What to expect when you don't want to be expecting.

In this episode of Choice Chat, we’re talking all about the logistics of abortion in Canada — what happens before, during, and after. Host Tara sits down with registered midwife Jenni Huntley and nurse practitioner/midwife Christy Tashjian to break down each step of the journey, from taking that first pregnancy test to deciding on care options and navigating recovery.

Jenni and Christy share their extensive experience providing inclusive, respectful abortion care, and discuss the difference between medical and surgical abortions, the role of ultrasounds, what to expect physically and emotionally, and the importance of support networks. They also tackle the stigma and silence that often surround abortion and advocate for normalizing the conversation as a common pregnancy outcome.

Whether you’re seeking care, supporting someone who is, or simply looking to understand abortion care in Canada more deeply, this episode offers practical information, compassionate guidance, and valuable resources.

SHOW NOTES

RESOURCES

Northwest Community Health Centers in Thunder Bay

 Thunder Bay Naturopathic Clinic

 Action Canada For Sexual Health & Rights 

The Access Line provides sexual and reproductive health information, and referrals to services including abortion anywhere in Canada. Available every day from 9 AM - 9 PM ET.

 Call 1-888-642-2725
 Text 613-800-6757
 Email access@actioncanadashr.org

 Abortion Care Canada – Need Support

 UnHushed.org

TAKEAWAYS

Abortion care is a vital aspect of reproductive health.

Individuals seeking abortion come from diverse backgrounds and circumstances.

There is often time to make decisions after a positive pregnancy test.

Medication abortions can be done at home, providing more privacy and comfort.

Ultrasounds are not always necessary for medication abortions.

Support resources are crucial for individuals making decisions about abortion.

Destigmatizing the word 'abortion' is essential for open dialogue.

Healthcare providers should meet individuals where they are at, without judgment.

Access to abortion medication can be tailored to individual circumstances.

Canada's healthcare system provides regulations to ensure safe abortion procedures.

SOUND BITES

"We have to meet people where they're at."

"There's time to decide, take a breath."

“…what I feel is so valuable is when we can offer abortion care and abortion services within the context of people experiencing all kinds of pregnancy outcomes.”

CHAPTERS

00:00 Introduction to Choice Chat and Abortion Care

03:10 Meet the Experts: Jenny and Kristy

05:57 Understanding Who Seeks Abortion Care

08:56 Navigating the Early Stages of Pregnancy

11:57 The Role of Ultras

Thanks for listening to Choice Chat, a Humanist Canada podcast about choice, dignity, and reproductive justice. We’re glad you’re here. Do you have a story to share? Do you want to suggest a topic? Email us at choicechat@humanistcanada.ca or connect with us on social media. We look forward to hearing from you.

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Transcript

 Tara (00:20)

Hello and welcome to Choice Chat, the podcast where we explore the complexities of abortion, sexual and reproductive health with empathy, clarity and a humanist and inclusive lens. Our goal is to foster dialogue, share resources, and empower individuals to make informed decisions. I'm your host today, Tara. In this episode, we're calling,” What to Expect When You Don't Want to Be Expecting”, we're diving into the logistics of abortion in Canada, what happens before, during, and after. This episode is a resource for anyone seeking abortion care, anyone supporting anyone seeking abortion care, and we want to empower you with the knowledge and tools that you'll need to navigate this journey.

Let's get started. I can't wait for you to meet our guests, Jenni Huntley and Christy Tashjian. Jenni Huntley is a registered midwife with Norwest Community Health Centres in Thunder Bay, Ontario. Jenni is an educator, author, and speaker who's dedicated to advancing comprehensive sexual and reproductive health care, as well as culturally congruent care for all birthing people, including the Two-Spirit LGBTQIA+ community. Having worked as a midwife in Texas and Haiti, as well as Quebec and Ontario. They've shared their insights into the delivery of respectful and inclusive care at conferences and through cultural sensitivity trainings with hospital staff, midwifery students and doulas. And they were a contributor to the 2020 sexual health curriculum with the Centre for Sex Education, as well as contributing to clinical practice guidelines for the Association of Ontario Midwives. Welcome Jenni. 

Thank you. Great to be here. 

