EDMONTON—PJ Dumont was four weeks along when she found out she was pregnant.

The 32-year-old Lethbridge, Alta. woman never envisioned motherhood as part of her future, so when her pregnancy test showed positive one Saturday morning last year, she spent hours scouring the internet trying to find the best options available for terminating the pregnancy.

It was Dumont’s first pregnancy, and she was unsure how to move forward or what procedures were accessible for her.

“There wasn’t a whole lot that you can really find,” Dumont said.

A lot of information she came across was confusing, she said. Multiple websites for pregnancy care centres — most of which are faith-based Christian charities — made their way to the top of her search results. They advertised counselling on options, including abortion, that are available for women who become pregnant unexpectedly. These centres, however, have no medical qualifications.

The official website of the provincial health authority, Alberta Health Services (AHS), proved perplexing and had very little medical information on the abortion procedure and does not clear up misconceptions about its safety. It’s also unclear on first glance — or second, or third — where one can obtain a surgical abortion, as opposed to a pill-induced medical abortion.

The confusion faced by Dumont is familiar to many women seeking abortion services in Alberta, particularly those who live outside Calgary and Edmonton — the only two municipalities in a province of 4.3 million people where surgical abortions are offered.

Health Minister Sarah Hoffman has spoken about plans to make abortion services more accessible to rural Albertans. She declined to comment for this story but is in talks with senior management at AHS “to ensure that Albertans have access to reproductive health services and to explore improved access to abortion services in rural communities,” according to a statement provided by Kate Toogood, a spokesperson for Alberta Health.

There are no updates, however, on the status of those talks. AHS deferred all comment to Hoffman and Alberta Health, the provincial ministry.

So, as Alberta heads into a likely spring election, advocates say women in rural Alberta have no more access to surgical services than they had when the New Democrats entered office. Meanwhile, a private members’ motion submitted in early 2017 by NDP MLA Marie Renaud, calling for a look at reducing barriers to abortion and reproductive health services in rural and Northern Alberta, is likely to die on the vine when the writ is dropped.

The government has made it easier to get the two-pill abortion drug, also known as Mifegymiso, when they made it available free-of-charge provincewide in 2017. But advocates and physicians say women still face barriers finding doctors that openly prescribe the pill in some conservative Alberta towns, ultimately resulting in abortion being inaccessible for many.

Dumont was “one of the fortunate ones,” she said. She had a strong emotional support system by her side, including her husband and a friend who drove down from Northern Alberta to help her, as well as means of financing extra travel costs herself. With her friend, Dumont made the day trip of more than 200 kilometres north from Lethbridge, a Southern Alberta city of roughly 90,000, to Calgary for a surgical abortion.

A surgical abortion was the safest choice for Dumont, who was inching close to the nine-week cut-off for the abortion pill, in part due to a series of medical appointments and a delay in obtaining a slot for an ultrasound. Calgary’s Kensington Clinic quickly became her only option.

For those in rural Alberta towns without support from friends or family, or the financial means to travel hundreds of kilometres, pro-choice activists in the province maintain more should be done to reduce those barriers and increase access to abortion.

“You have no choices,” said Kathy Dawson of the Alberta Pro-Choice Coalition. “Especially if you’re young or you’re poor or you’re Indigenous.”

Most Alberta hospitals with an obstetrical or surgical program have the capacity to perform an abortion procedure, according to Toogood, yet patients still cannot access an abortion at these hospitals. This includes facilities in Cold Lake, Fort McMurray, Grande Prairie, High Level, Hinton, Peace River, Slave Lake and Whitecourt.

It is not clear why abortions at these hospitals are not openly offered despite existing infrastructure, but Toogood said decisions on whether a hospital will provide surgical abortion services are made by AHS hospital administration and are based on a number of factors, including having physicians available who are both trained in and willing to provide the service.

For pro-choice doctors and their patients in smaller Alberta communities, change couldn’t come fast enough.

