Access Matters - Exposing the Illusion of Abortion Access

In this episode of Choice Chat, host Tara discusses the complexities of abortion access in Canada with TK Pritchard, Executive Director of Abortion Care Canada. They explore the systemic barriers individuals face when seeking abortion care, the funding challenges for abortion services, and the role of crisis pregnancy centers in spreading misinformation. The conversation emphasizes the importance of bodily autonomy, gender equity, and the need for open dialogue about reproductive health issues.

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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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.

https://www.instagram.com/choicechatpod/?next=%2F

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Transcript

CHOICE CHAT PODCAST - ACCESS MATTERS - EXPOSING THE ILLUSION OF ABORTION ACCESS

Tara (00:09)
 Welcome to Choice Chat, where we bring clarity and compassion to conversations about abortion, sexual and reproductive health through an inclusive humanist lens. Our goal is to foster dialogue, share resources, and empower individuals to make informed decisions. I'm a member of Humanist Canada and your host, Tara.
 
 Today we're exploring the realities of abortion access in Canada, including the options available for accessing abortion care, as well as systemic barriers and how patients navigate these systems. And we're going to look to the future of what hopefully equitable access may look like in Canada. We have an amazing guest today to help us examine these issues.
 
 I'm super excited to introduce you to TK Pritchard. TK is the executive director of Abortion Care Canada. TK was previously the executive director of a regional Planned Parenthood and has held several leadership roles in related sectors. TK has authored educational curricula, including sexual health and anti-human trafficking programs, as well as having served as a consultant related to trans and disability inclusion. I want to share the introduction that TK shared with me in all its raw and honest and beautiful glory. TK is queer, trans, non-binary, physically disabled, neurodivergent, a survivor of sexual violence, a parent, and an active community member, and brings this lens to all their work. Welcome, TK.
 
 And thank you so much for joining us.
 
 TK (01:52)
 Thank you for having me. I'm really excited to be here.
 
 Tara (01:54)
 I'm so excited you can talk to us. To start, can you tell us a little bit about Abortion Care Canada? What does this organization do, and what is your role there?
 
 TK (02:06)
 Yeah, of course. So, Abortion Care Canada is Canada's only national abortion charity. So, we're the only folks who are specifically focusing only on that kind of abortion access and delivery piece across the country. Some people may know us more commonly as the National Abortion Federation Canada. We just changed our name last year, so it's a pretty new adjustment. And we also have an American counterpart with a similar name. So sometimes it's a little confusing, but we primarily do two pieces. One piece is that we have a patient supporting program for folks who are experiencing higher barriers to abortion access. Sometimes, when folks are having challenges getting care, it can be navigated at the local level or within that province or territory. But often when someone has to travel significantly for care, or there's a lot of barriers in their access, there's financial concerns, there's other safety concerns, or there's just no local resource for them, which is also a common issue. A lot of those folks then come to us. And so we provide more of that complex case navigation support, particularly for people who have to travel out of province and also for people who have to travel to the US for care. We have team members who do that for folks across the country. And then we kind of work on the other side of the issue. We're working downstream and responding to how broken the abortion care system is and underfunded.
 
 And then on the other side, we're trying our best to fix it where we can. So, we have a pretty robust training and education program. We run professional development opportunities for abortion providers across the country. Those look at things like skills updating, community building, connection, all of those types of pieces. And we're the only national abortion conference that runs within Canada. But then, alongside that, we also train new abortion providers through our medication abortion training program.
 
 We have a number of other initiatives that look at training clinicians, whether they're new or they have a particular skill that needs to be developed in order to increase access. So, on that side of the organization, we're really trying to fill the gaps and looking at how do you operationalize abortion care in the country? We are busy, and we're a small team. So, I'm very fortunate to be the executive director of a six-person team, myself included, and they are a really amazing, dedicated team of go-getters who both know how to support someone so empathetically and with the best resources, and also how to come up with incredible options and strategies to fill some of the gaps that exist.
 
 Tara (04:39)
 So, you're busy? Incredible. How does somebody in need of the support find you typically?
 
 TK (04:44)
 Yeah, so through a couple ways and this is one of the challenges with the organization is that we've certainly had a lower public profile over the years and we work very strongly with the facilities, so the abortion providers themselves and that's one of the biggest ways that we receive referrals is someone has gone to a provider and it's either been found or passed a gestational availability of that provider so they have to go somewhere else, they need fee support, what have you, so they reach out to the facility but, in the recent past year or so, we've been trying to promote the organization more publicly as well. Folks do find us through our social media, and we also have our website, abortioncarecanada.ca. And a lot of people reach out via email or to our voicemail inbox, and we can navigate it that way. And we also receive a lot of from our other national and international partners. It's kind of a mixed bag of ways that people get to us, but certainly, that in itself is one of the challenges around access is making sure that people know that there are resources like us that exist.