Great to have you. Also with us today is Christy Tashjian. Christy is a nurse practitioner and midwife who holds a master's degree in nursing, which she pursued after 16 years as a home birth midwife in Austin, Texas. In 2020, Christy relocated to Thunder Bay, Ontario, with Jenni

and their child, where she navigated two years of bureaucracy before becoming a licensed nurse practitioner in Ontario in 2022. Cristy has taught social determinants of health at Lakehead University School of Nursing, provided care at a walk-in clinic, and has recently joined the Thunder Bay Naturopathic Clinic, where she offers sexual health care, gender-affirming care, and treatment for chronic Lyme disease and associated conditions. She is also an educator, having worked with the Mama Sana Vibrant Woman Project in Austin, providing perinatal support for low-income people of colour, and currently working to bring what she calls ‘edgy health information’, we love that, to the mainstream through her work with Unhushed, a sexual education organization for which Christy is chair. And I encourage listeners to check out the resources at unhushed.org - really a wealth of information, awesome, awesome website and resource there. Cristy has many interests, which I'm hoping she may tell us a bit about through the course of the interview. Welcome Cristy. 

Christy

Thanks so much 

Tara 

Thank you for being here. Can you tell us what brings you to Choice Chat today and what is the nature of the work that you do together? Where do your various projects, interests intersect?

Christy

I can start. So, Jenni and I are both midwives, and we met when we were already midwives. She was a midwife in Toronto. I was a midwife in Austin, and we met at a conference. She moved to Austin with me for a while, and after many years, got licensed, and we practiced together, and we both have a strong desire to help people know their rights around their bodies and learn about their bodies. And we've mostly focused on women's health, which has morphed into more like gender health and sexual health. And that is anything from gender affirming care to abortion care to health and rights around birth and home birth. And so we connected on that and have worked together actually since we met in those little niche spots around sexual health.

Tara (04:56)

Amazing.

Jenni (04:57)

And then currently I work in a publicly funded community health centre and am able to collaborate with Christy as one of the nurse practitioners in our community. Because I'm a registered midwife, I work under medical directives and my collaborating nurse practitioners and physicians are able to help my clients access more care. And so I do work with Christy and with lots of other providers in the city to help increase access to abortion care.

Tara (05:26)

Amazing. I'm so curious to learn more and to gain your perspective through this interview. I think that for me, it's learning and pushes at what I understand midwifery to be. And I think it's amazing learning for me and that you are out there as a resource for people in need of abortion care is really incredible. This podcast is about accessing that care and how a person with a uterus gets from learning that they're needing that care to seeking it and what to expect along the way, including afterwards. But I wanted to start by asking, in your experience, who do you encounter who's seeking abortion?

Jenni (06:19)

I have helped people access abortion and provided them with medication to complete an abortion from all different communities and with all different needs and pregnancy histories. And one of the values of being in a publicly funded system is that people will find us through other

agencies and organizations that are helping people navigate the healthcare system. And so I really feel like the people that come to us for abortion, myself and the midwives that I work with are really anyone from people who have had several pregnancies and carried babies to term and people who are having their very first time getting a positive pregnancy test with all different economic circumstances, all different partnerships and relationship circumstances. There isn't anyone who doesn't seek an abortion who hasn't come to see us really.

Christy (07:23)

I think that one of the stats we know is that there's a fair number of people who have abortions, who seek abortions, who are in a relationship, have other children, are in their 30s, 40s, and they find themselves pregnant and they're like, “Whoa, this is not what I want to have happening right now.” And there's a fair number of people who are in that category. It's not just young folks who are having sex and getting pregnant. It's a wide range of education backgrounds, work backgrounds, ethnicities. We do have a fair number of immigrants in Thunder Bay. And so Jenni and I often are trying to find a way to be able to pay for that because they're people who don't have OHIP. And so we have a fair number of people that we help that are sort of outside of the system as well. And that's kind of a whole other story. But for people who have OHIP, it's a pretty straightforward process and it can be, yeah, anybody. And one of the things that we really try to focus on is just meeting people where they're at without judgment, answering questions and asking them questions to see what they're feeling and what they're thinking as well about the initial coming for care.

Tara (08:49)

Amazing. I bet there are people listening to this who really wish that they had somebody like you to look towards to lean on for support in a time that can be very difficult and very isolating and where people don't know to reach out or reach out and bump up against judgment and experience that further isolate them. So thank you for sharing that. Okay, I'm just going to start from that pregnancy test, I've taken a test, I'm pregnant, I don't wanna be. What's my first step? What do I do?

