Nova Scotians’ bigotry is softer and quieter than its white supremacist cousins in headline-grabbing places like Charlottesville, Virginia—but it’s no less devastating.

Late last year, the Canadian Centre for Policy Alternatives (CCPA) released its 2017 Report Card on Child and Family Poverty in Atlantic Canada’s most populated province. In a single table the CCPA manages to demolish the notion of Canada’s greater inclusivity: Of 10 desperately poor communities in Nova Scotia, eight are predominantly First Nations or Black. Child poverty rates in those communities range from 72 percent in Eskasoni (First Nations) down to 38.7 in nearby New Waterford.

This is just one shocking fact revealed by CCPA director Christine Saulnier and Acadia University sociologist Lesley Frank, who co-authored the study. In 2015, the year this report covers, 21.6 percent of Nova Scotia children—almost 36,000 kids—regularly went to bed hungry or walked to school in windbreakers and sneakers following January blizzards.

By neglecting these kids’ basic needs so dramatically, the province is setting many children up for failure while perpetuating their cycle of poverty.

It’s been 29 years since Canada’s Parliament announced it would eliminate poverty among Canadian children by the year 2000. This millennial goal seemed entirely attainable. As the Berlin Wall fell, politicians the world over touted a peace dividend that would build just societies. Yet Canada has failed horribly: More children live in poverty now than when that lofty aspiration was proclaimed.

While that is tragedy enough, the report card’s granular truths are even more disturbing. Nova Scotia, the wealthiest Atlantic province, maintains the region’s highest percentage of children living in poverty and Canada’s third-highest rate. Recently, the provincial government has deemed balancing the budget their greatest priority, knowing that a few strategic investments could save lives.

Poverty rates follow expected geographic patterns. Halifax is home to industry, choice universities, and a world-class seaport, allowing for a quality of life that helps the city boast the province’s lowest poverty rate at 18.7 percent. Yet Cape Breton, though steeped in natural beauty, is a hard place to prosper. Resource industries have been dying for generations, and the tourism season is short. There, nearly one-third of kids face increasingly bleak futures.

Heartbreakingly, a rising tide doesn’t lift all boats. While Halifax’s poverty rate rivals the national average, the historically Black community of Preston, a 20-minute drive from downtown, is nearly two-and-a-half times worse.

The CCPA report also highlights how challenging a place Nova Scotia is for immigrants to land, despite a legendary reputation for hospitality. Many visible minorities often struggle below the poverty line for years. Numerically, 67.8 percent of Arabic children live in poverty here, compared to a (still dismal) national average of 43.3 percent. More than 50 percent of Korean children suffer. When immigrant children are twice as likely as white children to live in poverty, is it any wonder so many immigrants are quick to move on?

Gender, too, is a powerful force in determining which single-parent families will struggle. Women invariably earn less than men and are far more likely to cobble together multiple part-time positions or seasonal work to provide for their children. In single-parent male households, 30.4 percent of children struggle; in homes with single mothers, nearly one-half live in a Dickensian world of want and need.

Governments have a huge role to play in righting this wrong. Saulnier and Frank note that a progressive child tax credit, implemented by Justin Trudeau’s Liberals in spring 2016, should help all provinces lift children out of poverty. And while Ottawa is crafting a national poverty reduction strategy, the provincial Liberal government under Premier Stephen McNeil has promised to create an anti-poverty blueprint. Hope remains for even greater gains, but the report suggests that incredible need requires immediate action and firm timelines.

Right now, when single parents receive child support payments from former spouses, McNeil’s government claws back provincial support, dollar for dollar. In addition, thousands of parents don’t pay court-ordered child support; enforcement is lax. Changing the rules and beefing up enforcement would lift thousands above the poverty line.

Income assistance can also be tied to inflation and made flexible, allowing families with members who have greater needs, including those with physical disabilities, access to more money. Additionally, federal social funding to provinces arrives in block grants, yet provinces don’t account for how that money is spent and if any is directed to fighting child poverty. Greater oversight is badly needed.

Nova Scotia’s minimum wage is also abysmally low: At $10.85, it’s the worst in Canada. Child care is limited and expensive. Working parents often resort to families for childcare, or lose out on paid time.

Implementing some or all of these options can make a real difference. Yet few will be effective unless financial and social policies begin addressing racial disparities in the province to promote the economic and cultural value that people of colour and immigrants bring to Atlantic Canada. It’s past time for Nova Scotians to talk about reparations to overcome the economic disadvantages nurtured by centuries of racism and colonialism.