Tara (05:45)
 Such a challenge because the nature of the circumstance that folks find themselves in when they're in need of abortion care is often surprise, totally unexpected. That's a huge challenge, I would imagine, just even knowing what to Google, how to start the process of finding support, is so intimidating. You had alluded before to the funding situation in Canada. So I think I'd just like to kind of back right up and talk about that for a minute. Can you talk a little bit, because I think this is really murky for most people, how are abortion services funded in Canada? And why, guess, with the sub question, there is why is your organization even necessary?
 
 TK (06:37)
 Yeah, great question with a very complicated answer. But I think that if we look at just the funding on its own, it partially answers the whole question as well, because it is complicated. And while I explain this, also want folks to hold that abortion is a time-sensitive issue. And this is one of the things that makes it more complicated sometimes than accessing other forms of care. Of course, there are many layers around stigma and availability and geography, and all of those things, and then you add in that it's quite time sensitive. The limits of what people will provide to vary across the country and so you know there's also an urgency to this issue. It's not really something that you can schedule further out in a lot of cases. Holding that in mind, and also how that impacts the cost of accessing care. Most people believe that abortion care in Canada is covered, and that is not entirely untrue, but it's also not entirely true. So yes, the provinces and territories agreed for the most part to cover medication abortion, so people can go and get their prescription as long as they have their provincial and territorial coverage.
 
 There's also a number of other programs at the federal level if folks qualify for them too. But there is this kind of murky area when folks don't have coverage. So, for example, sometimes international students don't have coverage. Folks who are undocumented and refugees also fall into a complicated spot in here, around having coverage or not. But then there are also a number of cases where someone will have coverage and not actually be able to access it.
 
 So international student plans are one that make that complicated. But the other really big one is someone who's accessing a medication abortion but has an experience of intimate partner violence or family violence or violence from their parents and other folks who are the plan administrators on their insurance. So, a lot of places, they will try and bill your private insurance first, right? When you go to the pharmacy, even if something is covered by the province, they try to bill private insurance first.
 
 And so if you go to your own pharmacy and they know that, they'll bill your private insurance, and well, your plan administrator, whoever in your family or in your relationship is the administrator on your insurance plan, can see what prescriptions get run through your insurance. And so this is a barrier that we've run into in pretty complex safety situations as well. And it's more common than I think people realize. And there's this idea that, it's covered, so it's not going to be billed, but that's not what happens.
 
 And so that piece can be complex. And then also if folks need any other medications around it, that's often not covered. And then it's kind of outside of the medication abortion piece, where we kind of get into the larger expenses. So yes, procedural fees. So people, and I'm sure you've chatted about this before, but folks might use the term surgical abortion. They might say in clinic. More commonly, we say procedural, but a procedural abortion.
 
 Well, often the fees are covered, except again in those cases where someone doesn't qualify for provincial or territorial or federal coverage. The fees might be covered, but everything else around it is not necessarily covered. A lot of what we end up supporting people in the payment for is, well, there was no one in my community who would provide an abortion. Or the abortion provider in my community only goes up to 14 weeks, and I'm 17 weeks. And so now I need to travel out of my community, potentially out of my province, to access care. And that cost of actually getting there, whether it's a plane or driving gas, then hotels are sometimes covered and sometimes aren't, depending on the province. And when they are reimbursed, they're not typically reimbursed at a high enough rate. So a lot of them have a cap at how much a flight can cost or how much a hotel can cost. But I'm sure anyone who's booked a flight recently has seen how expensive they are. Particularly if it's
 
 Tara (10:29)
 Yeah.
 
 TK (10:31)
 I need a flight in a week or in two weeks. You're going to pay an astronomical cost. And so those pieces and the cost of a hotel and most abortion providers, particularly when we send folks to the US, but also the hospital-based ones in Canada, tend to require that you stay within a certain amount of distance of the hotel if you're there for multiple days. And so those things can be really pricey. We work with a lot of clients who have lost wages because something that's a relatively simple healthcare procedure, that you're now going to be off work for a week, just because you had to go somewhere else and come back. Those costs are often the kind of hidden pieces that people don't recognize. And so we end up trying to cover if we can or find support for anything from gas for someone's car to being able to make sure that they can afford to take a person with them, so that they're not alone in their procedure. Or trying to help someone because they spent their funds on the travel and now they don't have any for groceries and those kind of components where it's really tricky. And we have to see folks every day who are making these unbelievably hard and awful decisions between their bodily autonomy and paying for the rest of their expenses. So this was a very long way to say it's complicated. And there's all of these very hidden costs within abortion care. And that urgency makes it more expensive. Sometimes the safety, the privacy makes it more expensive. And then just the fact that it's not offered in a lot of communities can make it really challenging.
 