Jenni (09:26)

So I think most people reach us by either having had a previous care with our community health centre, and it's a small community. We work in a small city. It is a regional centre for the area. And so people come to Thunder Bay from lots of different outlying communities, but it is in and of itself, it's a relatively small city. And so a person taking a pregnancy test, first of all, I always like to reassure people that if you get a positive pregnancy test, you are, or were, briefly pregnant. They're quite accurate. So even the ones from the very low budget stores are accurate. The pregnancy tests we have now have access to are accurate at quite an early stage. So generally there is a little bit of a group of people that we see as soon as they've taken their often three, two or three positive pregnancy tests. And then we are talking to them about what happens at that early stage of pregnancy and how the hormones might be affecting them with symptoms like nausea, breast tenderness, other discomforts like fatigue. So all of those symptoms can start quite early. Well, you know, within a week or two.

There are also people who have taken a pregnancy test several months in. And so those people, there's a little bit more of an urgency around trying to help them find care. But the majority, I would say, are in that earlier category. And they have taken the test. They have called, often in my case, often they've either called our centre because they know that we offer that or they've called the local sexual health clinic from the district, or they've looked up online. There's some great organizations that list abortion providers in Canada; Abortion Care Canada, and Action Canada for Choice in Health. They are both excellent organizations that have hotlines, especially Action Canada, the hotline folks do refer a lot of people to providers in their local area. So connecting with an abortion provider or clinic.

Where the person can have those initial conversations about, okay, they have this positive pregnancy test. Where are they at in their pregnancy? Dating is really important. Accurate dating. And that doesn't necessarily mean in all cases with accurate dating through ultrasound, diagnostic ultrasound. Often diagnostic ultrasound is a really important tool for us as abortion providers, but it's not the only tool. And it can be a barrier to people accessing abortion care if they have to have a diagnostic ultrasound. What was really interesting was that during the early COVID-19 pandemic in 2020, there was a lot of research done on what was called no-touch abortion protocols. So abortion protocols where someone was able to access care virtually without a diagnostic ultrasound or other initial pregnancy testing. Because the other hormonal testing that we do is the pregnancy hormone blood test.

Tara (12:50)

And that would be highly accurate, I would assume. 

Jenni

Yes

Tara

And what's the need to have the diagnostic ultrasound? Is it time?

Jenni

So for lots of people, they can't get an appointment easily or quickly, especially if they live outside of a metropolitan city. But even if they live within a metropolitan city, often people face barriers. So it could be a week or two before they get that diagnostic ultrasound. The other thing for people who are choosing to have an abortion is that a diagnostic ultrasound can be a really difficult experience. 

When you have a good ultrasound place, and ultrasound places are private companies that offer that service that are OHIP covered or that people have to self-pay if they don't have provincial health insurance. A lot of them are starting to be really careful and considerate with people who are seeking abortion, but they might see a visual of their pregnancy. They might have to experience a penetrative ultrasound, intervaginal or interior ultrasound. And so those experiences in and of themselves can be, especially if the person has had a bad experience with that in a previous pregnancy, they can be barriers to just having accessing the abortion themselves.

Christy (14:07)

It can be triggering in bringing up difficult feelings.

Tara (14:13)

Right, I can certainly appreciate that.

Christy (14:16)

I just want to add that we know that if people know their dates pretty well, like know when their last period was, that a dating ultrasound or diagnostic ultrasound or whatever you want to call it, isn't necessary in order to do a medical abortion. I do lots of abortion care without people getting ultrasounds. It really is something that isn't needed. 

There's some rules, you know, or some laws that have gone into effect in some places where abortion isn't legal unless you have one, an ultrasound. And it's been used as a way to sort of change people's minds. And so I think that we have to be really careful about that. If we don't know the dates at all, if somebody doesn't know when their last period was or when they got pregnant, a lot of people will know exactly when they got pregnant, you know, when it was. when they had sex, when they were ovulating. Some people don't know at all. And then it is more helpful to get a diagnostic ultrasound to know the dates, to know whether a medical abortion with medications is something that can be done or if they need to have a surgical abortion. So there are times when it is necessary, but for the majority of the times an ultrasound is not necessary.

Jenni (15:35)

As long as they're monitoring for symptoms of a pregnancy outside of the uterus, which is part of the education that we do. 

Tara

Right 

Jenni 

So what we're doing with somebody who's seeking an abortion is we're talking to them about the dating. That's the initial consideration and how pregnant are they? And then do they have any risk factors or are they having any symptoms of a pregnancy outside of the uterus? And in those cases, diagnostic ultrasound is absolutely necessary and really relevant. And we need more access to that in emergency situations, honestly. Some of the hospitals who have that diagnostic ultrasound capacity aren't as quick to, or aren't able to give people those ultrasounds in emergency situations. And so we need to reserve those for those kind of emergencies.

Tara (16:19)

Okay, so that would be like an ectopic. 

