When and how quickly you can get an abortion depends on where you are in northern Ontario

After waiting through several weeks of appointments and a long "excruciating" wait outside the operating room in a surgical gown watching the sports channel on a hospital TV, it was time for the abortion.

The Sudbury woman in her 40s, whom CBC has agreed not to identify to protect her privacy, knew as soon as she found out she was pregnant in the spring of 2020 that this was the right choice for her.

She had suffered through postpartum depression after the birth of her two children, now teenagers. She had lost another pregnancy after that. And at long last, her career was finally going well. 

But during the surgery, doubt suddenly popped into her head. 

"There was a moment, a flash: 'Am I making the right decision?' I do love being a mother. It's a very important role in my life," the woman said, fighting back tears.  

"I think it's normal and OK to have conflicting feelings about it, but that doesn't mean you're making the wrong choice for yourself."

The woman had originally hoped to get abortion medication she could take at home, but said her Sudbury nurse practitioner did not know anyone in the city who would prescribe it. 

When she went for her first appointment at the hospital, she said, she expected to get the abortion that day and remembers the disappointment hitting hard. 

"Every day that you're pregnant that you don't want to be pregnant is a really terrible day," she said. 

"It's just a reminder of the situation that you found yourself in. You just want it over with."

She went back for multiple appointments and had the surgery on the one day of the week she said it's offered in Sudbury. 

Health-care professionals say surgical abortions are only done once a month at some northern Ontario hospitals. 

Doctors, nurses and patients also say that how late you can terminate a pregnancy depends on where you are in the northeast. They say that decision is made at a local level, based on hospital resources and the skill level of the surgeon.

Some clinics in the region will do a surgical abortion up to 12 weeks, while at others, it's 16 weeks. 

A doctor who performs abortions in the northeast, and who CBC has agreed not to identify by name or gender out of concerns for their safety, said women do talk to them about the lack of access in the region.

The doctor said they'd like to see increased access, but doesn't think it's their place to suggest solutions. 

"I'm just a doctor. I take care of the patients as they come to me. Women do have access to surgical procedures. I do give them good medical care," the doctor said. 

"Probably, if we could allow patients to know and the community to know that abortions are being performed and are available in the north, that their privacy is important and if we remove some of the stigma around abortion, I think patients would feel more comfortable accessing services or having frank discussions about accessibility."

Patricia Baker, a retired nurse who worked in the abortion clinic at the Sault Ste. Marie hospital about 10 years ago, said a doctor used to come in from southern Ontario once a month to do the surgeries, but not in the summer when he took holidays.

She said at the time it was known around the hospital as "the special clinic."

"Well, it was special," Baker said. 

"But I think maybe it gave it that name to mislead people."

She said she loved working there, but after a few years, felt on the "verge of post-traumatic stress disorder." 

"I saw and heard things, that I probably knew I'd hear. And some of them were abused women, rape, incest and some of them were young. As young as 13," said Baker, who only spent a few of her 46 years as a nurse serving abortion patients. 

"I mean everybody knew about it, but nobody talked about it. The general public knew about it, because every Saturday they'd be out with their signs protesting."

Provincial statistics show the number of surgical abortions in northern Ontario has been steadily declining in the last five years. But the Ministry of Health is refusing to say why that might be.

One explanation is that more women are choosing to take abortion medication instead of surgery. 

Tricia Provost is a nurse practitioner in Wawa who works in "virtual abortion clinic" prescribing medication to women across a wide swath of the northern Ontario, from Marathon to the Sudbury district.

In 2021, their first full year operating, the clinic served 80 patients. She expects to serve some 150 patients this year, most of them in Sault Ste. Marie. 

"When do you ever see patients referred from a city to a small community to get access to care? And we're so happy to do it, but we would love to see more providers in that area providing that care," she said. 

Provost said another possible reason for the dropping number of surgical abortions is that more and more women are using an intrauterine device as birth control. 

"I'm so eager to talk openly about it, because the stigma needs to change. The whole societal norm around abortion care and women's health in general, needs to shift," she said. 

"And now is just the greatest time for that to happen."