Reproductive health is fundamentally an issue of gender equity, and a plan that fails to address pregnancy, pregnancy prevention, and gynecological health is, quite simply, discriminatory.
During the province’s Speak Up for Healthcare Tour last fall, health care providers called for investment in reproductive health. Indeed, there is regular outcry about the severe gaps in gynecological and reproductive health care across Nova Scotia—from a lack of fertility specialists, to wait times for endometriosis diagnoses, to limited options for gender-affirming services.
Despite this, and reflected in the new plan, reproductive health continues to lack appropriate attention and funding.
Birth is the number one reason for hospitalization in Canada, ahead of heart attacks and heart failure. In 2021, COVID-19 ranked the seventh most common reason for hospitalization. Midwifery care results in fewer labour and birth interventions such as C-sections, is cost effective, and improves health outcomes for parents and babies.
Midwifery is fundamental to primary health care and a service to which all Nova Scotian families should be able to access and for which few do. And yet, expanding access to midwifery goes unmentioned in the premier’s new plan.
Evidence shows that when people plan their pregnancies, they can better care for their families, complete their education, achieve employment, and are less likely to experience intimate partner violence and poverty.
The cost of contraception is one of the most significant barriers to reproductive health equity in the province.
Providing universal access to free contraception would result in significant cost savings and improvements in population health, with governments saving over seven dollars for every dollar invested. And yet, the premier’s plan fails to address this potential return on investment.
Abortion is a very common reproductive health service: one in three people with a uterus will have an abortion in their lifetime. Although abortion access has drastically increased in Nova Scotia since the introduction of the toll-free self-referral line (1-833-352-0719) and primary care provision of Mifegymiso (medication abortion), two serious issues persist: there is no access to surgical abortion on Cape Breton island and no access to elective abortion beyond 16 weeks gestation anywhere in the province. These restrictions place significant burden on patients to travel within and beyond the province for basic care. And yet, this situation goes unremedied by the new plan.
Reproductive health is foundational to wellbeing and should be a foundational element of any progressive health plan. To realize this goal or to begin working toward it, at minimum, the provincial plan should prioritize: 1) Hiring more midwives to increase capacity for primary care in pregnancy; 2) Universalizing access to free contraception; and 3) Supporting improved access to surgical abortion.
Nova Scotia urgently needs increased access to reproductive care, and its absence from the new provincial health plan speaks volumes about gender health inequity in Nova Scotia. Reproductive care is a universal need this province should proudly and comprehensively provide.