 Tara (12:02)
 You know, I really never thought a lot of the dynamics that you just mentioned before. And I've thought about this quite a lot. When you're kind of itemizing, you could be talking in the thousands of dollars out of a person's income or out of their expenses. I really never thought about that aspect of the time-sensitive nature and needing to get a flight that alone could be totally prohibitive. So if you're able to help individuals in those circumstances, how do you get funded? How do you fit in to fill that gap?
 
 TK (12:42)
 Yeah. So, we have a strong donation pool. So, we have a Morgentaler Patient Assistance Fund, and folks do donate, and we're able to use those funds to help cover those fees. However, we pull about $50,000 a year in donations. And you're right that when you say it could be thousands of dollars, it's not uncommon for me to be approving payments for a client that are two, three, $4,000, sometimes more, by the time you add the travel, and everything in there. So it is difficult, and we have spent the last few years with funding from the federal government through the sexual reproductive health fund, which allowed us to support more significantly that travel aspect for people. 

We did lose our funding in December of last year. And so we've spent the last year kind of trying to figure out why and what's happening and what's going on in Canada with a shift around kind of priorities within the gender and reproductive health space. We're starting to go back into negotiations, at least to sustain the organization. But certainly, just before we joined, actually, it was almost a little late because I was working on another grant submission to get in tonight. It's a lot of grants and donations, and trying to make sure that there are funds to support people.
 
 Tara (14:01)
 Okay, so this funding cut was a big cut. It was a surprise.
 
 TK (14:07)
 It was a surprise. Yeah, we were very surprised when it was about 90 % of our operating funding. Yeah.
 
 Tara (14:15)
 Oh, okay. Oh my gosh. What have you found? You know why? Have you gotten some insight there?
 
 TK (14:25)
 Yeah, so the reaction just had a bunch of tears, and that's what my face looked like when we found out. 

Tara (14:31)
 Yeah, devastating.
 TK (14:48)
 But yes, it's yes and no in terms of kind of why. I mean, there's always complexities in funding, always more organizations needing support. But I think really kind of two pieces that put us in this situation to a degree is that obviously when you're supported that significantly by one fund, there's always a risk. But we were also previously more supported by our partners in the US and through an agreement there. With everything that's happening in the States, obviously, that kind of dictated that we needed to be able to focus here, and they needed to be able to focus there. And so that was a big shift that came after the Dobbs decision. Right. And we also saw a spike of donations at that point, but then they've kind of fallen back down as apathy has crept back in to some degree, or maybe not even apathy, just like overwhelm at how many things you could be supporting right now because of how complicated it is. But then the other piece of that is that I've had kind of many conversations with our funders and discussions around why and what does this look like. And because we have a strong government relationship as well. And I think that
 
 At the root of it, what I'm getting to and hearing from people is that there's a fundamental misunderstanding about what the issue with abortion access in Canada is. Think at all levels in the community, in government, with funders, in healthcare —everywhere —people are shocked, first of all, to learn how difficult it is to access care and what it actually looks like. But also, we talk a lot about the idea that abortion is healthcare, which I agree with, to be clear.
 
 Tara (16:08)
 Yeah.
 
 TK (16:09)
 But sometimes when we talk about abortion being healthcare, people go, then it's a healthcare system needs to figure it out. And it needs to happen within the healthcare regulations, within the provinces, within the territories. But the issue is that it doesn't happen. So we can say abortion is healthcare. We can have in theory access and not criminalize it in Canada, but then it doesn't actually do anything. Even when we go... dial way back to when abortion was first decriminalized and before. It was really community leaders, clinicians on their own, who were willing to stand up and start their own clinics. Wasn't the healthcare system responding en masse? We saw the same thing after the approval of medication abortion, that it was community groups and again, individual clinicians and organizations who outside of their
 
 Tara (16:42)
 Yeah.
 
 TK (17:07)
 healthcare system pieces lobbied and called other clinicians to deliver care, to get it in pharmacies, who did the work to get it out there. And that's still an issue today. And so there's this idea, I think sometimes that the work that we do and working outside of the system is not maybe needed. But the problem is it just without someone sitting here to kind of operationalize care and say, great, here's the policy, here's the research, here's
 
 what folks are agreeing to. But then here's the healthcare system way over here. You need this kind of middle ground to make it happen. And that's what we're really good at. But throughout all of the conversations in the last year, I think I've realized that for many reasons, people just have gotten maybe too comfortable with the idea that we have abortion, it's healthcare, and it's here. And the reality is it's just not for a lot of people.
 