Jenni 

Correct.

Tara

Okay. Yeah. And what are the symptoms? Or how do they differ from ⁓ pregnancy inside the uterus?

Jenni (16:29)

Significant bleeding with pregnancy, pain that is on one side or the other. And they can be vague symptoms. But, also if the pain is referred from the abdomen up into one of the shoulders, that can be a very clear symptom. Unfortunately, a complication like an ectopic pregnancy isn't always clear. Like the symptoms aren't always clear. And so part of what we're doing is walking people through what those symptoms might be and making sure that they're aware of them.

Tara (17:00)

Okay, crucial information for people to have. What about people who are unsure? What about people who get that positive test and are frozen a little bit? What resources or supports are out there for people who are trying to make this really important decision and difficult decision for many people?

Christy (17:21)

I think the first thing that people should know is that if they get a positive pregnancy test and it was just a few days after they missed when their period was supposed to come, there's time. There's not a big rushy rush. And I think that some people just have a huge amount of anxiety because they have to do something right now. And that's just not true. And so I think that for people to know that they can take a breath, they can sleep on it, they can gather their information. They can talk to some people if they want to. There's time to decide. Because we'll probably get into this later, but the latest medical abortion, which is with the medication, Mifegymiso in Canada, is the latest date we usually use that as around 12 weeks or thereabouts. And then surgical abortions can actually be up into the second trimester. 

Now it's a lot easier and a lot less complicated to do it before 14 to 16-ish weeks, but they can be done later on. Medical abortions are, in my opinion, a lot easier on the body in some ways. I think the opinion varies on that, but I just think that up until 12 weeks, that's a long time, that's three months. So it's best if it's done… well, best is kind of a strong word, but usually we do them between seven and nine weeks for the medical abortions. But that still is time. That's still like two months from when you've missed your period. So I think that that could provide a lot of comfort.

Jenni (19:02)

It's two months from your last period. We just want to make sure. 

Tara 

Two months from the first day of your last period? 

Jenni

The first day of your last period.

Tara

Okay

Jenni (19:10)

Just to clarify that I don't want there to be any misinformation on that.

Tara (19:16)

Yeah, that's helpful.

Christy (19:19)

So as far as resources, Jenni might know more about that than I do. I do know that Action Canada and the internet is full of, I mean, I guess you have to be careful. There's good information and there's not great information, but maybe do you know more about decision-making around?

Jenni (19:37)

So we often, what we'll do is we'll set up a series of appointments with people. It is part of our role, because as midwives we're trained to work with people who are having pregnancy losses, we actually have a lot of training and talking to people about how they want to do things. There's things where they take a wait and see or expectant management approach or whether they want to take action right away. And so that's a lot of the process that our clients are doing is, you know, with the time, like Christy said, just being really thoughtful, talking, and potentially even accessing counselling if it is an emotional decision. And we do have access to some counselling resources in our community, though people tend to access them after they've gone through with whatever their decision is. 

Tara 

Right, okay.

Jenni (20:35)

I think that talking to people who've experienced like who've had a positive experience with abortion, obviously helps people to make a decision either way. And so as much as possible, I really appreciate services like the Action Canada line because I think people are able to offer some positive just so that people can fully consider that option without the emotional dilemma or being worried about their physical safety. 

Tara 

Right.

Jenni 

Which obviously is not the case for people who are in situations of domestic violence or intimate partner violence. So, I do want to say that we have specific resources for people who are in an intimate partner violence or controlling situations. 

Tara (21:16)

Okay.

Jenni

Our local shelter has a counsellor specifically for people, and we have referred people in the process of getting an abortion to them as well.

Tara 

Okay, great. And we'll put the Action Canada line in our show notes so people have access to that. Thank you. Could you explain to listeners the difference between medical and procedural abortion in broad strokes?

Christy (21:39)

So a medical abortion is with the use of a medication and in Canada it's called Mifegymiso. It has two medications, one is called Mifipristone and the other one is called Misoprostol. And you take the Mifepristone first and it's one pill and you swallow it and then 24 or 48 hours later you take the Misoprostol and that's four pills that you put in your mouth and you let them dissolve. And the Mifiprostone the first one stops the pregnancy and the Misoprostol is what is supposed to help the contractions push the contents of the uterus out. Sometimes people start bleeding with the first one, with the Mifepristone, and that's totally fine. And there's some variations of how it can occur, but for the most part, people don't notice much with the Mifepristone and they start having cramping about two hours to three hours after taking the second one, which is the Misoprostol. That is called a medical abortion. And there's a lot of counseling and what to look for and what's normal and what you need to get follow-up care. If it's too much bleeding, what's a normal amount of bleeding, those all talked about in the appointment.

