Your patients must always have access to services in emergency circumstances. This means that, even in the cases where a service provider is uncomfortable or objects to the provision of a certain service, the safety of patients trumps the right to refuse to provide care.
Through the Access Line and Norma Scarborough Fund, Action Canada directly works to support people across Canada who are seeking information on pregnancy options, including abortion services. As part of a national and global movement, Action Canada also strives to learn from and exchange knowledge with its partners. We do this by collaborating with grassroots organizations across Canada and the global south in particular. Our associate organizations and Action Canada’s role as coordinator of the Sexual Rights Initiative, a north-south collaboration, play an important part in facilitating the organization’s research and advocacy on sexual health and rights. It is these partnerships that we depend on to strengthen our work and the national and global sexual health and rights movements.
Planned Parenthood-Newfoundland and Labrador Sexual Health Centre is the only centre in the province, servicing all of Newfoundland and Labrador, offering sexual and reproductive health services. We promote positive sexuality education and the improvement of sexual and reproductive health and well-being through frontline services, counseling, education, community partnerships, information and services within an environment that supports and respects individual choice and empowerment. Our services are available to anyone in our community, regardless of age, race, ethnicity, gender, gender identity, gender expression, socioeconomic status, physical or mental ability, sexual orientation, religion, religious creed, national or social origin, marital status, family status and political opinion. We actively support our provincial Poverty Reduction Strategy by offering free/ low-cost medical services in a safe, pro-choice, non-judgmental environment, offer comprehensive sexuality education sessions in schools and in the community, and are a resource center for vulnerable populations in our province.
About the authors: Planned Parenthood-NL Sexual Health Centre
Located in St. John’s Centre, Planned Parenthood-NL Sexual Health Centre is a non-profit organization that has been established since 1972 when two-hundred people met at City Hall to form the Family Planning Association of Newfoundland & Labrador. In 1978 Family Planning Association was changed to Planned Parenthood NL with new articles of incorporation and charitable tax status.
Our services are available to anyone in our community, regardless of age, race, ethnicity, gender, gender identity, gender expression, socioeconomic status, physical or mental ability, sexual orientation, religion, religious creed, national or social origin, marital status, family status and political opinion.
We actively support our provincial Poverty Reduction Strategy by offering free/ low-cost medical services in a safe, pro-choice, non-judgmental environment, offer comprehensive sexuality education sessions in schools and in the community, and are a resource center for vulnerable populations in our province.
About the author: Action Canada for Sexual Health & Rights
Action Canada for Sexual Health & Rights is a progressive, pro-choice charitable organization committed to advancing and upholding sexual and reproductive health and rights in Canada and globally.
Barriers to comprehensive family planning and reproductive health care services
Health service providers see all sorts of people who come to them with a variety of concerns, looking for help and for support in addressing them.
The information below gives us an overview of some of what may stand in the way of offering a comprehensive package of reproductive health services. It also offers health care providers way in which we can provide optimal care to the people who come see us for options counselling in the case of an unplanned pregnancy, are seeking support for family planning, need to access abortion services, help navigating adoption options, or support when they opt to pursue an unplanned pregnancy.
Conscientious objection means health care providers refusing to offer particular services on the grounds of moral or religious beliefs. Of course, doctors and other health care workers, like anyone, have personal values and may wish to step away from providing certain services. At the same time, they must ensure that patients receive the information, services and dignity to which they are entitled. Health care providers have a responsibility to their patients, colleagues, employers and the public in general.
Commonly, conscientious objection impacts access to abortion services, to contraception, including emergency contraception, and to other reproductive health services. Patients may find themselves being denied a service they are entitled to, have their health care provider refuse or delay referring them to a colleague in a timely manner, or even creating barriers that delay access, which, when the service is time sensitive like getting an abortion, can jeopardize their ability to the care they need. Delaying patients may look like imposing ‘waiting periods’, delaying or unduly pacing appointments, imposing time to “think things through”, multiplying the “mandatory” visits, etc.
This is a serious problem as it gets in the way of people’s ability to make choices and take charge of their own health, well-being and life in ways that work best for them/in their current circumstances. Some provinces have started to work on policies to define the responsibilities of doctors and health care providers who refuse to provide services.
Steps to take
In all situations, health care provider should make sure their patients get full, accurate and unbiased information so they can make informed decisions about their health care, regardless of personal feelings about the options. Beware of your language when you discuss options available to patients. Make sure you are not shaming your patients for considering their options, or for decisions they make. Refrain from using fear-based tactics or messaging. Look up options counselling resources to use the right language to present different reproductive health care options to your patients.
