An abortion procedure room. Photo: Martha Paynter

It was a tweet from Whole Women’s Health Texas clinic that got me. As abortion care providers we can be a bit hardened, but I was teary: The clinic staff were working until 11:59pm on August 31, 2021, the waiting room still full, trying to get everyone cared for before midnight, when Senate Bill 8 came into effect. 

S.B. 8, signed into law in May, bans abortion after fetal cardiac activity is detectable (around six weeks), and enables private citizens to sue anyone suspected of providing or supporting the provision of abortion care. 

On August 31, Whole Women’s Health performed 67 abortions in 17 hours. In a typical eight-hour day I might see five patients. These Texan providers are heroes.  

Usually when I write about abortion it is to discuss improvements to access in Canada. As a nurse providing abortion care, and an educator of nursing students, I believe the most important thing we can do (possibly even more important than the abortion care itself), is ensure the public know where things stand in Canada. 

I have worked in abortion activism for 20 years, and things are very different now than they were then. But a constant barrage of doomsday US media, and the preference for negative news stories in Canada, results in deeply rooted myths and misunderstanding about abortion here. 

It does not matter that abortion is completely decriminalized and has been since 1988, that medication abortion is Health Canada-approved and widely available in local pharmacies, and that aspiration (surgical) abortion is a safe, 10-minute procedure provided by family practitioners: you don’t know what you don’t know, and this ignorance is an enormous barrier to access. So usually when I write about abortion it is to demystify and spark optimism.

This week, however, I want to lean into US news, and I will admit my despair. At 30 million people, the Texas population nears that of Canada. There are about 50,000 abortions in the state each year. The implications of the new restrictions are enormous. Not only is care criminalized, S.B. 8 sets a $10,000 bounty on the heads of clinic staff, health care providers, and even the Uber drivers who get people to abortion care. It must be stated that this ban will disproportionately affect Black and Indigenous women, people in poverty and experiencing intersecting oppressions. Rich Texans will travel for care. 

Threats to ban abortion in the US are routine, but always met with immediate legal action, led by the American Civil Liberties Union (ACLU), non-governmental organizations, and clinics like Whole Women’s Health. Supreme Court injunctions or outright reversals have, in the past, always kept some line of access open. But not this time: the US Supreme Court refused to block this law. The buck really stopped at midnight, and the clinics emptied, and the staff went home indefinitely.

Remember the terror we felt when we went home indefinitely in March of 2020? Except abortion providers did not go home: abortion, an essential service, kept trucking along as usual across Canada all through COVID. In many ways we got better at care: more telemedicine, more collaboration, and fewer appointments and inconveniences for our patients. We cannot even imagine going back to our winter 2020 ways.

In Canada, for those of us providing it, abortion care is straightforward. We go to work, we provide publicly funded care, we call it a day by late afternoon. We may navigate a few hoops — like who is paying for a procedure for a non-citizen, or what private prescription drug coverage will make an IUD affordable, or what to do about an abusive boyfriend who keeps calling — but the fundamentals of our work are pretty uncomplicated. Aspiration (surgical) abortion is safe and quick. For medication abortion patients, we make sure they know to expect a lot of cramping and bleeding, and what to do when ‘a lot’ shifts into ‘too much,’ but they are experiencing the abortion itself at home. 

Unlike when I started in this field in the 1990s, very few of us have to walk through aggressive anti-choice protestors to get to our shifts. Recent surveys have found we do not generally experience anti-choice stalking, harassment, and violence. Many places, including Nova Scotia, have bubble-zone legislation or hospital policies prohibiting picketing near abortion clinics. The last shooting of an abortion provider in Canada was almost 30 years ago, when Dr. Garson Romalis was injured by a sniper. 

Although Conservatives in Canada routinely bring forward private members’ bills to limit abortion, like the recent Bill C 233, to criminalize sex-selective abortion, none of these bills ever pass. If they did, we are confident there would be immediate legal action to overturn them before they even went into play: limits on abortion violate the Constitution in Canada. 

PEI refused to allow abortion on Island for decades, but the instant a legal case was launched against them, the government cowed and opened a clinic. Abortion bans in Canada are unwinnable. 

So instead of worrying excessively about how are patients might afford care, or obstructionist legislation, or our own risk of physical harm, in Canada we providers get to focus on how to extend and expand access: increase our competence to provide care at later gestational ages; link primary care medication abortion prescribers to back up providers; expedite diagnostic imaging; remedy gendered language; and reach communities we have not yet managed to provide with adequate care. 

Today I am worrying about our colleagues in Texas. I worry about their safety. They are under authorized surveillance by quite literally anyone and everyone. I worry about their economic security, too: they just lost their jobs. 

But more than anything I worry about their hearts. The unimaginable and immeasurable distress of not being able to help. Of watching while the state forces pregnancy on people and punishes those who try to intervene. 

Solidarity with Texas. 

Martha Paynter is a registered nurse who provides abortion care.

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  1. Thank you for this moving article, Martha. I’m worried about them too, and all the women across the US since, once one state does a heinous thing, it always seems there are six more lined up to be next. Perhaps a doctor refugee program will help us build up our healthcare staffing while protecting abortion doctors of conscience.

    Thanks for giving this a platform, Tim.