The head of the Halifax Sexual Health Centre (HSHC) says unprecedented demand for its services is partly driven by patients being directed to the non-profit by primary care providers.
“It’s out of control. The demand for our services are definitely well beyond any reasonable capacity for any clinic, really,” HSHC executive director Abbey Ferguson said in a recent interview. “It’s simply impossible.”
The clinic deals with all manner of sexual, reproductive, or gender affirming care. Ferguson said while their “bread and butter” includes sexually transmitted infection (STI) testing and treatments, pap tests, and contraceptive prescriptions, it also handles everything from IUD insertions to “solving genital mysteries.”
“If something is weird, your bleeding is off. You want a second opinion because your pelvic pain was dismissed, that kind of thing,” she explained.
‘Schedule for the month filled in a couple days’
In recent months, Ferguson said the clinic has experienced an overwhelming increase in people seeking their services. The number one piece of feedback she receives is that people can’t get through to the clinic on the phone.
Anyone calling the clinic is advised via an automated message that HSHC is “experiencing extreme numbers of in-person appointment requests.”
Acknowledging that it’s a problem that must be improved, Ferguson said it’s also important for people to understand that it’s been “extremely challenging” to address. Each day and all day, two or three administrative staff members and a volunteer answer the phones in an attempt to help the hundreds of people calling.
“We are seeing a huge surge to our phone lines that we simply can’t address and we don’t have the appointments to navigate,” Ferguson said.
There are 17 people employed part time, and the clinic has anywhere from 500 to 900 available appointments each month. The schedule for the entire month is typically filled within a couple of days, Ferguson said.
“Then the rest of the month, so for about three weeks, we’re having conversations about navigation, alternate things, things you can hopefully advocate for to your family doctor, if you have one,” she said.
“And we’re just telling folks to call back. So you’re just telling people ‘no’ for three weeks, which is awful and doesn’t feel good from an employee perspective. There’s a lot of moral injury there. It’s just telling people no, people who are desperate for care.”
‘Really big increase’ in patients sent by providers
Many patients seeking HSHC’s services don’t have a primary care provider. But staff also see many patients who do. Ferguson said some of those might turn to HSHC because they’re uncomfortable their physician is a man or that it’s the same doctor they’ve had since childhood.
However, Ferguson said they’re increasingly hearing from attached patients who say their primary care providers are advising them to go to HSHC because they don’t deal with sexual and reproductive health issues.
“We’re seeing a really big increase in folks who are being funnelled here by their own providers. So, saying that they don’t do Paps anymore as part of their practice, or that the only place to get tested is at Halifax Sexual Health and that family doctors don’t do that,” Ferguson said.
“So anywhere between ‘I’m not comfortable’ and then straight up misinformation, saying that that’s not within the scope of practice of a family doctor. It is very, very frustrating that there are folks out there with providers, but those providers are cutting out sexual, reproductive, and gender affirming care services to make room for other things.”
A systemic concern
Acknowledging that she completely understands primary care providers are under “immense pressure” and have too many patients on their rosters, Ferguson said it’s nonetheless “deeply unfortunate” that sexual health is what seems to be getting cut by some providers.
“One thing is that it’s uncomfortable. But also there is a destination to send people,” she said. “Whereas you can’t really stop providing someone their asthma medication because there’s no community non-profit asthma clinic that you would send people to get their inhalers.”
Ferguson said it’s important to note that family doctors aren’t the only ones sending patients to HSHC.
“We have been hearing from some folks who were directed by Maple [virtual care] to come here. Or folks go to the ER and they’re told to go to Halifax Sexual Health. It is coming from the provincial system as well,” Ferguson said.
“It’s not like there’s just rogue family doctors out there who don’t want to do it. I think it is a systemic concern. And because there is this non-profit clinic, we have a great reputation, we’ve been around for 50 years, it just makes it really easy to send folks to us. And we’re happy to see you. But there’s so many of you.”
‘Something we’re keeping an eye on’
Despite the increased demand and often longer wait times for services, Ferguson said it’s important patients know they are always welcome. Although she’s expressed concerns to various provincial department officials about patients being funnelled to HSHC, Ferguson said the massive influx of patients continues.
“We are happy to see you. We are happy to see literally everybody. But that’s why there’s a battle royale on the phone. You can absolutely still [access sexual health services] through Maple [virtual care]. Even if you get connected virtually first, they do have their in-person clinics,” she said.
“I can’t speak to the exact flow. But we definitely have heard from folks who have spoken to Maple, and Maple told them to come to us. I don’t know how those decisions get made about when someone gets connected to their in-person clinic versus coming to us. It’s something we’re keeping an eye on.”
Nova Scotia Health hasn’t issued directives
In an emailed statement, Nova Scotia Health (NSH) spokesperson Brendan Elliott said Nova Scotia Health VirtualCareNS administrators “have not issued any directives to specifically funnel patients” to HSHC.
“We cannot comment on what primary care physicians and nurse practitioners are doing in their own private practices,” Elliott wrote.