 Tara (18:00)
 Wow. Yeah, I think that people will be generally very shocked unless you're in that situation and come up against those barriers yourself. I think you're right that the idea that with some comfort and some complacency mixed in there that we have abortion care in Canada, we're entitled to it. It's health care. So, I can get it, let's say, as easily as I need my knee replaced or something like that. Well, that's not easy either, but there is also not the same time component too. So, all of those aspects really underscore how super complicated it is. And I do think that there is a general complacency in the population that we're good. It's decriminalized, it's healthcare. We don't have to worry or be on our guard or advocate. I know in our conversations with podcasts and amongst our group and our allies, we are hearing that's the farthest thing from the truth. So, where do we want to go in this conversation from here? Um, a little bit, I don't know, you must get so overwhelmed in your day to day. I'm just like so overwhelmed right now about like where to even start.
 
 TK (19:26)
 You know, it is overwhelming, absolutely. And also, I think when I talk to people about why, why do I like doing what I do, even though it is very overwhelming, I worked the first decade of my career in kind of downstream work, right? Responding to the fact that the system is broken and trying to fight against so many barriers and so many pieces for an individual, which, again, we're still doing. But, now I get to see the other side of it and you get to see where there is actual increasing access. In the last few years, we've trained over 1,100 new medication abortion providers across the country. They're big-scale pieces like that. And then you also get these components of where you see how much it impacts a community. So another one of our programs trains folks in procedural care.
 
 And we look at very specific issues. So, one, for example, we had a clinician in a Northern BC community who absolutely was providing abortions. But in those kind of more rare circumstances where someone needed an ultrasound, there was no ultrasound access in that community that they needed. And so we were able to match that clinician with a provider in the lower mainland, get them trained in ultrasound so that instead of flying people over three hours for just an ultrasound, they could just do it right there. And so those moments where you get to see, okay, this actually changed access in that community. And you get to see that it really is possible to do this. It's hard and there are barriers everywhere, but it is possible, and it is unbelievably worth it because so much of our healthcare system needs support, needs help.
 
 Tara (21:02)
 Yeah.
 
 TK (21:10)
 Yes, you're going to wait a really long time for a lot of care that you absolutely shouldn't have to. And I'm not going to say to you and kind of weigh out different forms of healthcare access, but I do think abortion comes with this unique piece of the time, but also is fundamentally about bodily autonomy and gender equity and is such a life-changing piece to not. And on the other side of that is such simple healthcare. And so, to not have it is wild, right? It's wild to not have this in place and not recognize that it's the bodily autonomy, it's gender equity, it's, as we know from the turn away study and others, like deeply impacting the economic participation of women and people who can get pregnant. Like there's huge effects of not having it. And so, getting to push back on that, that it helps keep the overwhelm in check a little bit.
 
 Tara (22:02)
 Okay, that's amazing. That's so awesome to hear. In the case of that example that you talked about, about the ultrasound capacity, I guess, how do those situations come to your attention? Is the practitioner able to come to Abortion Care Canada to ask for support? Is that generally how that goes?
 
 TK (22:26)
 Yeah. So, one of the greatest assets in the work that we have right now is a very strong, strong network of abortion providers across the country. Quite often, whether they're already part of our network or they know someone who has started to provide, we do have folks who reach out and say, this is a particular issue. And we also hold community of practice for providers in different spaces. And we're about to launch a new membership program as well. folks will share issues with one another. And so sometimes we pick up on it and say, you know, we actually might have an option here, but a lot of times folks are coming for guidance and support. We receive a lot more applications and asks to help with procedural matching than we actually have capacity for, both because we fund it, so that folks can get the training. But then also there are not a whole lot of sites in Canada that have the capacity to train other people. So there's more than we actually can respond to, but we deeply prioritize communities where there's limited access already, and there's the possibility of kind of an immediate impact within that community.
 
 Tara (23:32)
 Yeah, okay. So there's some hopeful... There's some little glimmers of hope. Yeah, just really good to hear.
 
 TK (23:42)
 Yes, and there's really excellent work happening across the country. We're very fortunate to be involved in a number of national projects that are looking at issues like this and actually practically looking at how do you ensure that midwives are able to be medication abortion providers. So, I'm going to number of large projects related to that, as well as how do you increase the gestational availability or the gestational limits in particularly big hospital based providers across the countries. There's all of these components that are really working hard to change that. It's not very well systemically supported. It's a lot of really passionate individuals and small groups who are making it happen.
 
 Tara (24:23)
 Talk a little bit about the gestational limit piece. I'm surprised to learn that there's variability in the gestational limits across abortion providers. Can you speak to the reason for that? I think that a lot of listeners would be surprised to hear that you operate on the assumption that there is a limit, and this is the limit. You've just spoken to a range sometimes and I'm just curious what accounts for.
 