We need to talk about the value of all Nova Scotia’s children. Period.

Portrait of Charles Lawrence.

I went to church in August. I hadn’t been in 20 years. It was Monday and St. Paul’s Anglican in downtown Halifax was dead quiet. A young woman in burgundy sat at a table near the door. I looped around the pews before asking the question I had come here to ask: “Charles Lawrence is buried under here, isn’t he?”

“Yeah, he’s up front, to your right,” she said.

It’s a less-than-plain resting place. Battleship-grey floorboards, a flimsy hand-painted family crest; pretty modest for a former governor. I stomp my right heel into the wood. Then my left. I add a toe tap. Stomp. Tap. I sway my body, lift my arms, and stomp again, harder this time, trying to pull a groan from the old boards. No luck. I’m an awful dancer.

The woman at the front pays no attention to my arrhythmic jig. Later she tells me she’s seen quite a few people dance on his grave in her three years working here. Her face reveals no opinion. I suppose she knows I’m Acadian. She said the other dancers were, too, aside from a few Cajuns.

Dancing on someone’s grave is a sign of disrespect. It’s a “ha-ha, screw you, I relish in your demise, and outlast you.” It seems silly, but it’s not. Not here. Charles Lawrence was the racist megalomaniac behind the Expulsion of the Acadians, or Le Grand Dérangement—the forced deportation of almost the entire population of Acadie, about 14,000 people.

The ancestors of those deported haven’t forgotten what he did. The rest of Nova Scotia seems to have. We have two Lawrencetowns and many Lawrence Streets throughout the province. There are no statues to tear down—like the confederate monuments coming down across the American South—but there’s a conversation that needs to happen. I don’t want the history of Charles Lawrence erased—that was his bit—but I want him to be remembered for what he really was: a criminal, a racist, and a horrible man responsible for the displacement and death of thousands of innocent people.

Lawrence didn’t invent the idea behind the Expulsion— it had been around for years—but he put it into action. Since the early days of British rule in Nova Scotia, colonial officials were worried about the political leanings of the Acadians, the original French settlers of the land. The thinking went like this: If England and France went to war, which seemed likely, the Acadians would obviously side with the French, and probably bring along their Mi’kmaq and Wolastoqiyik (Maliseet) allies. Even old Edward Cornwallis—former governor of the colony, founder of Halifax, and a shameless racist in his own right—wouldn’t entertain the idea. He asked for an oath, and when this was rejected, he did nothing more; this from a man who put a bounty on Mi’kmaq scalps.

Lawrence was less kind. After a backhanded attempt to force Acadian community leaders to submit to the British Crown—or to use Game of Thrones lingo, to bend the knee—he signed the decree setting about a series of events that add up to nothing less than cultural genocide.

It began in 1755. British soldiers forced Acadians out of their homes dotting the shore of the Bay of Fundy and stuffed them into decrepit transports and decaying naval brigs. The ships called along the bustling British ports of the Thirteen Colonies, dropping off small groups of prisoners at each city. Homeless, linguistically and religiously alienated, and torn from their families, most exiles ended up destitute on the streets or dead. More than a quarter of the 7,000 deported in the fall of ’55 never made it back to dry land, succumbing to wretched ship conditions and disease. Those who escaped to surrounding French territories were hunted down and deported three years later, from Ile St-Jean, the island we now call P.E.I. This time the ships sailed for France; death rates at sea were even higher. Two ships packed with hundreds of prisoners never made it at all, sinking with all hands lost in the frigid North Atlantic.

But some families escaped the fate of the ships. That’s where I come in.

I don’t speak French. The few church events I attended as a kid were Anglican ceremonies. I didn’t even know my last name was Acadian until someone told me two summers ago while I was working as a tour guide in Cheticamp, N.S.—the largest Acadian community in the province. Acadian culture was erased, at least in my family. But I’ve traced my ancestors back to some of the first settlers that arrived in Port Royal in the middle of the 17th century. No one in my family knew of the connection until a few months ago. I’ve been told French was spoken in the house four generations back, but memories are getting foggy. We’ve nearly forgotten. Many of the unlucky souls who landed in the hostile ports of America had their culture physically stolen. For my family, among those who escaped the deportations, the erasure happened much more slowly, but it happened nonetheless.