Jenni (22:57)

So for a procedural abortion, that is done in clinics and in hospitals. The procedural abortion, depending on how long the pregnancy has been going on, can be something where there's a manual suction involved. So the person goes into a clinic or hospital, they usually are given pain medication. Generally that's a pain medication that makes them feel woozy, for lack of a better word but not put them to sleep. But some hospitals do use general anesthetic, so put people to sleep for the procedural abortions. And if they're doing something called a D&C, a dilation and curettage, then they will sometimes use the general anesthetic. 

So it is a procedure that is over within a short period of time. Usually it takes less than an hour to actually do either the suction or the D&C and then the person recovers from whatever type of anesthetic they've had and then leaves the clinic or hospital that same day. So as you can imagine, the longer the pregnancy has been going on or the more intrusive the process, the more likely there are complications. So that is one of the considerations that we talk to people about because with the medication, there is a risk that the abortion doesn't occur, but there is very low risks of complication as long as people are monitoring their symptoms. With more procedural abortions, especially as you get into a D&C, that does carry risks like any surgery. 

Tara 

Okay 

Jenni 

There's no incision, so there's less risk of infection than some places, but the D&C was developed as an emergency procedure for people who were bleeding too much or who were

post birth, like if they've had a term birth and to kind of empty the contents of the uterus if they thought that that was contributing to the extra bleeding they were having. So it's, and it's still used that way in lots of hospitals, primarily rather than for abortions.

Tara (24:54)

Okay. I didn't know that history.

Christy (25:10)

I think that when people hear the term abortion, they most often think of surgical abortion, like going to a clinic, having a speculum put in, something inserted through the cervix, the uterus, the contents sort of cleaned out, and then they stay a while and they go home. Like I think that's what a lot of people think about. It's just really in the last, gosh, I don't even know how many years, I'm not very good at statistics or history, but the medical abortion has come about that makes it, in my opinion, a lot more accessible and it can be done at home. Usually it's done at home. It's not just that it can be done at home. I suppose there are some places where you can go to a clinic and take the medication and wait there for the bleeding to occur and be finished. But for the most part, people do them at home. 

And when I'm helping people, I sort of go through the whole thing like make sure that you have soups on hand, make sure that you have a friend with you, make sure that you have you know, Ibuprofen or Tylenol, plan to take a day or two and just use it as a self-care day while you're taking the medications and doing this process, right? So I really talk people through the process and how they might go about it at their house. I also talk to people about the spiritual aspects of it and if people want to save the contents and bury them in the earth or not. A lot of people don't, they can just be flushed down the toilet. It also can be saved and a ceremony done. So when I'm talking with people about abortion, I bring all of that in so they can decide. You know, some people may not think about like all the options that there are around the process.

Jenni (26:58)

And they can do that with a surgical, but it takes a little bit more work beforehand to make sure that doing the procedure the surgery is aware that they want to keep the contents.

Tara (27:10)

Right. You'd have to coordinate with the medical team. So you're talking about support at every stage beyond what I would have even thought. I didn't know. I had never thought of that. I didn't know that was an option.

Christy (27:23)

I think that one of the reasons that is, is because Jenni and I are both midwives and we work within the midwifery model of care, which tends to be a much more holistic approach. It's much more about collaboration with our clients. We call people clients, not patients. And it's about informed choice. It's a very different approach than medical model care. And I think medical model care does strive to do that, but often it misses the mark a smidge. I'm not licensed as a midwife in Ontario. I was licensed in Texas. I'm not any longer. I still call myself a midwife because I will always be a midwife, but I often will call myself a midwife with an NP license because I still work from that model of care. And so I think that's what you're picking up on and saying that it's like more than you thought the care would be around abortion care.

Tara (28:20)

Okay, that's so amazing. You've talked a bit about what to expect after a medical abortion. What would people expect after a surgical or procedural abortion?

Jenni (28:37)

So generally that is, it's fairly straightforward. 

Jenni

The person is recovering from whatever anesthetic they've had and that generally takes an hour two. It's not generally much longer than that. And then they will have someone accompany them home from the hospital or clinic where they've had the procedural or surgical abortion. The bleeding is quite minimal after a surgical abortion because there is more of a suction in it. Like you're emptying the contents of the uterus. So the bleeding is limited to a very short period of time during the procedure. There is some bleeding for a week or two, but minimal. And then generally the pregnancy symptoms are gone within less than 24 hours.