 TK (24:52)
 Yeah, it's a great question. Yes, across the country, there's significant variability in what the gestational limits are. There's a number of reasons for this, but it is important for folks to know that there's not a law or an actual regulation that is saying you must stop at this many weeks. And that's a common misconception, particularly when we look at what's happening in the US. But here, it's not that. There is no limit. It's not regulated in that way. The variance has to do usually with either the provider themselves, what they're comfortable doing. And sometimes that comfort is rooted in their training and access to the training, even though there's some differences based on the gestational piece. Not extensive, but the training opportunities to learn to do gestations at an advanced stage are limited. So that training piece can be part of it.
 
 For some folks, it is like a personal comfort with what they're comfortable doing within an abortion setup. But a really big piece often is actually outside of the providers themselves. So sometimes it's the hospital or the facility that limits what their access is. Sometimes it's other people who work there that are impacting it. There's a number of pieces that are often not rooted in the actual healthcare aspect itself.
 
 But more, you know, for a hospital, example, one, some hospitals won't take on abortion at all because they're afraid of the reputational risk or other pieces. And then others say, we'll do it, but only to here. So there's, you know, a lot of components that kind of change that. And then there are sometimes reasons around like the other services that are available in those types of things, but it is often just a choice that is made.
 
 Tara (26:28)
 Mm-hmm.
 
 TK (26:42)
 And I think one of the things that makes it really confusing is that we treat abortions differently based on why someone is having one. So if someone is having an abortion because it's medically indicated, so a fetal anomaly, for example, if someone goes through a genetic screen or they find out that there's a good chance that the fetus won't survive or will have significant impacts, then usually they're rooted through a maternal fetal medicine specialist you are more likely to be able to access that in your own community, regardless of gestation, than you are to, if it's an elective, and people can't see my air quotes, but an elective abortion, where you've chosen it for a non-medical reason. And the people who provide those, sometimes they're the same. There's lots of folks on abortion permission who do both, but there's a lot of people who don't. And so it's really...
 
 There might in theory actually be a person in your community who does those abortions, but only for medical indications. And so that layer makes it complicated too, but you will see a huge variance. really with your later care providers, the folks that are 20, 22 weeks and above, you're really situated in kind of Toronto and Vancouver. There's a few outliers, but for the most part, you're also having to come to one of the major cities then.
 
 Tara (28:04)
 Okay, so that piece impacts accessibility hugely then because of the time component is maybe a person in need of that care wouldn't even know they're past the clock to get it in their community or even in their province.
 
 TK (28:22)
 Yeah, absolutely. And because this isn't a particularly common conversation, think folks that are surprised when it's not available sometimes in their community. But then I think one of the most kind of shocking conversations that I have with people is around sending folks to the US because we really do support fairly significant number of clients year over year to go to the US to seek care because while we don't have a limit, there's in Canada most of the facilities kind of top out between 24 and 26 weeks. Occasionally we're able to support someone beyond that in particular circumstance but really beyond that we're sending them to the US and obviously that's adding a lot of complication to getting care. Folks who are seeking later care at that 25, 26 plus weeks. Often the situation is also pretty complex already and so there's a lot of support pieces. But this is also a good example of how flimsy our abortion care system is because it's not uncommon for us to have a community where there actually is a provider who will do 21, 22, 23 weeks. Sometimes we can't get those folks in though, because that provider, very reasonably, is on vacation. But they may be the sole provider in that community. And that's one of these pieces when we look at just how flimsy the system is, that access can be taken down by someone being on leave. So it's hard.
 
 Tara (29:48)
 Right. Flimsy is a great word to use for this situation and I think it will be shocking to many people to learn that it is so precarious and so situation dependent, geography dependent, time dependent, that people in need of that care are at the mercy of so many factors that are outside their control. And that does seem flimsy.
 
 TK (30:16)
 Absolutely, absolutely. And just not a system, right? The one we talk about healthcare. Like this is not a system. This is really, you know, wonderful people who are doing this care and working often significant over time. There's providers who get people in for us when I know they didn't have space. And we're really just kind of going off the dedication of these people.
 
 Tara (30:38)
 Which isn't a system, which is like a piecemeal pulling things together sort of piece by piece in each situation rather than, no, this care is going to be needed. And there's a fail-safe, I guess, and alternatives if in the case that Plan A falls through or isn't accessible. What is your biggest concern? I mean, there are so many and it is very complicated. But right now, just today, if you had to pick one, what's the issue that's concerning you the most?
 