In the event of someone’s health and wellbeing not being in immediate jeopardy but them needing timely services, health care providers must not abandon patients but instead refer them to another provider willing and ready to take over care in a timely way. It is important to keep a list of colleagues, clinics and services to make sure you are able to make these important referrals. Sexual health centers and/or public health units in your area are a good starting point to seek out providers who can work with you to ensure your patients get the care they need.
Health care providers wanting to object to a procedure or a service on moral or religious grounds should give adequate and timely notice to patients, employers and others who will be affected by their doing so. Take the responsibility to create a network of providers to ensure the people receive the care they are entitled to, in a timely way. Be clear about what services you do and do not provide and on what grounds. Make sure that you pass on accurate, fact-based and non-judgmental information to your patients even if you are not going to provide them with the services themselves.
Doctors, clinic/hospital managers and other people who oversee teams of people should also ensure that everyone is aware of their responsibility when it comes to conscientious objections.
Gatekeepers, including Crisis Pregnancy Centers
People must be able to access abortion without being harassed, misled, or discriminated against because of their decisions. People who are anti-abortion work in almost every sector of society and can sometimes act as gate keepers to abortion services. In the health care context, gatekeepers can be social workers, hospital staff, and health clinic employees who work to prevent people from being able to access abortion services. Gatekeepers also contribute to a culture of shame, stigma and misinformation around people’s rights to end a pregnancy. This can look like a receptionist who gives wrong information about how to book an appointment, delays calling people back or mislead people on what services are available. Or a hospital staff being deceitful about when people can book their appointments to impose long waiting times and/or to go over gestational limits in the area. It can mean a counselor directing people to anti-choice services for “options counseling”, or a doctor giving false information about the risks of abortion procedures as someone is weighing their options.
Crisis Pregnancy Centers
Crisis pregnancy centres (CPCs) are anti-choice organizations that exist to prevent people from having abortions. They outnumber abortion clinics in Canada and can usually be found in communities where abortion is available, and others in communities where it is not. They are often located on same block as abortion clinics, presumably to attract people who are looking for abortion care. Though often religiously funded, not all CPCs are transparent about their religious orientation.
Steps to take
People are entitled to judgment-free and factual information when they are making important decisions about their bodies and their health. If you are in a management position in a health care setting, do make sure the expectations are clear in terms of what information is to be shared and how it is shared when it comes to patients seeking information about abortion.
Speak up if you witness a colleague misusing their position or authority to share myths about abortion and/or mislead patients about what services are available and/or how to access them.
Make sure you make factual and judgment free information and resources on abortion available in your clinic/office. Inform yourself on abortion, on the procedure itself and on services available.
Make sure you have a list of trustworthy referrals for options counseling services or post-abortion support services to ensure you do not send patients to Crisis Pregnancy Centers
The stigma surrounding abortion plays a critical role the marginalization of abortion care. Abortion stigma can be defined as abortion being framed as morally wrong and/or socially unacceptable. This stigma can manifest in many ways and it certainly can come up in medical settings. Abortion stigma can be the reason why hospitals and health care providers decline to provide abortion services for fear of being picketed by anti-abortion protestors, or because they don’t wish to be seen offering that service. It can look like a doctor congratulating you on your pregnancy when you haven’t yet announced that you plan to pursue it or giving you the cold shoulder if you bring up considering an abortion.
Abortion stigma is as complex as abortion itself. It’s tangled with issues around gender stereotypes, sexuality, power, and other forms of stigma. All these are linked to other reproductive health issues.
Steps to take
Beware of the language you use when you discuss abortion. Do not use stigmatizing language when discussing abortion. Be mindful of language that impose a certain meaning to the experience of pregnancy, of abortion and even of having to make a decision about an unplanned pregnancy. Follow your patient’s lead in terms of how they are talking about their needs, about the pregnancy, about the services they are looking for. For example, ask you patients how they feel about the news if they just figured out they are pregnant. See how they refer to the pregnancy/fetus and mirror that language.
Language can play right into abortion stigma so the way we talk about it matters! Stay away from stigmatizing or polarizing language about abortion providers or abortion. A few examples:
Beware of creating a good/bad hierarchy of reasons why people get abortions.
Be careful not to position or present abortion as an inherently difficult decision to make.
Beware of presenting it as an inherently painful choice and that people will automatically feel a certain way if they consider or get an abortion.