“Healthcare providers on VirtualCareNS will refer all patients to the appropriate level of care, based on their individual needs. And if any in-person follow-up care is needed, patients are directed to NS Health primary care clinics.”
Eilliott also said more Nova Scotians are taking care of their health through the province’s “hugely successful” and convenient virtual care platforms.
“This has resulted in across-the-board increases in the use of allied healthcare services throughout Nova Scotia,” he wrote.
While primary care providers can refer patients to HSHC, Elliott noted that the clinic also operates as a self-referral service, so patients can call directly to book appointments. He also pointed to the province’s new mobile app, YourHealthNS, as a useful patient tool.
“As we create more awareness of available resources and navigation pathways, including YourHealthNS, we know the uptake of services will increase,” Elliott said. “All services are generally seeing this happen, including our mobile services.”
Demand for free birth control doubled this year
HSHC celebrated its 50th anniversary at the height of the pandemic in 2020. While staff didn’t get much of a chance to celebrate that milestone, the clinic is revelling in recent news that it received a national award in recognition of its compassionate birth control program.
That program provides contraceptives for those who can’t afford them. It was one of three recipients of the 2023 Bentley Awards of Excellence from Action Canada for Sexual Health and Rights, announced earlier this month.
Since about 2000, the program has helped people access birth control pills, patches, rings, injections, emergency contraceptive pills, hormonal and copper IUDs, and implants.
“As is the case with most provinces who do not cover the costs of birth control, paying out of pocket can be a huge barrier for people without private insurance,” noted an Action Canada for Sexual Health and Rights news release.
With more Nova Scotians finding themselves unable to afford contraceptive care, costs to run the compassionate birth control program have doubled. While the clinic used to receive discounts that helped stretch their funding, pharmaceutical companies have ended the well women clinic discounts that used to benefit organizations like HSHC.
“We used to buy a box of Alesse [birth control pills] for like $5. That sort of relationship does not exist anymore,” Ferguson said. “Sometimes they give us a tiny little benefit, but we’re essentially paying the same amount that a private pharmacy is paying for their stock.”
The clinic also started offering free hormonal IUDs and hormonal implants. Costs for those can range between $350 to $450.
“For folks who do not have insurance plans, that is simply out of the question, so that eats a big chunk of that budget,” Ferguson said.
Choosing rent, food, power bills over contraceptives
Ferguson said the skyrocketing cost of everything from rent to groceries is “absolutely impacting” people’s ability to afford birth control. It’s also continuing to drive demand for the clinic’s birth control program.
Since the summer, Ferguson said demand for free birth control has been “huge.”
When you’re not able to access your birth control for financial reasons, you are making decisions where you are possibly putting yourself in a worse place. So if you are not ready to grow your family and you are making choices about rent or food or your power bill or your heating bill over contraceptives, that is a big, big choice.
And if there is a scenario that comes up in which you do become pregnant, that is only going to be exacerbated by the fact that you’re financially strapped. So if you are considering, OK, you do want to keep this pregnancy, or you have religious or moral feelings that you feel that you must keep it even though that wasn’t really your intention, that is going to change your financial situation.
If you are seeking something like an abortion, you can also think about that, the rides that you have to take and the medications or support products that you’ll need to support that decision. It is just an entire financial mountain that can come from not being able to control your pregnancy options.
Advocating for free contraception
While the national award and its accompanying $12,000 prize was welcome news for the non-profit organization, Ferguson said it also serves as a tool to raise awareness about the growing need for the program.
“This [birth control] is something that you simply must prioritize when it comes to planning your life,” Ferguson said. “And for something that is so common, it is very frustrating that it’s so overlooked or seen as such a non-issue.”
September marked the launch of Access Now Nova Scotia, a coalition that advocates for making contraception free in the province. Its members include organizations like HSHC, the Elizabeth Fry Society of Mainland Nova Scotia, Avalon Sexual Assault Centre, South Shore Sexual Health, and many others. Members also include physicians, researchers, social workers, professors, and students.
In March, the provincial NDP called on the government to make birth control free for Nova Scotians. In April, British Columbia became the first province in Canada to offer free prescription contraception.
“From HSHC’s perspective, I think individually all of us here have always mumbled this should be free,” Ferguson said.”But I think until BC made it real, I guess it didn’t really come up as as something that we should really be be pushing through as an actual reality.”
‘Work your way out of the work’
Ferguson said while provincial pharmacare sounds ideal on paper, co-pays are so high that it’s not helpful for something like birth control pills in the $20-30 range.
“You’ll be paying the full price of the prescription unless you have enough other prescriptions on hand that are upping your costs so that you finally actually see the benefit of that,” Ferguson explained. “So it’s essentially negligible when it comes to actually covering contraceptives.”
From HSHC’s perspective, Ferguson said if they no longer have to purchase contraceptives for its compassionate birth control program, it’s a major savings to the clinic.
“Because it’s all private donations that’s funding that, those donations can go to other innovative programs,” she said. “So it’s one of those ones where you actually do want to see yourself work your way out of the work.”