 TK (31:16)
 Yeah, I think that, you know, a lot of kind of what we're chatting about and the fears that kind of keep me up at night are this. At this moment, what it feels like a decline in targeted support to actually change the system. And I don't say that only about our funding. Obviously that's a big piece for us. But when I look to other folks who maybe were going to do similar work, also our other organizations who can sometimes support things like client fees, you know, everyone's losing funding.
 
 Everyone is really struggling. We have a really hard time and we have clients coming forward that do need a fair amount of support right now that there's not really anywhere to turn to. We're all pooling what we can. But that piece is concerning alongside why aren't we investing more in actually making these systems? We run our organization on less than a million dollars a year, which is not no money, but in a national scope, it's pretty low. Very low.
 
 Tara (32:14)
 Yeah.
 
 TK (32:15)
 We're able to see these kinds of clear impacts on abortion access, but they're not seen as priority investments. And I think that the last year in particular, you know, there's been so much happening internationally. We're having a lot of conversations about tariffs, which is important. And also what's happening in the US is distracting. And people should be paying attention, absolutely. But it means that folks don't focus in on the same way about what's happening in Canada with an access. And so I worry that we're losing focus a little bit. These things are letting us kind of backslide in some ways. And as we approach new federal budgets and conversations around where investments are happening, that I am concerned that particularly women and trans folks are going to be left behind in a lot of these conversations and that there is not a shared understanding across this country of why we need to see such significant investment in not only our work, but the work of our colleagues and peers and folks who are doing this gender equity piece that without that, we're going to see a decline in all of our.
 
 Tara (33:22)
 Yeah, really well said. Honestly, that was such an awesome answer. A little bit knocked the next thought right out of my head.
 
 TK (33:32)
 It's okay, it's okay. My child waking up at 5 a.m. keeps those thoughts in my head, so don't worry.
 
 Tara (33:39)
 Yeah, it's really beautiful. Little goosebumps. TK, can you talk a little bit about conscience rights? What is that, first of all, and how does it impact access?
 
 TK (33:42)
 Thank you.
 
 Yeah, so I think that when we're talking about conversations, particularly around like conscientious objection or kind of other, there's a number of terms that folks are using to kind of address this right now. But there is this aspect where within not only clinicians as well as pharmacists and others can say, I don't want to participate in abortion care. And there's a number of reasons that people do this. There's rules around what it looks like, and that folks are supposed to give strong referrals and ensure that people do have access to care. But particularly this has a really big impact generally, but also in like smaller rural communities, right? So I often talk quite a bit around the pharmacy access because we've increased a little bit, particularly with the introduction of telemedicine for medication abortion. It doesn't change all access routes, but it is added.
 
 But we've really struggled over the years to have pharmacies that would carry and dispense a medication abortion. And back when I was at a regional Planned Parenthood, we were supporting a client in a small town, 17-year-old who really had no family support. No one knew. It was not a particularly safe situation. Order the prescription, sent her to the pharmacy. Pharmacist says, no, we won't do that. We won't dispense abortion medications. There's no other pharmacy in that town and they have to drive at least an hour. They don't have a car. It's more than an hour with no public transport to get the medication. And so we ended up working at a very complicated system of a volunteer who was able to get it. But it's those types of pieces where there's actually not real access. Objections to delivering care are complicated, especially when I work in the later care space and trying to get more folks on board with providing that kind of 25, 26, 27, 28 week care. Often when people think about abortion, they're not thinking about that gestation, but we certainly are. And it's complicated on why and how people do and don't engage with it to some degree. Particularly, the pharmacy one is often one that I get stuck on. Medication abortion is sold in a box. It's just selling a package. That's it.
 
 Tara (36:02)
 Yeah.
 
 TK (36:13)
 And I want folks to think about there's this tension between kind of the rights and also do you want someone providing you care or selling you medication or giving you information who doesn't want to? Like that tension alongside the access. But when I go to my pharmacy, my regular pharmacy where I get my antibiotics, if I walk in and I say I need a particular medication and they say no, like how many medications can you think of that they're going to do that to? And, the reality is, and I'm sure there are more, but there are two that come to mind for me. One, and this is rooted in my experience as a trans person, is hormone replacement therapy when you're trans. There's often refusals at the pharmacy level. The other one is abortion, but it's this really bizarre thing where, okay, but I can get everything else, but I can't get that here. And I think it's so important that this is an access issue, but it's also a stigma issue. Because you can say, I'll give you a referral to another pharmacy, I'll give you a referral to another provider, but what is the impact on me as an individual when I'm standing in my regular pharmacy and they say we won't do that? And how does that feel, right? Like, I can't come here for that, I shouldn't have come here. How that impacts stigma is really significant. And that challenge exists at the provider level when you get a referral too that, you know,
 
 Tara (37:25)
 Yeah.
 
