 400 people, it's hard to keep things private," said Fair. 

She added in small towns, where everyone knows each other, there could be stigma, or even safety concerns.

"It's not just missing time from work, or having to find childcare," said Fair. "It's also, some people have struggled to get to Opal because other people have tried to prevent them from coming."

Sigourny Whipple-Grantham is a project co-ordinator for the Yukon Status of Women Council. The organization supports a number of different projects to improve gender equity in the territory. Most recently, Whipple-Grantham has been working on a reproductive justice research project. She says she's heard anecdotally that abortion pills are not always available at local health centres. 

"There's clearly a mismatch between what people are actually able to access versus what's being stated by the government on their website."

Knowledge gap for physicians and patients

Lindsay Campbell, a physician who works at Watson Lake Community Hospital, says one barrier to access is temporary doctors, known as locums, who might not know the process.

"Sometimes what happens is they just refer to me instead to take care of things, so that may delay things by a week," said Campbell.

According to the Yukon government's website, medical abortions using Mifegymiso can only be done up to nine weeks. Campbell says the further along in the pregnancy, the more chance of potential risks to the patient.

The Yukon government says abortions are covered under the territory's medical travel. 

For example, if a doctor diagnosed a patient as being over nine weeks and needing a surgical abortion, community hospital doctors can make an appointment for the patient at Whitehorse General Hospital. The doctor would then submit a request for medical travel through the hospital's reception services, thereby covering the cost of travel for the patient, while retaining doctor-patient confidentiality.

But Campbell acknowledges this isn't always how it goes. 

"If [patients] just go to Opal Clinic on their own, then they would have to get the form signed by the doctor at Opal, and then apply for funding afterwards."

Campbell says that upfront cost of travel could be a barrier for some patients. 

Whipple-Grantham says another barrier is people simply not knowing the Opal Clinic exists. 

"A lot of people we've chatted with about the work we're doing have said, 'Oh, wow. I didn't even know we had a clinic that provided abortions in the Yukon'," Whipple-Grantham said.

Personal beliefs still an issue in abortion care

Campbell also acknowledges some doctors may not feel comfortable providing Mifegymiso. 

"Some people just don't want to necessarily be involved, but they just have to do their proper referral,"  says Campbell. She says she's not aware of a time when a physician at Watson Lake Community Hospital has refused care to a patient.

Doe, on the other hand, says during an interaction with a different doctor, she was asked if she had had any abortions in the past. She says she was also asked who the "father" was and if she had consulted with him about the decision to terminate the pregnancy. 

"I was just stunned by this question, because, it's an embryo. This person's not a father." says Doe. 

Fair says doctors often refer patients seeking abortions to the Opal clinic. 

"I think the reality was always physician-dependent, meaning whichever physicians were working there, and if they were comfortable."

Telemedicine a potential solution to access barriers

In B.C., Mifegymiso is available at all hospitals, health centres and clinics. The pill is also available for free at all pharmacies. Pharmacists are able to dispense Mifegymiso to their patients at no cost. 

B.C. also has what's called "no touch abortions" where you can get a prescription from a doctor or pharmacist over the phone who will then mail you the abortion pill. In B.C., doctors and nurses are available by phone 24/7.

The Yukon Status of Women Council, in collaboration with the Opal Clinic and Yukon Strategy for Patient Oriented Research (YSPOR), part of Yukon University, is researching how to lower barriers to abortion access across the territory.

The organizations are conducting a feasibility study on mailing pills either to health centres to be picked up by patients, or directly to patients, in rural communities. This would require a phone consultation with the patient. 

The Yukon government says there are barriers to telemedicine. The Department of Health says it has limitations for providing remote consultations for abortions, in order to ensure the safety of patients.

The territorial government points to a lack of physician access and emergency care for rural community members. 

Health Canada says so long as pregnant people track their cycles and can confirm they are less than nine weeks into their pregnancy, they are eligible for a medical abortion.

Doe says better access can't come soon enough.

"I'm a loudmouth. Like I don't back down easy, but for women who don't have that capacity, in the current system they could be trapped in a pregnancy that they don't want to be in," Doe said.