Tara 

Okay

Jenni (29:34)

So the pregnancy hormone is not being produced in any great quantity. That doesn't mean that it will be zero. Like if they were to take a pregnancy test within a couple of days of having a surgical or procedural abortion, it would still be positive. It can be positive for up to a month.

Tara 

Oh ok I didn't know that.

Jenni

Generally, it's already the hormone, the pregnancy hormone in their blood or the urine is already going down. 

Tara 

Okay

Jenni 

And their pregnancy symptoms are going away, and then it's often healing from a procedure. However, most people I think would describe it as fairly minimal in terms of pain and there might be some minimal cramping within the first 24 hours, but very minimal.

Christy (30:20)

I think one of the differences between surgical and medical abortion is the amount of bleeding to be expected after the procedure. By procedure, I mean after taking the medication or after having the surgical procedure. When you take the medication, of course, you're going to see all the blood. It will either go into the toilet or a pad or whatever. And people usually bleed. Usually there's a pretty large amount of bleeding and then it gradually decreases. There can be a bit more of a spike a little later. It just depends. And then it just gradually decreases. And usually people will bleed up to a week or two, but it's not uncommon to bleed up to four weeks. Just spotting, like just a little here and there. 

Whereas with the procedural abortion, all the contents are removed and then there's just a little blood and people don't see the blood. So that might be a reason that someone would choose a procedural abortion over a medical abortion at home is just the amount of blood they're going to see. Some people really have a problem with that. Now, procedural abortions are a little more what I call invasive because there's things going into the body in order to get the contents out. Some people may feel more triggered or feel like that's more problematic than seeing the blood at home by taking a medication because a medical abortion is not invasive at all. Right? So those are the kind of differences in the pros and cons of why people might choose a medical abortion or might choose a surgical abortion over the other.

Tara (31:56)

Okay.

Jenni (31:56)

And then the follow-up care is fairly similar. In our practice, we do, and this is based on our community, the practitioners who provide abortion, we do repeated hormone testing at least once within five to seven days of the person having taken the medication because we're wanting to make sure that their pregnancy hormone levels are going down quite dramatically. 

Tara 

Okay

Jenni

And so that is one of the pieces that's a little bit different. Some people who provide surgical or procedural abortions will actually order a diagnostic ultrasound a week after or for medication abortions, but it doesn't actually provide us a whole lot of information, especially with medication abortions. Usually you still have some bleeding, some blood in the uterus and it can be mistaken for continuing pregnancy symptoms. But if the rest of the picture is normal, if the person has passed clots or even a small amount of what they could see as tissue or an embryo, if they're that far along, then generally the diagnostic ultrasound is not needed as a follow-up.

Tara (33:01)

Okay. And how does one actually get a hold of the medication for a medical abortion? You need to get a prescription and take it to a pharmacy? Is that the process?

Jenni (33:15)

Yeah, so in Ontario, we work the medications covered by the Ontario Health Insurance. And I believe that it is covered in all provinces now by provincial insurance, but I'd have to double check on that. But it is a prescription that you have to obtain. Now, with the no-touch protocols that some clinics do, they can get a prescription sent to a pharmacy close to them or even have a prescription mailed to them from a pharmacy. And we've used those for people in different areas of the province that still need access to the abortion medication.

Tara (33:54)

Right. So I'm picturing, I've taken the test, I've made my decision, I've decided with my healthcare provider, and I've had to ask for a prescription and now I'm going into a pharmacy with a prescription. What I was wondering is that seems like a few steps or interactions that require some bravery, maybe even pushing through some judgment. I'm wondering what advice do you have for people seeking abortions who are worried about that, live in a small town need to go to a pharmacy where the pharmacist may know them or their family. Or not or just are concerned about the judgment of the pharmacy and the pharmacy team do you have any advice for people navigating that?

Jenni 

I don't feel like I have any strong advice. I can say that I have not had people come back to me and say that they had an issue with the pharmacy as far as judgment or anything like that. One of the things is it could be faxed to the pharmacy so they don't have to actually take in the prescription. They just have to pick up the medication. A lot of times with the people I've worked with, the partner will go and pick it up so they don't have to.

Tara (35:09)

That seems only fair.

Christy (35:13)

Yeah, I just haven't had that experience. know where Jenni works, sometimes they have some of the medication they just give to the folks, especially the ones who don't have pharmacy coverage. They just give them the Mifegymiso there in the office. That would be ideal, right? Wouldn't that be ideal for us just to have cupboards of it and just give it out to the people who need it, like in the moment, instead of having to go through all those steps? But in our system currently, the steps are mostly happening except a few times whenever we can just pass it out.