Mr. Lawrence, I danced on your grave because you deserve it. I drive by towns named after you whenever I go surfing on the eastern shore or apple-picking in the Annapolis valley, and they anger me. Nova Scotia’s need to memorialize you angers me. We talk about removing statues and changing street names a lot in this province, and I want your name added to the list. May you not rest in peace.

A CN train passes through Africville in 1965. Photo courtesy of Bob Brooks/Nova Scotia Archives.

Fifty years ago, the city of Halifax destroyed the historic Black Nova Scotian community of Africville, demolishing its church and homes and forcibly relocating nearly 400 residents. In 2010, Halifax’s mayor apologized and funded the rebuilding of the Seaview United Baptist Church. The following year, the mayor, in response to activism by former residents, also renamed a commemorative park after Africville. But for many, the reparations do not sufficiently address the devastating effect the loss of Africville has had on Nova Scotia’s Black community. More than 40 descendants have been seeking compensation for communal lands through a class action lawsuit since 1996.

Anti-Black systemic racism remains rampant across the province. In Halifax, Black people are three times more likely to be street-checked than white people. Black Nova Scotians are overrepresented in child welfare and incarceration systems. Black students are suspended at disproportionately high rates. Last fall, when Halifax’s North End elected Lindell Smith, he became the city’s first Black councillor in 16 years.

At the same time, members of the North End’s Black community gathered at a meeting to mourn and discuss the deaths of several young men to gun violence. When the community requested the event be private, some white residents were outraged over being excluded. Meanwhile, in rural areas, Black communities like Lincolnville and Shelburne endure severe environmental racism, with nearby landfills polluting the air and water.

For the most part, white Nova Scotians ignore and dismiss these issues. The willful ignorance serves a purpose. As poet and activist El Jones writes in the Halifax Examiner, “By erasing the historical Black presence in Canada, and the anti-Blackness ingrained in Canadian history, Canada is able to present itself as a peaceful, progressive, and multicultural nation.”

Protests erupted across Nova Scotia this fall when forestry company Northern Pulp was approved for its latest round of aerial herbicide sprays. The controversial chemical, glyphosate, is banned in parts of Europe and for forestry in Quebec due to questions around its propensity to cause cancer.

In the Maritimes, glyphosate’s recent history is troubling. Rod Cumberland, the former chief deer biologist for the Natural Resources department in New Brunswick, found that glyphosates are a major contributor to the province’s deer population collapse. It wasn’t until after he retired in 2012 that he made his research public. Company J.D. Irving, responsible for spraying most of New Brunswick’s glyphosates, subsequently attacked his research. Last year, former N.B. chief medical officer Dr. Eilish Cleary was working on a study of glyphosates when she was placed on leave and then fired. Meanwhile, former provincial premier, Dr. John Hamm, chairs Northern Pulp’s mill board.

“You need governments that are going to be strong enough to stand up to these industries,” says Lenore Zann, the Truro, N.S.-area MLA who’s rallying against the spraying. But in a region under economic pressure, reigning in such industries is often easier said than done. “[Northern Pulp] has threatened to leave a number of times,” adds Zann. “Anytime anybody tries to get serious about pushing them on their environmental footprint.”

Glyphosate is Health Canada approved, and is registered in more than 130 countries. It’s commonly used in forestry, agriculture, and along rail and power lines. It was introduced by Monsanto in the 1970s, and accounted for just under a third of Monsanto’s earnings last year.

While the human health impacts of glyphosate remain up for debate, its effects on forest health are more straightforward. Cumberland’s researche showed that New Brunswick’s deer population collapsed because glyphosates kill a main food source: hardwoods. Forestry companies such as Northern Pulp spray to encourage conifer growth, which they harvest, by killing off competing species. The result is a less resilient forest.

“If a bug comes in, like the spruce bud worm for instance, it’s going to wipe everything out,” says Zann, noting that the spraying is a symptom of an outdated approach to forest management that places fibre output above forest health. “You’re basically turning everything into a monoculture,” Zann continues. “If they say there’s no other way, I say bullshit—you just have to want to find them.”

Details of Invisible Publishing Titles. (L-R: Bats or Swallows, Ghost Pine, Fear of Fighting, This American Drive, Rememberer, The Art of Trespassing.)

Even when it’s not faced with an uncertain digital future, the publishing industry occupies a very uncomfortable place at the intersection of art and commerce. “Intersection” may not be the right word; it’s more like art is one end of a teeter totter and money is the other, with publishing in the middle, trying to make sure neither side bounces too hard or falls off or knocks the whole thing over. It’s a tough act.

