“If I ever did have a daughter, I wouldn't raise her in New Brunswick:” exploring women's experiences obtaining abortion care before and after policy reform

• Published in: Contraception (Stoneham) 2017-05, Vol.95 (5), p.477-484
• Main Authors: Foster, Angel M, LaRoche, Kathryn J, El-Haddad, Julie, DeGroot, Lauren, El-Mowafi, Ieman M
• Format: Article
• Language: English
• Subjects: Abortion; Abortion, Legal - economics; Abortion, Legal - legislation & jurisprudence; Adult; Ambulatory Care Facilities; Attitude of Health Personnel; Canada; Female; Gestational Age; Health Care Costs; Health Care Reform - economics; Health Care Reform - legislation & jurisprudence; Health disparities; Health Expenditures; Health Policy; Health Services Accessibility; Humans; Mifepristone; New Brunswick; Nuclear Family; Obstetrics and Gynecology; Patient Credit and Collection; Pregnancy; Referral and Consultation; Reproductive health; Waiting Lists
• ISSN: 0010-7824; 1879-0518
• DOI: 10.1016/j.contraception.2017.02.016

Abstract Introduction New Brunswick (NB)'s Regulation 84-20 has historically restricted funded abortion care to procedures deemed medically necessary by two physicians and performed in a hospital by an obstetrician-gynecologist. However, on January 1, 2015, the provincial government amended the regulation and abolished the “two physician rule.” Objectives We aimed to document women's experiences obtaining abortion care in NB before and after the Regulation 84-20 amendment; identify the economic and personal costs associated with obtaining abortion care; and examine the ways in which geography, age and language-minority status condition access to care. Methods We conducted 33 semistructured telephone interviews with NB residents who had abortions between 2009 and 2014 ( n =27) and after January 1, 2015 ( n =6), in English and French. We audiorecorded and transcribed all interviews and conducted content and thematic analyses using ATLAS.ti software to manage our data. Results The cost of travel is significant for NB residents trying to access abortion services. Women reported significant wait times which impacted the disclosure of their pregnancy and the gestational age at the time of the abortion. Further, many women reported that physicians refused to provide referrals for abortion care. Even after the amendment to 84-20 , all participants reported that they were required to have two physicians approve their procedure. Conclusions The funding restrictions for abortion care in NB represent a profound inequity. Amending Regulation 84-20 was an important step but failed to address the fundamental issue that clinic-based abortion care is not funded and significant barriers to access persist. Implications NB's policies create unnecessary barriers to accessing timely and affordable abortion care and produce a significant health inequity for women in the province. Further policy reforms are required to ensure that women are able to get the abortion care to which they are entitled.