Of all the billboard designs created by the Pro-Choice Coalition to display around the city, one was more controversial than the rest and has yet to be approved by any advertising company.
It reads: Abortion is essential healthcare.
Could be that the word itself, ‘abortion’, is one that carries a lot baggage. But also, there were those who argued that it was not essential and also, not health care.
Lucy*, a 42-year-old Sudbury woman, would beg to differ. (*Lucy’s name has been changed to protect her privacy.)
An abortion saved her life. She is pro-choice not just because she believes every person with a uterus should make that choice for themselves, but that being pro-choice also means being pro life, in this case, the life of a mother.
Lucy was 23 and a young college student when she became pregnant. Though she was from an extremely restrictive religious background, she had recently left religion behind. She was nervous, of course. Her decision to leave her religion behind also meant she had to leave her family behind, as they shunned her for her abandonment of their faith.
At the same time, she welcomed the chance to become a mother.
“I had a boyfriend, we were very much in love,” said Lucy. “It was very unexpected, but I was okay with it. I thought, ‘Okay, it's going to be hard. But I see women all around me doing it. It's going to be great’.”
But she didn’t get the chance to find out. She had an ectopic pregnancy. One in 50 pregnancies is ectopic, wherein the fertilized egg attaches in an area other than the uterus, most often in the fallopian tube.
In this situation, there is absolutely no option but medical termination of the pregnancy, either through medication or emergency surgery. Though she was still exercising her option to terminate the pregnancy, it didn’t feel optional to her. And it wasn’t.
The choice was life or death for Lucy, and every person suffering an ectopic pregnancy. Terminate, or allow the egg to continue to grow in the tube, burst, and cause her to bleed to death slowly.
She wanted to keep her child, but she knew the risks. Even so, she says she felt pressure from the health care professionals. It was warranted and now appreciated pressure, she admits, and they saved her life. But in no way did she feel it was a choice.
It is, however, an option for which she will always be grateful. “I wanted to live,” she said.
In her mind, however, that option shouldn’t just be for those who so clearly require a medical termination, but for anyone who requires an abortion. That is, anyone with a uterus.
And that is because not only is unwanted pregnancy attached to higher incidents of suicidal ideations and actions, harm caused by unsafe attempts to end the pregnancy — either personally or at the hands of well-intentioned but untrained hands — but also because, as Lucy says, “Pregnancy itself is a life-threatening situation.”
Per Statistics Canada, in 2018 there were 31 maternal deaths and one late maternal death (occurring 42 days to one year after birth) in Canada.
The maternal mortality rate was 8.3 deaths per 100,000 live births in 2018. In the past 10 years, the maternal mortality rate has fluctuated between 4.5 and 8.7 deaths per 100,000 live births.
This is in a country with full access to medical termination, birth control and socialised medicine.
Perhaps, as is often appreciated when emotions are heated and inflaming further discussions, logic and data are in order. To examine the idea of medical necessity, it is important to examine both the economic and medical aspects of ‘necessity.’
The medical aspect of the necessity points to the Supreme Court of British Columbia and their decision in what is known as ‘The Auton Case’. An autistic infant boy was denied funding for a specialized treatment in what could be summarized poorly as ‘if we do it for you, we have to do it for everyone else.’ The argument being that if this infant boy received this care, they would have to offer this specific care to every autistic child — regardless of their need for it — and they couldn’t afford to fund that. Because the child had a degenerative response to the lack of treatment, the courts disagreed with the governments named in the suit.
The trial judge found that “the failure to fund ABA/IBI therapy violated the petitioners' equality rights, directed the province to fund early ABA/IBI therapy for children with autism and awarded $20,000 in damages to each of the adult petitioners.”
In a simplified and direct statement, their definition of medically necessary is a, “medical service that is essential to the health and medical treatment of an individual.”
However, the economic impact is not one to shy away from. There are aspects of this that are costly to the socialized medical system that performs these terminations.
In the words of economist Mark Stabile, “The idea that this is only a medical decision, we have to let go of that. We have to consider cost and effect.”
Stabile is the director of the School of Public Policy and Governance and professor of economics and public policy at the Rotman School of Management at the University of Toronto. He led a study into the effects of removing publicly funded medical services, which determined there are “four important factors to consider when building a framework for assessing whether a medical service should be delisted.”
These include providing a medical value, as well as “a benefit per unit of cost that exceeds the next best alternative,” and noting “how delisting will affect demand, how changes in health outcomes because of the removal of funding compares to the benefits gained by the money saved, and if delisting will disproportionately affect particular groups of people.”
Because abortion is time-sensitive, not something one can simply decide to cease, i.e. ‘just stop being pregnant’, and there will be no end to the requirement for abortion — in fact, most people who get abortions report using contraception during the month they became pregnant — it is not procedure that will face a decrease in demand if left unfunded.
There is also a cost benefit, in that many women may die without abortions, the cost of trying to save them or even the child far outweighs the financial cost of the abortion, though certainly not the emotional one.
Considering a termination ‘not medically necessary’ could be said to disproportionately affect particular groups of people, those with a uterus.
Stabile agrees because his research agrees.
“Overall, our results suggest that policy makers should be aware that the demand response differs significantly by service and by individual characteristics,” the paper concludes. “This information should be considered as services are considered for (continued) public funding.”
There is both a medical and economic argument for abortion as essential healthcare. There is also Lucy, here today because she had the choice to save her own life — a choice she says she will never leave in the hands of anyone else, let alone a stranger.
“I'm trying to advocate personally for something that I know is right,” said Lucy. “Because even if you hate the idea of women having abortions, look at the statistics where it's legal, where it's acceptable and there's less stigma around it. In every country that they've made it legal, abortion rates go down."