Enter Invisible Publishing. Started in 2007 in Halifax by pals Robbie MacGregor, Nic Boshart, and Megan Fildes, Invisible chucked out the teeter-totter in favour of one giant sandbox. It’s a collective, in that beautiful old lefty way; they’ve just officially incorporated as a non-profit, though that term seems a little dry for a group that has so much fun together. The three chiefs have titles, sort of: Robbie is publisher, Megan is art director, and Nic, who has decamped to Toronto, is president, a title he can’t quite say with a straight face. They all have other jobs; Nic works at the Association of Canadian Publishers, Megan as production designer at Halifax’s The Coast, and Robbie spends his days at the Halifax Public Library—which means they don’t depend on Invisible to pay their rent. In fact, Invisible doesn’t pay them at all.

That’s right: they spend their evenings making books because they want to. And that sets the tone for the whole enterprise. They don’t publish books for authors, they publish with authors; writers can participate as much as they like, as can just about anyone else who’s keen to be a part of Invisible. So people offer to help. Jenner Brooke-Berger, for example, volunteered to read the slush pile and ended up doing promo and editing. Sacha Jackson, an editor, tackled marketing. And Sarah Labrie made an e-reader case for one of Invisible’s book covers. They even have a manifesto (not a mandate, a manifesto), which includes these lines: “We are collectively organized, our production processes are transparent. At Invisible, publishers and authors recognize a commitment to one another, and to the development of communities which can sustain and encourage storytellers.” Publishing as communal act: what a brilliant idea.

Speaking of brilliant, perhaps the most important part is the work they do. The folks at Invisible publish smartly: award-winning design; a forward-thinking and successful focus on e-books, complete with a super-smart blog; distribution and marketing savvy; and, most important, a discerning eye for talent. Commercial viability isn’t Invisible’s primary concern; good writing is. They’ve published 14 books, including Devon Code’s In a Mist, Stacey May Fowles and Marlena Zuber’s Fear of Fighting, and Ian Orti’s L (and things come apart), which recently won CBC’s audience-choice Bookie award. Invisible’s most recent release is about Montreal band the Dears.

Make no mistake: publishing is no picnic these days. Books are having a tough go of it in an age where people expect to get information for free. No one is in publishing for the money, but Robbie, Nic, and Megan take their labour of love one step further and make publishing a vehicle for creating community. With that, Invisible proves that publishing is not down for the count—not in the least.

Off the Hook uses the community-supported agriculture model to keep fisheries healthy and bring fresher fish to market. Photo by Sadie Beaton.

It’s hard to find fresh fish to buy in Canada. Even in Halifax, in view of the ocean, it takes at least six days for local fillets to make it from the fishing boats to the supermarket. Now, a group of five fishers are changing the way fish are caught and sold. They’ve founded Off the Hook, an organization they call a community supported fishery, inspired by the local food movement’s community supported agriculture (CSA) plans. As with a CSA, members pay the fishers at the beginning of the season in return for a weekly share of the catch.

This close connection between consumer and fisher is new to Nova Scotia. Ever since colonial times, the Maritime fishing industry has fed the long-distance market. The fisherman relied on the fishing lord, the middle-man, to buy the entire catch. By creating the cooperative and selling directly to the consumer in nearby cities, fishers are reinventing the supply chain. They can also make more money. Whereas the price at the dock for haddock is between 80 cents and a dollar per pound, members of the group buy the fish for $3 a pound, which means they’re helping to keep the fishers on the water.

And because they have a guaranteed market, fishers are able to fish with a bottom hook and line, a method that doesn’t damage ocean habitat—unlike the commercial fishery’s trawlers that drag a large net along the ocean floor, sweeping everything up with it—a technique that contributed substantially to the collapse of the cod fishery.

The fish is good too. As people picked up their fish on one of the final days of the season last fall, they planned dinners of fish tacos and baked fish with herbs. Selling fish that’s just hours out of the water, rather than days, Off the Hook is giving “fast food” a whole new meaning for its members.

Illustration by Dave Donald.

It’s just another September day in Nova Scotia—sun shining, birds chirping, a late summer breeze playing in the treetops. Only one thing is different today for Shawna Young: she is pregnant. This one fact makes the sunshine seem a little brighter, the birds’ songs just for her. It’s like carrying around a secret, a secret that makes her smile at strangers and hold her head a little higher. Just yesterday, Shawna and

her husband, Benjie, put their one-bedroom house on the market, already full throttle into planning their lives for their little one. They’d dreamed of moving into a bigger, more family-friendly home when the time came; now, it was finally here. Today, Shawna is on her way to the doctor for her 13-week ultrasound. She knows exactly what to expect: the doctor will say she’s 12 weeks and six days pregnant, and she and Benjie will get to see the little hands and feet of their miracle baby.

