Written by: Jillian Schneidman (she/her), Jill Koebel (she/her).
Edited by: Etienne Maes (he/him).
Summary: The SHORE centre, located in the Waterloo region of Ontario, offers sexual health services, programs, and resources to their community. This article, inspired by a conversation with Executive Director of the SHORE centre TK Prichard (they/he), provides an introduction to the SHORE centre, explores access gaps to abortion care in the Waterloo region, and discusses the ways the SHORE centre is addressing these gaps in abortion care.
The SHORE Centre:
The Sexual Health Options, Resources & Education (SHORE) centre, founded in 1972 and located in the Waterloo region of Ontario, offers sexual and reproductive health services, programs, and resources to their community. This includes pregnancy and abortion care, support, counseling, and outreach. Most recently, they have been working to develop a physical disability program and a program specifically for Black youth and sexual health.
The centre provides a holistic and flexible approach to their care, offering multiple services to meet the diverse needs of their community. These services range from counselling for abortion, pregnancy and perinatal mental health to newcomer sex ed and a developmental disability program. They also house a medical clinic that prescribes medication abortions (“abortion pill”; click here for more information) and carries out IUD care and PAP testing.
On inclusivity, TK explains, “We recognize that abortion care [and] reproductive health care has been dominated by women-only narratives… we do a lot of work to ensure that we recognize that people of all genders may need access to abortion care [and] reproductive health care, and so you’ll see a lot of person-centered language… and not gendering the procedures that we offer.”
Large Access Gaps in Abortion Care:
In our discussion, TK highlights the major gaps that still exist when it comes to accessing abortion care, especially within the Waterloo region. TK explains that the Grand River Hospital remains the only place that provides surgical abortion in the entire region, which does not provide the procedure past 14 weeks of gestation. Even more so, access gaps exist regardless of gestational limit for those with higher BMIs and other previous health conditions, whom the hospital often refuses to treat. Those who don’t fall under the criteria at the Grand River Hospital are referred to clinics in London or Toronto, a minimum of a one hour commute from Waterloo.
Additional gaps to comprehensive care TK highlights include stigma, a lack of cultural considerations, and poor logistical support like transportation. The SHORE centre sees many individuals who are frustrated with the approach their primary care provider took in providing abortion care: “Some folks have been like, I just wanted an abortion like I felt good about having abortion and then my health care provider asked me 8 million questions that made me think, should I be having an abortion? … it was not a moral issue for them until their health care provider made it one.”
SHORE Centre Addressing These Gaps in Abortion Care:
The SHORE centre is attempting to reduce many of these gaps when it comes to abortion care. Five years ago, they incorporated a medical clinic within their centre to provide additional services like medical abortions to the community. TK explains that this change came about when a local doctor wanted to prescribe medical abortions in their practice but was not supported in the clinic in which they worked. Throughout the pandemic, the centre shifted to telemedicine and low touch/no touch medical abortion care, where as much care as possible is offered without the patient and provider needing to meet face-to-face (see this article for more information on low touch/no touch medical abortion care).
Additionally, in 2019 the SHORE centre developed choiceconnect.ca, a website that helps individuals across Canada find the nearest abortion provider based on their needs. The website, which is accessible in both French and English, asks the user a set of questions and provides contact information for abortion providers most suited to the users needs. According to TK, the resource was largely developed to increase accessibility to folks in Canada looking for abortion services, as many hospitals and healthcare providers who offer abortion services may not be known to the public at large and/or are difficult to find through a google search.
Another service that the SHORE centre provides is a driving program called Wheels for Choice. Wheels for Choice provides transportation or accompaniment assistance to and from abortion appointments both within and outside of Waterloo, including London and Toronto. This program is one way the centre is helping those who are referred to clinics outside of the Waterloo region when they don’t meet the criteria for abortion services at Grand River Hospital (to access Wheels for Choice, email the SHORE centre at general@shorecentre.ca)
What Providers Can Do:
When asked about the challenges the clinic faces around abortion care, TK says “the biggest issue is that there’s not enough providers. There’s too few and it’s hard for us to support the volume of people that need care”. TK urges all healthcare providers to include abortion care in their practice and treat it like any other form of healthcare. As TK puts it “abortion is healthcare; it’s past time that we treat abortion like a moral, ethical outlier and look at it as this basic health care that people need access to”. The lack of transparency around abortion care is also a problem for people navigating the system. TK explains that often clinicians do provide abortion care, but don’t explicitly share this. They emphasize the need to be transparent about these services, as often clients are hesitant to ask for fear of stigma.
Additionally, TK touches on the fact that a lot of people experience judgements and/or are asked unnecessary questions from their healthcare providers when seeking abortion care which makes the process more challenging. TK says that it’s important healthcare providers are aware of what makes abortion access difficult in order to know how to navigate abortion services properly with patients who are seeking care. A lot of healthcare providers don’t think through some of the current logistical considerations of abortion care services, such as the distance of the clinic or hospital the provider is referring the patient to.
In conclusion, TK emphasizes the need for more holistic organizations like the SHORE centre to avoid healthcare silos, but highlights the funding challenges in doing so. They conclude with two calls to action: 1) sustainable, flexible funding for multi-disciplinary centres like SHORE, and 2) a commitment from healthcare workers to provide transparent, non-judgemental abortion care that accounts for the social determinants of health. As TK concludes, “It all comes back to … learning to treat abortion as any other form of health care.”
