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Open Letter to
September, 1983 We, the undersigned medical practitioners in the province of Ontario, wish to state our support for the establishment of medically-insured, free-standing abortion clinics in Ontario. As physicians we know that there is no completely reliable method of birth control and that not every method is suitable for every woman. We have seen the devestating results of unwanted preqnancy -- to the child and the mother. Until birth control techniques and the dissemination of birth control information greatly improve, we face an undesirable but necessary choice -- that of abortion. As physicians, we are all too familiar with the obstacles confronting many women seeking abortion in Ontario. Accessibility to abortion has been compromised by several factors. Section 251 of the Criminal Code of Canada states that all abortion requests must be screened by a Therapeutic Abortion Committee in an accredited or approved hospital. Many hospitals, particularly in rural and smaller urban centres, in response to minority but powerful anti-choice pressure, have not established such committees. In larger centres, the number of abortions being performed has been severely limited by quotas limiting the operating space allocated to the abortion procedure. For example, the clinic in the Toronto General Hospital receives approximately 75 calls daily from women requesting abortions and only six are booked daily. Calls are accepted only during certain restricted hours, with that single line being busy for hours on end. Finally, many private gynecologists levy a fee to the patient of over two hundred dollars in addition to the OHIP rate. This has recreated a two-tiered system of selection whereby wealthier patients are able to obtain abortions earlier and more easily through private services. These circumstances conspire to force many women to wait unnecessarily long periods of time to obtain procedures (often three weeks or more). The result is an increased medical risk to women. In addition, many women must travel long distances from all areas of the province, from smaller centres to larger centres for a simple procedure, and increasingly to Quebec to the Morgentaler Clinic or across the border to Buffalo or New York (often from Toronto, itself). We believe as well, that as a result of these delays and obstacles, an unnecessary number of second trimester abortions are being performed. As physicians, we feel that the present lack of guidelines governing therapeutic abortion committees often leads to humiliation for women already facing a crisis in their lives. Whereas one committee may utilise the broad definition of health given by the World Health Organisation, another may grant abortion only on the strict grounds of serious impairment of health. Ontario women need access to early, medically safe and medically-insured abortions. This access in not guaranteed by present legislation and practice. We believe that free-standing abortion clinics could serve this purpose. The safety of these clinics has been demonstrated already in Quebec and the United States. They can also offer a supportive environment for women which hospitals seem unable to do. Clinics have the potential to make the procedure more humane and offer more comprehensive care in the form of birth control counselling and psychological support and thus have a more preventive role. In order to combat the resurgence of the two-tiered system of medical care delivery we must ensure that these clinics will be fully covered under medicare. We suspect that in the end such clinics would be much less expensive than the hospital situation and certainly decrease the number of second trimester abortions being performed. To reiterate, as physicians concerned with the health care of women in this province, we support the establishment of free-standing abortion clinics that are medically insured. 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