Reproductive Choice Is Not a Reality in Rural and Remote Regions

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I work at an abortion clinic in Toronto.

Sometimes it’s amusing that postcards with totally inadequate address directions from traveling friends promptly land in my mailbox at home. For safety’s sake, I have requested that I never get mail from work, and that my visitors never talk to anyone about where I work.

When I lived in Toronto, I never thought much about the privilege of access and privacy.

Almost a decade ago, I moved from downtown Toronto to a secluded riverside house in the near north. It’s a three hour drive each way

If I were a pregnant teen with no one to turn to, how would I get to a clinic? Any bus service is 30 kilometres from here, and runs only twice a day. I couldn’t walk, and where would I get the $50 return cab fare to get to the bus stop? What if I missed the bus, coming or going?

It’s beautiful here. Idyllic. Surrounded by woods and wildflowers. I wake to birdsong or loon call on summer mornings, lulled to sleep on winter nights by the eerie song of wolf or coyote. Deer and fox wander past my windows. Beaver and otter play in the river outside my door. Osprey, heron and sometimes bear fish in it. The air is clean and fragrant. The water in my well is pure and unchlorinated. Summer visitors fantasize about living here.

If I were a sexually active teen, where would I get contraceptives? At the local pharmacy, everyone knows me and my family. How would I learn what to use? Everyone knows about condoms, but here, there’s no place to get them free and privately, and if my boyfriend buys them…well, everyone knows who he’s going out with.

People are friendly and helpful here. They also know intimate details about everyone else for miles around. My nearest neighbour, who lives almost a quarter of a mile away, knows when I’m working on my computer by which light I have on. In turn, I cannot avoid knowing when they go to bed, who comes to visit them, and often, what they are having for dinner.

The school bus driver, garbage collector, snowplow driver, dog catcher and game warden all live on my road. Although I’ve never actually met many of them, I know who has a gambling problem, who had to go to a women’s shelter, who has not paid their property taxes. A local woman buys her booze two towns away to avoid talk about what she buys, how much, how often.

Anonymity and confidentiality do not exist in places where everyone knows everyone else for miles around.

Where could I have learned about safe and unsafe sexual activity? What if I thought I might have a sexually transmitted infection? What if I learned that my boyfriend had a shared needle?

Our little village boasts a pharmacy, which is also a post office, Sears outlet, dry cleaners, gift shop, travel agency and drapery franchise. Anyone doing business in the village goes there. There’s a big Catholic church and Catholic grade school. That’s it. Oh, and a small, part-time health clinic. I don’t know if the one and only doctor there is pro-choice or anti-choice.

Doctors in this and other remote rural areas have refused contraception to unmarried women, and have given women deliberate misinformation about abortion.

What if I was 14 and sexually active? What if I was a student at the Catholic school? And what if I missed a period? Where would I get a pregnancy test? Would I have to wait until I had missed several periods before I knew for sure?

Every place but the village is long distance by phone. The only pay phone is at the intersection in the village, and that’s where the whole local world passes by and sees.

I can’t risk calling a clinic from home – it will be on the phone bill. Not safe to call from a friend’s house for the same reason. If I can get a hold of a clinic, they want me to call them back on a certain day to confirm that I am coming. More risk and hassle. I could get information on the Internet, but not make an appointment – besides, my parents might check what websites I’ve been visiting.

Every day I talk with teens who live very far from Toronto. Their fears and anxieties are palpable, not only about the abortion procedure, but about the very logistics of making an appointment and getting to it. Pretty much, only adult women return to the clinic for a follow up check up if they live any distance from Toronto.

Phone lines that accept collect calls and 800 numbers are useful to a limited extent. But for reproductive choice to exist in fact, not only in theory, resources need to be accessible. They, and we, need to be where women need us.

Lobbying to all levels of government, and to all political parties, to push for rural sexual health funding, and for availability of medical abortions, and to easy access to follow up care…pressing private donors for funding…traveling health buses…satellite and part-time sexual health clinics for rural and remote areas…easy, free and confidential access to emergency contraception…educational information in public places in accessible language and widely disseminated: all of these measures are urgently needed.

Sadly, they do not seem to be a priority for anyone.


If you’re looking for abortion and/or birth control information, please call the Canadian Women’s Health Network confidential information line, Toll-free: 1-888-818-9172 (TTY 1-866-694-6367), or visit:

For more information on rural and remote women’s health issues visit:

  • Centres of Excellence for Women’s Health: Toll-free: 1-888-818-9172; TTY 1-866-694-6367
  • Electronic mailing list: Rural and Remote Women’s Health Interest Group. To join, send an e-mail to asking to subscribe. Please include a brief introduction.

Coming soon

Rural, Remote and Northern Women's Health: Policy and Research Directions (Summary Report; Centres of Excellence for Women’s Health, March 2004).

The culmination of a two-year study, this summary report will be available and released in March 2004. The Centres of Excellence for Women's Health and community and academic researchers across Canada participated in shaping this project. Chapters include reviews and bibliographies from Canadian literature in both official languages, results from focus groups in both languages with over 200 women across the country (including minority-French, Inuit and Metis women), and a report from a national consultation held in 2003. The report will be available in both French and English at or or by contacting: (204) 982-6630.