Jenni (35:46)

I do think that there are some pharmacies that are willing to fill these prescriptions and mail them to people in smaller communities. So we have taken advantage of them. One of them offers a program for people without health insurance and they just charge the shipping. They don't charge the full cost of the medication. So that's a partnership with the company that makes the abortion medication in Ontario and it's invaluable really in our work. 

So what I would say is that organizations like Action Canada and Abortion Care Canada have really advocated for these settings. And then abortion providers have also advocated for more access to the medications in all sorts of different ways so that there's not one way that people have to access it. It can be tailored to the person's circumstances. I have had a couple of pharmacies where the person has had staff people that they have called me and said, and we have this luxury because we do live in a town with multiple pharmacy chains that they said, no, I'm not willing to go back into that place again. You need to, could you send it? And I just send it to somewhere else. They've been able to make that decision for themselves. There has been some pharmacies that have instituted an extra set of documents that you have to sign for abortion.

So people encounter that, they can question that process because when you've made a decision and gotten a medication prescription from your provider, you shouldn't have to then go through a whole other consent process with the pharmacist. That's really not reasonable in our system, but I do know pharmacy chains that have for brief periods had that process.

Tara (37:25)

Not reasonable, not necessary. Nope. Nope.

Christy (37:28)

I just want to again highlight this idea that if it is a small town, there are pharmacies that you can have the prescription sent to. They will mail it to you so that you don't have to deal with people that you might know. 

Jenni (37:40)

And it can be within a couple of days, like 24 hours. They really ship very quickly.

Tara (37:48)

I think that's very reassuring information for people when we're talking about barriers, I feel like every one of those interactions is a potential barrier, at least in somebody's mind. No shade to pharmacists. I know some amazing pharmacists. Mostly they're incredible, informed people, but there's an exception to every rule. I think even just in your imagination, if you were to think, I might encounter this, that's one more barrier. I think that's really  really reassuring for people to hear.

Jenni (38:20)

It does for the most part need to be within a province. So if somebody living on the edge of one province and goes to an abortion provider in another province, I think that's where it can get sticky because people don't necessarily send it to the same province. that's, there's still strategizing and advocacy going on nationally, but we have provincial healthcare systems. So you do have to stay within your province unless the provider that you're going to has abilities to prescribe medications in multiple provinces.

Tara (38:54)

And then there's the coverage aspect. 

Jenni 

Right exactly 

Tara 

You wouldn't be covered in another province other than your province of residence. Can you tell us a little bit about Canada's healthcare regulations and how they ensure the safety of the procedures, meaning both the medical and surgical abortions?

Jenni (38:56)

So, Mifegymiso has been regulated in Canada for a number of years now and is regulated by Health Canada. It's a standardized medication that's available across the country. For procedural and surgical abortions, there are a lot of requirements for facilities to get certified in their provinces to provide procedures of any kind, but surgery especially. 

And so, I've worked in several independent abortion clinics and they have facility rules, they have the same privacy laws that any other healthcare provider would have. They follow very strict confidentiality. They often have to have more security for people accessing abortion and for the providers and the staff within the abortion clinics. So there are standardized certifications for abortion clinics, for standalone abortion clinics and then hospitals follow the hospital legislation in each province. So I would say that there's a lot of protection. The interesting thing about abortion in Canada is that there's no law prohibiting abortion, but there's no law guaranteeing the right to abortion.

And so legally, many abortion advocates actually would prefer to keep it that way as a medical procedure that's organized within each province without some of the political touchpoints that have occurred in the United States.

Tara (40:54)

Right. Because you can't repeal something that isn't enshrined in law in that way.

Jenni (41:01)

That being said, I mean, there are people that were jailed and strong abortion advocates, including Henry Morgentaler and all of the people that supported his clinics and the clinics that were both being targeted by protesters and other people as well as by the government. And so there's lots of people that fought for the prohibitions against abortion to be taken away.

Tara (41:06)

Yes. that was, I think, Morgentaler was 1988 or somewhere abouts, right? So the current legal status has been such since that time. Okay. I'm wondering, are there resources that you can think of people could access if they need funding to travel, to seek an abortion or any other financial supports that you know of for people who may need to take time off of a job to get to a centre that could provide that care?