Dr. Jillian Demontigny, a family physician in Taber, is one of the only doctors that prescribe the abortion pill in the small Alberta town. For the last three years, she’s tried to be vocal about the importance of accessible reproductive health care in Taber — but the denunciation from much of the town is quieting her protests.

Anti-choice sentiments are visible through a number of billboards spread across highways and even in the town’s cemetery. Some read “Life is a beautiful thing” and “Have you considered adoption?”

“The floodwaters just keep rising,” Demontigny said. “It can feel futile; it can feel exhausting.”

Demontigny’s drive to speak out comes from her fear that patients in Alberta’s small towns are being fed biased, anti-choice information about the medical options available to them. She said the faith-based Pregnancy Care Centres, run by volunteer counsellors, are active across the province and are far more visible than medical information about abortion available through AHS.

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Monica Loewen, the executive director of Lethbridge’s Pregnancy Care Centre, 40 minutes west of Taber, said volunteers at her centre are all Christian and “hold a pro-life stance.” But she added her centre is careful not to push personal beliefs on clients and rather emphasizes options available to those who become pregnant unexpectedly. If a client chooses to have an abortion, counsellors turn them back to their doctor.

“At the end of the day, it’s her decision and her decision alone,” Loewen said. “We’re not here to judge her; we’re not here to tell her what to do.”

But Demontigny worries the centres derail access to “unbiased, balanced, complete health-care information,” she said. “This is some people making really important health decisions.”

As a response, women in smaller communities have formed grassroots pro-choice groups to point those seeking an abortion or other reproductive health services in the right direction. Jen Takahashi, who launched Pro-Choice YQL in Lethbridge, calls it a “whisper network” of sorts.

The group has helped a few reach Kensington Clinic in Calgary or find a physician who would prescribe the abortion pill. Hibo Farah, a University of Lethbridge student, is one of the women they helped.

“I was told that the abortion pill was accessible throughout Alberta, so I assumed I could get it here in Lethbridge,” Farah said.

But she said her doctor refused her a prescription because it was against their ethics and wouldn’t refer her to a doctor who would prescribe, despite rules outlined by the College of Physicians and Surgeons that require doctors to do so. The doctor suggested Calgary as the only option, she said.

Through Lethbridge’s pro-choice group, Farah was able to land an appointment with Demontigny in Taber. The process was daunting for Farah, who said she felt the urgency of the care she needed was dismissed by her initial doctor.

In other parts of Alberta, some say the abortion pill is hard to find at all.

Lauren Johnson of Red Deer noticed a severe need to help people navigate reproductive health services in her city of just over 100,000, as there is no database that shows which doctors and pharmacists can dispense Mifegymiso.

To help, she received certification to be an abortion doula in May 2018, through a program offered by U.S.-based Full Spectrum Doula Circle. She was trained on how to provide non-medical support and care for those seeking an abortion. In this role, Johnson drove people to and from their appointments, either in Calgary or Edmonton, and stayed with them throughout the process.

“This is everything I’ve already done for my friends who needed help anyways,” Johnson said.

Barriers are more severe in Alberta’s northern communities. In Fort McMurray, a Northern Alberta urban centre with a population of roughly 66,000, the nearest clinic offering surgical abortions is in Edmonton — a five-hour drive away.

A debate on offering abortion services in Fort McMurray’s only hospital was once ignited in 1984, when its board conducted a vote on whether to open a therapeutic abortion clinic within its grounds. According to newspaper reports at the time, the vote was “close” but ultimately tipped in favour of not opening the clinic.

Of over 5,000 written submissions from Fort McMurray residents on the topic at the time, 90 per cent were opposed to opening an abortion clinic within the hospital, newspaper reports said.

Renaud, the MLA who introduced the private members’ motion on abortion, said she had hoped reigniting the topic at the legislature level would answer important questions about why surgical abortions are not offered in Alberta hospitals that have the capacity to do so.

“Access is very much determined by the province and the way that services are delivered,” Renaud said. “I felt it was so important that we start talking about this.

“We’re reducing women’s ability to manage and control their own bodies, and geography shouldn’t be that determinant.”

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