Nova Scotia

Snapshot

50%
urban points of service |
50%
rural points of service*
Patients in Nova Scotia can be referred to the provincial self-referral line operated by Reproductive Options and Services (ROSE) Clinic.
57%
urban points of service |
43%
rural points of service
59
% urban population |
41
% rural population*
Urban refers to census metropolitan areas and agglomerations (CMAs and CAs). Rural refers to areas outside of CMAs and CAs.
2 points of service per 201,725 women of reproductive age
*
Women, aged 15-49 (reproductive age as defined by the WHO). Based on the 2021 Canadian census. Not all people who can get pregnant are women, but the data available only includes two gender categories.
Link
5
unregulated pregnancy centre(s)*
Unregulated pregnancy centres (UPCs) are anti-abortion organizations that present themselves as clinics or counselling centres. Also often referred to as “Crisis Pregnancy Centres (CPCs)” or “fake clinics”. Data from the Abortion Rights Coalition of Canada.
Link

Access Overview

2
publicly listed point of service offering both medication and procedural abortion*
publicly listed points of service*
Data on the points of service are based on Action Canada’s directory. These numbers are up to date, but not always complete as they do not include all primary care providers who prescribe medication abortion and the landscape of abortion access can change quickly.
Link
1
point(s) of service for medication abortion
2
point(s) of service for procedural abortion
Functional gestational limit of
16 weeks
Functional gestational limit of
16 weeks
*
Only one point of service provides abortion up to 16 weeks
A provincial self-referral line operated by Reproductive Options and Services (ROSE) Clinic is available toll-free at 1-833-352-0719 to access abortion services in Nova Scotia.
A provincial self-referral line operated by Reproductive Options and Services (ROSE) Clinic is available toll-free at 1-833-352-0719 to access abortion services in Nova Scotia.
No centralized system to assist the public in connecting with abortion services
Information about abortion is available on a
provincial/territorial website
Information about abortion is not available on the provincial/territorial website

Medication abortion

Cost coverage

Mifegymiso is fully covered for Nova Scotia residents with a valid health card.

Billing code

Billing codes are used by physicians to bill provincial/territorial health insurance plans for the different services that they provide. When there isn’t a billing code for medical abortion, physicians can be de-incentivized from providing it.

Nova Scotia’s Physician’s Manual includes a billing code for medical abortion.

Telemedicine

Telemedicine abortion has been found to be as safe and effective as medical abortions provided at clinics. Because telemedicine abortion allows patients to access care in their homes and often requires just one trip to a pharmacy or clinic, expanding its availability is critical to improving abortion access for people who live in rural communities, who can’t take time off work to go to appointments, or who are at risk of stigma or discrimination.

Patients in Nova Scotia can be referred to telemedicine providers across the province through the provincial self-referral line operated by Reproductive Options and Services (ROSE) Clinic.

During the COVID-19 pandemic, physicians were authorized to bill for virtual care at the same rate that they would for an in-person visit. Telemedicine is now insured under Nova Scotia’s Physician’s Manual when in compliance with the Provision of Publicly Funded Virtual Health Services Policy.

The College of Nursing of Nova Scotia has set Telenursing Practice Guidelines for nurses to provide telenursing services that are consistent with their legislated scope of nursing practice, individual scope of practice and scope of employment.

Under the Pharmacy Practice Regulations made under Section 80 of the Pharmacy Act, all health practitioners dispensing drugs are required to provide in-person consultations to patients before the first fill of each prescription. However, the legislative requirement is relaxed where it is not “practicable” for a patient to have in-person consultations, meaning that in some situations it may be possible for the consultation requirement to be met over the phone or online.

Legislation, policies, and regulations

Access to abortion for minors

There is no legislated age of consent for medical treatment in Nova Scotia.

As such, the mature minor doctrine applies to minors accessing health care, including abortion. This means that a minor who can understand and appreciate the nature, purpose, and reasonably foreseeable consequences of a proposed medical treatment and its alternatives/refusal can give valid legal consent.

Bubble zone legislation

Bubble zone legislation aims to prevent anti-abortion protestors from harassing people within the vicinity of a facility that provides abortion care. Even though criminalizing individual people will not effectively curb the larger anti-abortion movement, these laws can be effective in deterring anti-choice protestors from harassing providers and patients entering and exiting abortion clinics.

Nova Scotia’s Protecting Access to Reproductive Health Care Act was passed into law on March 10, 2020. Under the Act, every facility that provides abortion care has a 50 metre “access zone,” though they can apply to expand the zone up to 150 m if needed. The act also prohibits the harassment of abortion providers and allows for access zones to be established for the homes of physicians and service providers through regulations.

Belief-based care denial

Although abortion is an essential medical service, physicians and nurse practitioners can refuse to provide abortion care due to their personal beliefs under current legislation and policies set by regulatory bodies. This practice is often referred to as “conscientious objection,” although a more accurate term may be “belief-based care denial.”

Physicians

The Professional Standards Regarding Conscientious Objection require that an objecting physician must provide an effective referral to a “non-objecting, available, and accessible physician, healthcare professional, or agency or service that oversees the delivery of the care being sought.”

Nurse practitioners

The Nova Scotia College of Nurses adopts the Canadian Nurses Association’s Code of Ethics for Registered Nurses, which states that in cases of conscientious objection, nurses are obligated to notify their employers or the patient receiving care in advance so that alternative arrangements can be made.

Out-of-country medical policy

In some instances, patients may have to travel outside of the country to receive abortion care currently not available in Canada.

The Nova Scotia Medical Services Insurance Program includes out-of-province coverage for patients referred for insured treatment. Patients must receive a referral from a specialist registered in Nova Scotia. The policy states that if the claim receives prior approval from the Department of Health and Wellness, all medically necessary services, whether provided on an in-patient or out-patient basis, will be insured at 100%.

There is no legislation related to out-of-country medical care in Nova Scotia.

Travel support

Patients who are pre-approved to travel out of province for medical care are eligible for some financial support under the province's travel and accommodation assistance policy:

A maximum of $1,000 CDN in travel assistance (round trip) and $125 CDN per night up to $1,500 CDN per month for short-term accommodations of less than one month
If a longer-term stay is required, assistance of up to $2,500 CDN per month
Transportation costs of up to $1,000 CDN (round trip) for an escort to travel with the patient will also be covered if required, or if the patient is under 19 years of age.

In order to be eligible, patients must have their Nova Scotia specialist write a letter seeking pre-approval from the MSI Medical Consultant. A patient must fill out an expense form and submit all original receipts in order to receive reimbursement.

Travel support from the Employment Support and Income Assistance (ESIA) program might be available for eligible patients, but cannot be used in conjunction with the MSI program.

court cases on abortion

Nova Scotia v. Morgentaler (NS, 1989)

1989 NS SC 5201

The government of Nova Scotia charged that the defendant was performing abortions in his abortion clinic in violation of section 4 of the Nova Scotia Medical Services Act, 1989, which prohibited abortions outside hospitals. It sought an interim injunction to prevent the defendant's activities.

The court granted the request for an injunction, stating that there was an overwhelming public interest that provincial laws not be flouted. It rejected the argument that the Supreme Court's 1988 decision in R. v. Morgentaler prohibited provinces from passing laws restricting the performance of abortions to hospitals.

The decision was overturned in 1993 by the Supreme Court of Canada.

References

top