Jenni (42:03)

I would say that when we're trying to help people take time off work, for example, we are generally nonspecific in our letters I mean, requiring sick notes for employment is a whole other discussion, the debate. We generally try and help people advocate for time off work. If they're having procedural abortion, it is a procedure that they're going into hospital for, so they have a date. Some people do need that. There are travel funds within provinces. I know Ontario's

Non-insured Health Benefits cover quite a lot of travel costs as well as the Northern Travel Grants. So we help people access those. 

If people are having to travel out of the country for a later term abortion or abortion that's not available in their community, there are funds available. The funds that are available through Abortion Care Canada and Action Canada are hugely beneficial to people who have to travel. And I would just encourage people to support them if you have the funds because they're always fundraising. They are funded by different organizations, but they could always use more support and lots of our clients really benefit from those funds.

Tara (43:19)

Okay.

Christy (43:19)

I feel like I just need to add in here that for the most part, routine abortions at an early gestational age, there doesn't really need to be much traveling because there are a lot of places to access no-touch abortions. We can talk to people on the phone, have phone appointments, send the prescription to their local pharmacy or to one of these other pharmacies and there would not need to be traveling. The traveling occurs if there's a later term abortion or an ectopic pregnancy or like more complicating factors which we hear about but are not the norm. So I think that there is funding available for these more complicated situations but for a routine, just straightforward abortion, traveling is just not necessary or shouldn't be necessary.

Tara (44:14)

Okay, good to know. Well, this is a good note to wrap up on I think, we've got some information about donating to these organizations that support people seeking abortion care. What is one other thing maybe that you wish would change in the landscape of abortion care?

Christy (44:35)

I can start. knew as soon as you asked that question, I knew what I was going to say. I wish there wasn't as much taboo around the word and that people talked about their experience in pregnancy loss of all kinds. Abortions, miscarriages, stillbirths. I wish there was more space in our society and our culture to walk with people in that grief in a way that is verbalized and talked about. Because even people seeking abortion, there is grief involved. If they don't want to carry the pregnancy, there's grief involved. If they wanted a pregnancy and it didn't happen, it didn't stick, there's grief involved. And talking about it is super important. So I wish the taboo around the talking was just gone.

Jenni (45:26)

I do think the word abortion, as much as we could destigmatize that, not only for the people experiencing it, but for the people providing abortion, there are communities where people don't feel like they can offer abortion services because they don't feel safe enough to say that they are an abortion provider amongst many other things and so what I feel is so valuable is when we can offer abortion care and abortion services, within the context of people experiencing all kinds of pregnancy outcomes, and that we can talk about abortion being one of the pregnancy outcomes. Similar to what Christy said, I really believe that it's a pregnancy outcome and that providers should be able to talk about the work that they do in the context of providing all these other services. And one of the most valuable things that I get to do is to see people for multiple pregnancy outcomes in my community health centre and where they get really good care for all pregnancy outcomes.

Tara (46:36)

That is such a helpful and powerful way to frame this in the whole arc of a woman's life, which our reproductive span is so long that there are multiple outcomes that a person might come up against or come out with. And I think that's so helpful. And we are very much on the same page here. The Morgentaler Committee of Humanist Canada, who is the creative team behind this podcast, our number one objective is to normalize using the word abortion, to take it out of the shadows, out of that taboo area, because the silence and the shame hurts. They're grieving, but it's invisible. It's in total silence. Nobody in their family, their community knows that their life has been turned upside down or their heart is broken.

Thank you so much. I really appreciate the generosity of your time, sharing your expertise with us and sharing your breadth of knowledge. If you're looking for Christy and Jenni, you can find Christy at the Thunder Bay Naturopathic Clinic and Jenni at Northwest Community Health Centre. Whether you're seeking information for yourself or supporting someone else, we hope this conversation has been helpful and we will list further resources in the show notes. We'll post that number for Action Canada. And please email us at choice chat to share your story or ask a question or suggest another topic. Thank you for talking with us. 

Thank you listeners for listening. And until next time, remember that abortion is healthcare and in Canada, it's your right. 

Thanks for listening to Choice Chat, a Humanist Canada podcast about choice, dignity and reproductive justice. If you have an abortion story you'd like to share, in your own voice or anonymously, we welcome you to reach out. Do you have a topic you'd like us to explore? Email us at choicechat@humanistcanada.ca or connect with us on social media.

We believe that by speaking truthfully and listening with care, we help shift the conversation. Because abortion is healthcare, language matters and silence serves no one. Talking about it is how we change everything, and we're grateful you've joined us. Keep the conversation going with your friends, your family, and your community. 

 Say the word. Share the facts. Break the silence.