 TK (37:35)
 Is there, I think there is, there can be a path, but I don't know that a lot of folks practice this skill of how do you give a referral that doesn't like stigmatize the issue for the client? And it's just so hard and again, such a kind of basic aspect of care. There's a lot of people who don't do abortion care, not because of this particular issue, but because of the myths and misconceptions around it. And we're training providers here where I live in around medication abortion.
 
 I had a conversation with a provider at one point who had no kind of moral or ethical opposition to it, but was worried about protesters. And I like, you know, I hear you. I run, however, the most public facing abortion clinic in the city - almost never have protesters. And that piece of like you're in a family office is one component. But then their next concern was about the complexity of care and being able to say, do you do miscarriage management in your setting? And they do, and it's the same medications with a very similar protocol and so I think that this kind of like trying to work through with people around like what are their objections to providing and yes sometimes it is rooted in kind of the moral and ethics and background but sometimes two people are saying like no I don't do it for reasons that are maybe not rooted in what abortion care actually looks like.
 
 Tara (38:53)
 Interesting, interesting and speaks again to just the situational case-by-case access really means? You think of the downstream impacts of going and standing in a pharmacy and being told no when you've made the decision, you've worked through all those pieces, you worked up the courage to go in there, you've gotten the prescription, you've gotten the prescription. What do you do? Where do you turn then?
 
 That just makes me so sad for that individual to hear that is even a possibility that that could happen. I just got told I couldn't get the Tylenol that I take for my headaches the other day. I was so offended and upset, but that's Tylenol. I can't imagine how devastated you'd be just standing there with your prescription in your hand.
 
 TK (39:50)
 Yeah. Yeah. And I think that a lot of folks just don't even know that this can happen. And that's why it can be so tricky. And I think that, know, both if you receive a refusal at a pharmacy or you don't get a referral from another doctor or you get a not great referral, where do people go? And they go to the internet. And if you Google pretty much anywhere in Canada, abortion near me, the first thing that's going to come up most likely is a crisis pregnancy center. And that piece of when you don't get a good referral, now that's what you get. A crisis pregnancy center is not a real clinic. Lots of folks will call them a fake clinic, but many of them do disguise themselves as clinics. So we've seen many a client who went to a crisis pregnancy center first and was told significant myths about abortion. They experienced significant harm in that process are crisis pregnancy centers who are procuring ultrasound machines and doing a lot of work to portray themselves as clinics. And so I think that this is one of those other  layers that makes abortion so complicated is that not only is it actually just hard to access, but there are a lot of people who are actively working against good access and putting out harmful, violent, wrong information. And like actually tricking people and using a lot of methods, including setting up near actual abortion clinics or using similar branding and things that confuse people who are just trying to find the information. So I think that it's important when you want a referral for anything that you receive it. But on this particular issue, if you don't get a good referral, the internet is also likely not going to be your friend in this.
 
 Tara (41:36)
 Devastating, that is terrifying to hear what a lonely place that individual is in who's left to Google abortions near me. No, that's not a system. That's crazy. For listeners who may not know, how would you describe what is the purpose of modus operandi of so-called crisis pregnancy centre?
 
 TK (42:01)
 Yeah, know, crisis pregnancy centers are really just trying to convince people out of having abortions. And so they exist so that when you go there, if you ask for an abortion, they're going to likely share a lot of things about abortion that are not true and that they cause breast cancer, that you won't be able to have other children or that you will be like everyone is significantly depressed after having an abortion, all things which are very much just proven over and over again. But, they're just trying to trick people out of having one. And I think that a number of the centers do legitimately run groups for folks who are navigating pregnancy. Some of them give out resources and baby items and things like that. But they're not long term, first of all. It's part of the, we'll support you, but then you don't. And I think a lot of folks in the abortion space, the challenge that we have is that they're not representing themselves truly. There's not typically a very clear, we actually don't talk about abortion, but if you're navigating something and needed support because you're continuing a pregnancy, we can help you. It's not phrased like that. It's very much a trick. And so they really are just trying to convince folks to not access care and to divert them from having abortions.
 
 Tara (43:23)
 These, are they religiously funded, or how are those clinics supported? If they have rented space, they have potentially an ultrasound machine, they have people who look like nurses and doctors just for the purpose of dissuading through trickery people from accessing abortion care.
 
