My Body My Choice?

My Body My Choice?

Abortion Pills, Hormone Replacement Therapy, and Fertility Services

This article was included in our 2017 year end newsletter sent to Friends of Medicare members. We intend to publish our newsletter every year so make sure you sign up today so you can get your copy for 2018!

The Alberta Government announced on July 24 that they would be providing access to Mifegymiso, a medical abortion pill, at no cost to all Albertans.

Health Minister Sarah Hoffman was quoted on the decision saying "Women's reproductive options should not be determined by their income or where they live."

Friends of Medicare applauded the move which had Alberta become the second province to add universal access, and we recognized that this is in line with the principles of universal public health care. We hope to see other provinces follow the leadership of New Brunswick and Alberta.

At the same time, we have been hearing of unacceptable and unnecessary wait times, some over two years, for trans patients to access hormone replacement therapy (HRT).

During Calgary Pride Week, Friends of Medicare called on Alberta's Ministry of health to remove discriminatory barriers to access HRT. 

HRT is an important aspect of care for trans patients. Being trans is not an "illness", yet many patients in Alberta are required to be "diagnosed" as trans through a lengthy gate keeping and referral process where they must first be seen by a psychiatrist, and then an endocrinologist before they can begin much needed HRT. 

A lack of access to medications has created a black market for hormone drugs in Alberta, and can lead to avoidable cases of self harm, addictions, and even suicide among patients.

Cis patients - those who identify with their assigned sex at birth, typically cis women, are often able to access hormone medication directly through a general practitioner without lengthy referrals. We have an unequal system that discriminates against trans patients and moves them to the back of the line.

For years advocates have been calling for an informed consent model for HRT, as is being practiced in clinics like the Howard Brown Health Centre in Chicago, and the Catherine White Holman Wellness Centre in Vancouver.
This model would shorten the process, and free up resources to better support trans patients and all Albertans. It is more cost effective to provide HRT on informed consent, it is a more respectful approach to patient care, and in line with human rights.

Friends of Medicare have also been troubled by a recent decision of Alberta Health Services to stop providing fertility services like Inrauterine Insemination, In Vitro Fertilization (IVF), and donor egg and sperm programs at the Lois Hole Hospital in Edmonton. Patients are now being referred to a private clinic instead.

The World Health Organization recognizes infertility as an illness, and we are concerned that this move furthers the wrong direction of turning patients into consumers.

We have seen research suggesting millions of dollars in savings are possible by covering IVF under our public health insurance. This is possible because of stronger controls on the process leading to fewer cases of birth complications and multiple births which the public system ends up paying for.

Instead of moving towards cost-saving coverage of fertility services, the decision by AHS will have patients paying over 20% more for services at the private clinic.

Private clinics operate in a regulatory grey area. In 2014 when issues arose at Calgary's private fertility clinic prohibiting mixed-race conception, it was reported that neither the government nor the College of Physicians and Surgeons of Alberta had jurisdiction over private clinic policies.

We also stand to lose valuable clinical research and physician training at the public hospital. The fertility services were of benefit to patients, and of value to the public.

In line with the stated principles in providing Mifegymiso coverage, we hope to see the Ministry of Health reverse this decision for infertile patients, and eliminate discriminatory gatekeeping for trans patients. Removing barriers in all aspects of sexual and reproductive health should be a priority.