Don’t assume how people may feel after an abortion. Some people feel grief, others do not. There are no studies that link any kind of mental state or mental health issues with getting an abortion. In fact, what can be more damaging to people’s mental state is being forced to continue an unwanted pregnancy or having to overcome barriers put in place to deter people from accessing this service.
Get your facts and terms straight when you discuss abortion. For example, there are no such thing as partial birth abortion, the science of fetal pain thresholds has been debunked, while some people need support, post-abortion stress disorder is not a real thing, and abortion is not a high risk procedure that jeopardizes people’s physical health, mental health or future fertility, it is a very safe procedure that carries less risks of complications than giving birth or getting a wisdom tooth extracted. Get informed!
Mirror the way people talk about their pregnancy and unless someone specifically speaks about a baby, stick to the medical terms like embryo and fetus, gestational sac, pregnancy tissues, etc.
Don’t use loaded terms like murder or killing or baby-killers, or abortionists or expressions like getting rid of, unborn child or dealing with consequences. Instead, use words like terminating a pregnancy, abortion service provider, etc.
Normalize talking about abortion and options counselling with your patients by approaching these conversations with a calm and open demeanour, asking open ended questions, using appropriate language.
Abortion services not being as easily accessible as people think
A lot of people in Canada, including health care providers, believe that abortion is easily accessible when needed. Abortion is legal in Canada and has been for over 30 years and it is recognized as an essential medical procedure, required to be fully accessible and financially covered by provincial and territorial health insurance plans. That said, the small number of facilities where someone can access abortion services in Canada is a significant barrier for those who choose to terminate their pregnancies, particularly if they live in smaller cities or in rural or remote areas. Only 1 in 6 hospitals provide abortion services in Canada, most of them, like free standing sexual health clinics, can mostly be found in urban centers. This means that lots of people end up having to travel long distances to access care.
Barriers to abortion access most drastically affect marginalized people, especially those who are low-income, people of color, immigrants or refugees and those who do not speak English or French. Specifically, the link between high levels of poverty and low access to sexual and reproductive healthcare has been made. People who can’t afford contraception are more likely to require abortion care and people who live in Aboriginal and rural communities are less likely to have an abortion provider nearby.
Steps to take
You or you patients may assume that if they need to access abortion services, they can easily be referred to a clinic or hospital near them. In many instances, that is not the case. Inform yourself on what services are available in your area. You can do that by contacting your local sexual health center or Planned Parenthood, or other service provider who specialises in the delivery of information and services touching on sexual and reproductive health. You can also contact national organizations that maintain databases of abortion providers in the country.
As each abortion facility sets their own gestational limits based on physician training, facility regulations or institutional policy, find out what are the gestational limits of the providers in your area. This is important information to have to assist patients who are weighing their options or how much time you have to ensure a proper referral
Inform yourself on the process to get out of country coverage when a patient has to leave Canada to access abortion services. Assist your patients in contacting organizations that can assist them in organizing their travel or finding the right providers to meet their needs.
Get trained to be able to provide abortion services in your community.
Even in a system with universal health care, financial barriers may reduce access.
The lack of abortion services offered through clinics and hospitals in many regions of the country means that some people end up having to travel long distances to access services. When abortion providers aren’t available nearby, it can cost people a lot of money to get to where to need to go. The financial impact can be steep when someone needs to consider transportation costs (sometimes for them and a companion, hotel rooms, lost wages, childcare expenses, eldercare and sometimes having to pay for the procedure itself. Procedures costs range from hundreds, to thousands of dollars, which some people have to cover if they are uninsured (if they are migrants and are not yet covered for medical expenses) or when they are out of their home provinces as clinics are excluded from reciprocal billing agreements between provinces even though they assume a significant number of abortions in Canada. This disproportionately impacts low income members of our communities.
Currently, Canada does not offer universal coverage for birth control. In most places, once someone gets a prescription for birth control, they have to pay for it unless their private drug plan happen to cover that particular contraceptive option. All contraceptives aim to prevent pregnancy, but there are a variety of ways they can do so. They aren’t interchangeable and the method that may work best for one person may not be suitable for another. That said, cost affects the choices people will make. People rely on the method they can afford but cheaper methods such as external condoms have higher failure rates. The monthly price of pills is in the range of $15 to $30 a month, depending on the brand. The Mirena IUD costs at least $350 up front. A non-hormonal IUD can cost between 50$ and 200$, and Depo-Provera, an injection effective for three months, costs about $45.
