PHOTO ILANA PANICH-LINSMAN, THE NEW YORK TIMES ARCHIVES
Ultrasound is an important tool that must remain accessible, especially in special cases such as those where it is difficult to determine the stage of pregnancy. But it does not need to be mandatory in all cases.
In the end, it took a pandemic and a small earthquake provoked by the American Supreme Court to oil the mechanism for access to abortion in Quebec.
Posted at 5:00 a.m.
Don’t get us wrong: access is exemplary when compared to the rest of Canada, and even more so to the United States. And nothing suggests that this principle will be questioned, neither now nor in the future.
But… there is always room for improvement.
As of 2018, Quebec was the only place in Canada that set two prerequisites for an abortion. The first: a consultation with a health professional specially trained in voluntary termination of pregnancy (IVG). The second: an ultrasound before choosing the method of abortion, medical (with the abortion pill) or surgical.
The pandemic has obviously forced everyone to do things differently. Thus, in 2020, when it allowed its members to conduct consultations remotely to avoid unnecessary congestion in clinics and hospitals, the College of Physicians also suspended the obligation of pre-abortion ultrasound.
Two years later, a decision by the American Supreme Court forced us to question the accessibility of abortion. That’s good, the College had also initiated this reflection. And its president, the Dr Mauril Gaudreault, can already assure us: the obligation to undergo an ultrasound before an abortion will not be restored.
This is good news… the implications of which should nevertheless be closely monitored.
Lifting this restriction will therefore allow women who prefer a medical abortion to terminate a pregnancy more quickly — a situation where, of course, every week counts.
The abortion pill (not to be confused with the “morning after pill”, which must generally be taken within 72 hours after unprotected sex) is prescribed in cases where the pregnancy does not exceed nine weeks.
Nature being what it is, it is not always easy to determine the stage of a pregnancy at the moment when the test proves positive… Thus, it happens that patients who estimate to be in the sixth week of pregnancy discover with surprise, during the ultrasound, that they are rather at 12 or 13 weeks. Or that the pregnancy develops outside the uterus (ectopic pregnancy), in which case the abortion pill will be ineffective.
This is also what the pre-abortion ultrasound is for, argues France Désilets, director of the Morgentaler Clinic in Montreal. With a more accurate portrait, the patient can make a better informed choice.
True, answers midwife Mélina Castonguay, from the organization Les Passeuses. Ultrasound is an important tool that must remain accessible, especially in special cases such as those where it is difficult to determine the stage of pregnancy. But it does not need to be mandatory in all cases. An argument to which the College of Physicians agreed.
This decision should therefore ensure that the abortion pill will be prescribed much more often than it is currently.
Access to this safe and effective treatment (even beyond nine weeks, in some cases) should obviously not be at the expense of adequate supervision offered before and after the intervention.
Nor should it come at the expense of access to surgical abortion. Elsewhere in the world, constraints on access to the abortion pill have been eased precisely because it was impossible to offer suitable surgical abortions. If fewer surgical abortions are needed in Quebec, they could have to be grouped together in a smaller number of clinics, thus reducing accessibility to this care, especially in the regions.
It would be a shame to add kilometers when you want to save time…