But something feels wrong when she lies back in the chair, looking at the ultrasound image up on the screen. There is no movement. She tries to convince herself that everything is fine, even though a nagging feeling in the pit of her stomach suggests otherwise. The nurse’s words come like a blow to the head.

“Well, you’re not 12 weeks and six days.”

“Oh, is the baby measuring a bit small?” Shawna asks, looking helplessly at the blob on the screen.

“I’m sorry,” replies the nurse. “I have no good news for you today.”

When Shawna repeats the nurse’s words to me on the phone from her home in Halifax, I hear her voice crack, and I know it’s not the quality of the connection. For any woman who has miscarried, the emotional devastation is something that lingers long after the event has passed. But for a woman who has had fertility problems and struggled through years of tests, medications, alternative treatments, and thousands of dollars in debt, the devastation is that much harder to bear.

A few days after finding out she had miscarried, Shawna went in for her scheduled “D & C”—dilatation and curettage—which refers to the widening of the cervix so a doctor can scrape tissue from inside the uterus; in this case, excess tissue resulting from the miscarriage.

“I had the distinct feeling we were going to a funeral,” she says of the drive to the hospital. “After a morning of meeting with doctors, nurses, intake people, seemingly half the people who worked in the hospital, I was taken into the operating room. I walked in and climbed up on the table. I extended one arm out straight so they could put the IV in, but they couldn’t get it in, so they had to try the other arm. So I was lying there with my legs in stirrups and both arms extended out and very bright lights shining on me. The operating room itself and the procedure to that point reminded me very much of my egg retrieval for the in vitro fertilization, and as I lay there, the tears just started streaming down my face. I couldn’t wipe them away because both of my arms were extended and being worked on. I felt so alone and such complete and total sorrow. I didn’t fight the feeling, though; I just let myself feel what I felt and grieved for the baby I was about to lose. I was not only mourning the loss of our baby, but I was really grieving for my fertility.”

At 37, Shawna was on her second in vitro fertilization treatment after a year and a half of trying to conceive naturally. The decision put her and Benjie in debt more than $20,000. A single round of IVF can cost up to $10,000, which includes costs other than the procedure fee—women also pay for the drugs they need to inject themselves with in preparation for the procedure, and these can cost as much as $5,000. IVF is currently not covered by the provincial health-care system in Nova Scotia or most provinces in Canada. In Ontario, it is funded only for women with blocked fallopian tubes—no more than 20 percent of infertility cases. Last summer, Quebec became the first Canadian province to bring IVF under its provincial health plan when it passed Bill 26, which allows funding for up to three IVF treatments for women having difficulty conceiving. Outside Quebec, IVF remains a private medical cost in most cases.

IVF involves fertilizing an egg with sperm outside the uterus. It falls under the umbrella of Assisted Reproductive Technologies (ARTs), which emerged in the late 1970s, with the first Canadian fertility clinic opening in 1983. IVF is the most effective ART: with each cycle of treatment, it’s successful 38 percent of the time for women under 35; for women aged 35 to 39, it’s successful 28 percent of the time; starting at age 40, success rates drop to 11 percent. According to the Canadian Fertility and Andrology Society (CFAS), these rates have increased by 10 percent over the last decade.

The causes of infertility are numerous, and doctors usually look at lifestyle factors first—smoking, alcohol, and drug use all inhibit fertility. But the biggest cause of infertility in both men and women is unknown, and the most common type of infertility is unexplained—doctors simply find no reason why a woman cannot conceive naturally; everything seems to be medically normal, but it’s just not happening. In Ontario, infertility is known to occur in one in six couples, and in 2008, the CFAS reported a combined total of almost 10,000 IVF procedures performed in the 28 clinics across the country. However, although it is the most effective treatment, IVF is usually not the first procedure that couples attempt.

According to Dr. Keith Jarvi, director of the Murray Koffler Urologic Wellness Centre and head of urology at Mount Sinai Hospital in Toronto, doctors often try to increase ovulation in women and the number of eggs they produce during ovulation. This is done through stimulation medications that women take for a period of time prior to the procedure, so the sperm have more targets to aim for. If the process, known as Intrauterine Insemination, fails more than once or twice, the next step may be the use of IVF.