Emergency contraception play an important role in reducing the risk of unplanned pregnancies. There are two methods of emergency contraception: the use of emergency contraceptive pills (ECP) or the insertion of a copper Intrauterine Device (IUD). The cost of either of these methods is significant and prohibitive to many: as a copper IUD can cost up to 200$ and the average cost of ECP is between $35 and $50. In cases where ECP is less effective, such as for those who have higher body mass indexes, the copper IUD remains the more effective method and these patients are counselled to choose this method, which costs more. Access to both of these forms of emergency contraception is uneven and the costs are not covered under provincial health insurance meaning that people have to pay for the IUD themselves, which makes them unavailable to many people.
Prenatal and postpartum care
For some people who are uninsured, for example, refugee claimants, access to prenatal and postpartum care is severely limited. An uneventful vaginal birth can cost up to 3000$, without even considering the costs of prenatal care, or the impact of people being unable access prenatal care during their pregnancy.
Steps to take
Make a list of organizations, government programs, and charities who can offer financial support to people who need to travel to other cities, out of province or out of country for medical reasons, who need assistance for childcare expenses, who are uninsured, etc.
Make a list of organizations that are able to provide patients with free or low cost contraception or emergency contraception options.
If you work with people who are uninsured inform yourself on the what people are entitled to under different programs like the Interim Federal Health Benefit package, make a list of organizations that are able to offer free or low-cost prenatal care and post-partum supports and consider what has been done in other provinces to fill the gaps. Provinces and territories should build on existing resources to ensure primary and other care is available for all refugees and refugee claimants. For example, a number of specialized clinics have emerged in various cities. These clinics are a testimony to the innovation and commitment of front-line healthcare providers. In provinces like Ontario, health care providers pool funds for community health centers to meet those needs. Look into who can offer care to uninsured patients in your area.
Be mindful of timelines when you are referring patients who need to access abortion services as going beyond the gestational limit of the nearest service provider may lead to people having to travel.
Be mindful of timelines when you support someone who needs a copper IUD inserted as a method of emergency contraception as it is a timely procedure.
Inform yourself on the modalities of reciprocal billing (see below) as people who are from another province can access abortion services in certain facilities without having to cover the procedure costs.
In June 2015, abortions were removed from the excluded services list for interprovincial billing agreement. This means that, if a patient needs to access abortion outside of their home province and if the procedure is performed in a hospital, the procedure can be billed directly to their provincial insurance. This has flatten considerable barriers people faced when needing access to the procedure while studying or traveling in another province. This should inform your referrals as it means it is best to refer out-of-province patients to the closest hospital as opposed to the closest clinic so the procedure costs are covered. That said, it still means that certain people need to travel or cover procedure costs if the abortion provider in their city works out of a clinic, for example, in the cities of Fredericton, St-John’s or Edmonton to name a few).
Quebec is not part of the Interprovincial Reciprocal Billing Agreement which means that this development does not affect residents of Quebec who are seeking services in other provinces. Quebec has individual agreements with some provinces, or in some case, there are some regional agreements but people are traveling to Quebec or are from Quebec still face financial barriers if they need to access abortion while in another province.
Steps to take
Make sure you let patients who are out-of-province know about where they can access services without having to cover any procedure costs.
If you are in a hospital that does offer abortion services, make sure the appropriate people know of the changes in reciprocal billing modalities.
If one of your patients still need to travel to access abortion, make a list of organizations, government programs, and charities who can offer financial support to people who need to travel to other cities, out of province or out of country for medical reasons, who need assistance for childcare expenses, who are uninsured, etc.
Worries about privacy in areas where “everyone knows everyone”
There is much stigma that surrounds accessing or providing abortion as a part of a complete package of reproductive care. When a patient is considering abortion, is trying to access one or has had one, they may anticipate to face or deal with judgment. This may lead people to delay seeking care, travel to seek care away from their home communities, or suffer the consequences of having disclosed this information to a care provider that is opposed to abortion. The challenges of navigating secrecy can be exacerbated in smaller communities where it is harder to go unnoticed, remain anonymous when accessing services, or have service provider respect confidentiality. Establishments and individuals who are or consider providing abortion care are also navigating the stigma that surrounds abortion care. This means that there are very few people trained to provide abortion in Canada, or that hospitals opt out of providing abortion altogether, or abortion is not offered as part of core medical training.
Steps to take
In smaller and more isolated communities, there are fewer service organizations and agencies available to provide support and resources, and an increasing emphasis on a ‘circle of care approach’ (information sharing across agencies). It is of utmost importance to maintain patient confidentiality and be aware of how sharing information about a patient needing or having had an abortion can impact people’s access to other services.
