Newfoundland and Labrador's only abortion clinic almost ran out of cash earlier this year.
Until April, the St. John's-based Athena Health Centre operated on a fee-for-service model, meaning it was paid a fixed rate for each person treated. When the pandemic cancelled most social gatherings, the demand for abortions cratered – and so did the clinic's revenue.
"It really impacted people's getting out and mingling, and our numbers fell dramatically during COVID, like really significantly, because none of this unplanned sexual activity was happening," said clinic owner Rolanda Ryan of the pandemic, and the resulting public health restrictions.
Early in the pandemic, in April 2020, as the cost of medical supplies skyrocketed and Ryan watched her clinic slide into the red, she began asking the government for a new funding model — one that would provide a guaranteed source of income regardless of how many patients she saw.
Asking gradually turned to begging, as the province waited two years to act. The government finally changed the funding model after Ryan threatened to close the clinic for good.
'I got very, very close to being maxed out'
"Things got really expensive at the same time I was losing money," Ryan said Tuesday, during an interview at her clinic. "My overdraft with my bank was $75,000 and I got very, very close to being maxed out. And that's after the [federal government] small business loan and after the wage subsidy. So we were really, really struggling."
"I was frantically writing email after email to the government explaining the situation we were in and saying, 'Does the hospital have the capacity to take these patients?'"
Ryan said Athena Health Centre performs about 900 abortions in a normal year — more than 90 per cent of the abortions performed in the province. In 2020, the clinic performed about 200 fewer abortions than normal. In 2021, between 200 and 300 fewer than a regular year.
While the Health Science Centre, the main hospital in St. John's, can also perform abortions, Ryan said her clinic does them faster, cheaper and without taking up space in hospital beds and operating rooms.
"To redirect hundreds of people to the hospital would have significant impacts," she said.
She said her clinic also allows people to get abortions without a referral from their doctor and ensures the procedure does not appear on their electronic medical record.
Ryan said she never felt government was unwilling to change the funding model for her abortion clinic, a facility offering abortions one day a week that she's owned since 2010.
"I really believe government did want to do this, but the wheels move slowly," she said.
As of April 1, Athena Health Centre receives quarterly block funding, meaning they get a lump sum of money four times a year, regardless of how many patients they see.
"There will be some cushion there for unexpected events," said Ryan.
CBC News asked the Department of Health and community services why it took so long to switch the clinic's funding model. The department did not respond by deadline.