 TK (43:44)
 Yeah, so most of the crisis pregnancy centers certainly are funded by faith-based organizations. That is a really strong aspect of it. And I think that this is one of the challenges of being in the abortion movement, is that there's so many crisis pregnancy centers. You're much more likely to find one in a community than you are to find an abortion provider. And we see a protest, not necessarily the providers that is less common in Canada. They do happen, of course, but there's the Life Chain folks and the March for Life. There's kind of specific times of the year that you'll see protesters. These things together give the appearance that we have a very large anti-choice movement in Canada. And we actually don't. They're just really well organized and well funded. And that piece of funding, organization, and honestly having the time means that the anti-choice movement tends to make themselves look a lot bigger than they are. Whereas folks who are doing abortion work, to be honest, most of us are too busy trying to navigate the abortion provision and also navigate funding and support that aspect that we're not out having the same visible public presence in the same way. And it skews this idea of what is it in Canada? How do people actually feel about abortion, even though most research shows that people overwhelmingly actually do support abortion access. And then you have this just huge section of people in the middle who just don't say anything. And they might support abortion, they're not involved in the work, they're not anti-choice, but they're also just not gonna say anything. And because we're kind of out-resourced in a lot of moments by the anti-choicers, it looks like we don't support it here. And when you Google, it's certainly gonna look like that, because that's who you're gonna find. But that's not the reality. It's just who has the money and who has the time and space.
 
 Tara (45:43)
 Fascinating. My gosh. That is such good information for people to hear that for as overwhelming as the access crisis can be, there are these glimmers of hope and change and maybe that wall of opposition isn't as big and solid as we may have the impression that it is.
 
 I'm wondering if we could end on a note of what's one thing that you would like listeners to take away? What's one thing you'd like them to do? How can people support your work, support reproductive justice in Canada?
 
 TK (46:27)
 Yeah, I think the biggest thing around abortion and reproductive justice and health in Canada for me and I think for the organization is really just wanting more people to be having these kinds of conversations, which I know sounds like a low bar, maybe does not sound like the biggest ask, but the reality is that we suffer from the fact that abortion becomes this kind of silent issue that people don't clearly demonstrate their support kind of struggle with how overshadowed we are by what's happening in the US. And that means that people don't dig into what's happening here. And I think that the layers of what it looks like here, yes, some people know there's geographic disparity. Some people know that there's funding challenges. But there are all of these layers around, whether or not you're going to be able to access care in time, safely if you are disabled, finding care that can navigate that disability is really difficult. If you are trans person, finding care that will extend to you is not particularly easy. Finding culturally competent care, care that supports Indigenous folks, like when you add all of these layers onto an already very complicated access issue, it becomes even harder. And we're not on a broader scale talking about it or funding the work to really get in there and change the system. But I really do believe that we can. I will say that I'm not one of those people who wants to be like, talk about my children or my mother or my sisters. I don't have a sister, but I have two kids based on their lives now who would use the term daughters. And my oldest daughter asks me a lot about what I do for work, but keeping in mind she's six. And I'm like, well, I work with doctors and nurse practitioners and midwives and all of these people so that people get to decide whether or not they want to have a baby and whether or not they want to be pregnant. my daughter, you know. I think there's lots of people who like, why do you tell your kid what you do? And I'm like, I want her to have autonomy. My daughter, first time I told her, at me and she goes, she calls me Dee Dee and she said, Dee Dee, will you help me one day when I have to decide whether or not I want to have a baby? Cause I don't know, but I want you to be there and make the choice with me. One, obviously she broke my heart, but also that she can recognize that it's going to be a choice, that it's going to be a decision, that my kids, I hope so deeply, will grow up not only in a home, but also in a society that lets them have that kind of autonomy and make those decisions and recognize that this is not a given. 

This is a choice. This is autonomy that you deserve. And so,there are very tough days and I think I hold a lot of client stories really close to my heart. I hold a lot of the excess issues that we navigate close to my heart. And I also hold my two kids there too and recognize that I refuse, I refuse to let them grow up in a society where they do not have those rights. And I think if we collectively fight for that, for us now and for future generations, that this is a fight. This is hard, complicated work that we have to talk about, have to dedicate resources to, but it is possible. It is possible to have access. It is possible to have bodily autonomy and choice, and I refuse to stop believing that and fighting for it.
 
 Tara (50:02)
 TK, thank you. Thank you so much for sharing your insights, your perspectives, your story about your kids. We want to thank you so much for sharing your precious time with us today. We want to encourage our listeners to find out more about Abortion Care Canada. Go to abortioncarecanada.ca. When you go there, you'll be able to donate to the Autonomy Fund to support Abortion Care Canada and ensure they can continue to provide the vital advocacy work as well as direct services to people in need of abortion care, particularly following the loss of this crucial government funding. 

Please email us at choicechat at humanistcanada.ca if you have a story to share, have a question to ask, or have an idea for a topic that you'd like to hear covered. I want to thank you for listening and until next time.
 
 Remember, abortion is healthcare and many, many other things besides. And in Canada, it's your right. Bye-bye for now.
 
 Narrator (51:08)
 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 at 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, your community. 

 Say the word, share the truth and break the silence.