Do ensure that everyone on your team is aware of their obligations and of the high expectations in regards to information sharing and maintaining confidentiality.
Inform yourself about who offers abortion services in your area or where to refer patients for reproductive and sexual health care if needed.
Lack of inclusivity in the services that may be available (youth, trans, etc.)
The lack of inclusion of all people in the provision of our services can create significant barriers for some patients. Discrimination in the provision of services can cause people to delay or avoid necessary health care services often to the point of putting their overall health at risk. People feeling welcome and able to share their concerns means being aware of how we talk about issues of reproductive or sexual health care. It also means not making assumptions about who can or wants to get pregnant or continue a pregnancy or not, may they be very young, older, already have several kids, are trans, present as very masculine, identify as queer, etc.
Steps to take
Use trans-inclusive or non-gendered language when speaking of pregnancy options and avoid making limited statements by adding words like ‘may,’ ‘might,’ or ‘could,’ as it can help include needs that are often overlooked and de-essentialize experiences related to pregnancy, birth, parenting, sexual health, sexuality and abortion. Make sure the resources you have available are also reflective of that inclusivity. Do read up on position statements from other agencies and professional bodies who are auditing their own practices and organizations to ensure everyone is treated with dignity and respect, for example: http://www.canadianmidwives.org/87-news/September-25-2015-Trans-Inclusivity-Human-Rights-A-Statement-from-CAM-ACSF.html
Do not assume you know how someone feels about a pregnancy or about becoming parents based on their age, their gender, their gender presentation, their sexual orientation, their economic situation, or the size of their family. Several cases of coercive sterilization have been reported in Canada, especially targeting Indigenous people, people of color and poor people, especially those who have large families. Alternatively, young people are often assumed to not want to continue pregnancies or are not asked if they wish to become parents. People who are already parents, as well as women of reproductive age, are often assumed to want to continue pregnancies or to be unambiguously happy about being pregnant.
Make sure you have resources available to support young people who are pregnant that cover all pregnancy options they may face, such as abortion, adoption and continuing the pregnancy. Inform yourself on the modalities of supporting youth who may want to access services with or without their parents’ knowledge or consent.
Lack of knowledge on birth control options and pregnancy options
For people to be able to make important decisions on matters relating to their sexuality, reproduction and gender, including their sexual and reproductive health, they need access to factual, up to date and comprehensive information, resources and support. While not everyone is an expert in reproductive health care, it is important for health care providers to keep themselves informed on options available when it comes to birth control options and pregnancy options.
Steps to take
A quick how-to for Pregnancy Options counseling
Thanks to Laura Salamanca of the Access line for her contributions to the guide
People become pregnant at many different ages and stages of life. Everyone is different, faces different circumstances and wants different things. What to do next may or may not be an easy decision for someone. It is important to be able to provide information on all options available to people (abortion, adoption or parenting).
None of the three options is better than the other. Every person needs to make the decision that is right for them. If your patient has mixed feelings about being pregnant and about the choices available to them, making a decision can feel difficult. It is helpful for people to know their feelings, to name them and to examine them. It is important to note that many people may continue to have conflicting feelings about each choice. People may find that whatever decision they make, it won’t feel like the perfect decision. It is natural for some people to continue to have some mixed feelings.
As health care providers, we may come into contact with people who ask for support as they go through that process.
Tips on how to best accompany clients in such situation
Find out what are support services available to your patients if they are struggling with an unplanned pregnancy. *Beware that most agencies offering pre or post-abortion support in Canada are anti-choice/pregnancy crisis centers and often reinforce stigma around abortion so it is best to check-in with sexual and reproductive health centers in your area.
Sometimes anxiety around finding an abortion provider, or going through an abortion procedure, stems from ambivalence regarding the abortion decision. You may identify someone as needing options support because they exhibit considerable fears about the effects of the procedure, they ask about specific timelines to make a decision, may comment that someone else feels differently about their decision, do not seem committed to overcoming potential barriers or gatekeepers, etc. It is important to clarify this by asking whether the client is anxious about the procedure itself, or unsure about choosing abortion at all. Reassure them that they will feel better about their course of action if they feel clear about their decision. Pregnancy decision making often brings up moral, ethical, relationship, economic, spiritual concerns, to name a few. Making a decision about whether to keep a pregnancy can be a difficult process, and is best taken one step at a time.
Once you determine how far along the pregnancy in question is (by asking for the date of the first day of the last period) and where a provider may be accessed, it is important to point out how much time a person has to make a decision. Even if the person decides to go with their original instincts, there is much value is taking the time to realistically explore every option and go through a thorough decision making process. This is a time that will prove a useful coping mechanism because the person may later look back on it in order to provide context and take comfort in having made the most manageable decision for themselves. Providing structure for this decision making process is the purpose of options counselling.
Pregnancy options counselling sessions generally last 45 minutes to 1 hour. This is optimal time to make some progress, but if the session is running longer generally it can cease to be useful. There are many psychosocial, socioeconomic, spiritual and cultural factors that may complicate pregnancy decisions. Non-judgmental and supportive counselling entails holding space for the caller to explore their emotions and what is important to them in making their decision. The person needs to tease out and organize what they would like to do about their pregnancy, whether they will be able to cope with their decision, and what sort of support they may require.
Our job in a pregnancy options counselling conversation is three fold
Ask as many questions as possible to tease out all relevant factors
As much as possible, assist the client in organizing their thinking process into identifying concrete factors
Help the patient come up with clear ways in which they would be able to cope with each option
Health care providers who are able to provide support to their patients on such matters may be able to help them feel more at peace with their decision, but it is enough to help them organize their thoughts and feel heard even if they leave the appointment with some ambivalence.
Here is a book that may be helpful in increasing your comfort in providing options counselling support to patients
Another crucial element of such service is our ability to provide accurate and thorough information on all pregnancy options so inform yourself on all of them and ensure you have a list of all appropriate supports services and relevant agencies that you can direct patients to.
This section is a quick checklist of what a health care service provider should be mindful of to ensure a positive experience when you first connect with clients/patients about family planning/pregnancy options.
Signal that you are happy to discuss matters of reproductive health and pregnancy intentions by making it a part of your intake form or interview and ensuring that these questions are not only directed at people you believe would want to be or can be pregnant. Many people feel unsure about being able to bring up unplanned pregnancies or wanting to access abortion with their service providers. Many people who are trans and/or have non-traditional gender expressions feel unsafe bringing up matters of reproductive health.
Make sure you are non-directive and supportive when a person just tested positive for a pregnancy or generally discusses a pregnancy. Do inquire about how they are feeling about the news, be open to the diversity of responses that may come up and mirror the person’s words. Offer the appropriate supports and resources.
Check your assumptions. Do not assume you know how someone feels about a pregnancy or about becoming parents based on their age, their gender, their gender presentation, their sexual orientation, their economic situation, or the size of their family. Several cases of coercive sterilization have been reported in Canada, especially targeting Indigenous people, people of color and poor people who have large families. Alternatively, young people are often assumed to not want to continue pregnancies or are not asked if they wish to become parents. People who are already parents, as well as women of reproductive age, are often assumed to want to continue pregnancies or to be unambiguously happy about being pregnant.
Be mindful of using non-gendered and neutral language when bringing up pregnancy, birth, parenting and other reproductive health matters outside of the specific circumstances of a patient you are supporting. This may make it easier for people who may not fit our preconceptions of who can be pregnant/wants to be pregnant to bring up important information about themselves, including an unplanned pregnancy or their pregnancy intentions.
Be mindful of non-verbal cues that could shut down conversations about pregnancy intentions, abortion, or options counselling such as being visibly pleased and happy when someone mentions a pregnancy, being brisk or cooler or uncomfortable when someone brings up abortion, etc.
Be mindful of your office space or clinic being accessible and welcoming to all your patients. For example, be mindful of the presence of an abundance of photos of babies and happy moms, religious symbols, anti-choice material and/or posters with only one kind of parents pictured – excluding LGBTQ families or people of color.
Services in your community
Find out what services are available in your area and keep that list handy! Some suggestions on where to start!
Your local AIDS Service organization as many of them provide up to date, sex positive sexual health information
Your local Sexual Assault and Crisis Centre
Your local Mental Health Services Crisis Line
Abortion providers in your area
Local Women Centre and shelters (being mindful of their policy and practice regarding the inclusion of transwomen and gender diverse people)
Kids Help Line 1-800-668-6868
The Access Line: 24-hour Canada wide toll free number providing sexual health info and referrals on pregnancy options 1-888-642-2725
Available prenatal postpartum supports and programs
Your local LGBTQ organizations
FOR IMMEDIATE ASSISTANCE:
Click the number to dial on a mobile phone.