“We take the eggs out, take the sperm out, and incubate them together in a dish,” says Jarvi. Once the eggs are fertilized, the doctors take as many embryos as they feel are necessary for optimal chances of conceiving and return them back to the woman’s uterus. If IVF doesn’t work this way, doctors perform Intracytoplasmic Sperm Injection as part of the procedure. “[With ICSI], you can take the sperm and bring it closer to its targets,” Jarvi explains. To do this, doctors take a single sperm and inject it into a single egg, (after they have been extracted from the couple), and then place the fertilized embryo back into the woman’s uterus.

The costs of these procedures ranges anywhere from $5,000 to $8,000 each, not including the cost of the drugs women may need to take at the same time. “And you’re probably going to end up doing it two or three times,” says Jarvi. “You could easily spend a compact car’s worth of money on it. It’s not Lamborghini kind of money, but still, it’s a lot of money.” The huge expense adds a financial burden to the already high emotional cost of infertility, says Shawna. “It is really unfortunate that [the decision to do IVF] has to be a financial decision.”

Beyond the financial or emotional considerations, IVF also has implications for the health-care system. Such procedures result in a high number of multiple births, for one; because IVF costs so much, doctors transfer more than one embryo at a time to increase the chances of one coming to term. Multiple births suffer more complications, and it costs the health-care system a lot to care for them. Many doctors say these multiple births end up costing the government more than publicly funding IVF treatments mandating a single embryo transfer would.

As birth rates continue to drop, many advocates, patients, and doctors alike say that provincial governments need to recognize that these procedures inflict high costs on individuals—emotionally and financially—and additional economic costs on the public healthcare system. The solution, they say, is to make IVF a publicly funded treatment.

Most women spend a great deal of their lives trying to avoid pregnancy. We are taught to practise safer sex and use condoms and go on birth control. We do these things until we want to start a family, and it’s easy to assume that as soon as birth control stops, a pregnancy will occur. We’re conditioned to expect the process to happen naturally, like turning on a light switch. And when it doesn’t, we feel frustrated, angry, and confused.

“You feel at fault because you can’t do something that comes so naturally to everybody else,” says 39-year-old Charmaine Graham, of London, Ont., who has been through 11 IVF treatments. “You’re faced with people who are parenting children and they’re going through [general] parenting angst—they’re frustrated, they’re tired, they yell, they snap—and you just would do anything for that opportunity. I just wanted to go to the grocery store with a baby like everybody else.”

Graham says infertility can be an intensely isolating experience. Not only do women feel like outsiders for not being able to do something natural—and, arguably, what many women may feel is their unique duty—but they are further isolated by constant reminders of their failure.

“No matter where you go, every single person that you meet came from somebody’s womb. That is what we do as a human species—we procreate. And so there’s no way ever to escape that,” she says. “You have a lot of feelings that are paradoxical. You’re really happy for your sister when she gets pregnant, but you also want to smash her head up against the bathtub because you can’t. It’s very hard to live with those feelings all the time.” Of Graham’s IVF treatments four were fresh, and seven were frozen (frozen fertilized eggs are stored in case a fresh treatment fails, which is less expensive than starting again with another fresh treatment). While her husband, Jim, believes the experience ultimately brought them closer, Graham remembers how taxing the treatments were on their marriage at the time.

“You have to deal with the anger and frustration you might have with your partner as a result of them being infertile, or the guilt that you feel for being infertile. And then I have to make this man who loves me live with me when I’m fucking insane going through hormone treatments,” she says. “Women become so focused on just getting pregnant, it doesn’t even become about parenting anymore. Men don’t feel that they’re married to the woman they got married to. Something has hijacked their marriage entirely.”

This is one of the most compelling things about the struggle of infertility: it affects men and women very differently. Even if a man is the one with the issue, the procedure is still done on the woman because she is the child-bearer. “They’re the ones who have to do most of the drugs, they have to do most of the invasive technologies. They’re the ones being poked and prodded,” says Graham. “A man has to masturbate to get his sperm out. A woman has to have a probe put in her vagina, with a 22-gauge needle that goes through the side of her vagina into her ovaries to withdraw the eggs. I think it’s a very separating experience for most men and women.”

Other women agree with Graham that the reminders of what they can’t do never seem to cease. Some describe difficulty attending baby showers, seeing mothers with their children in the grocery store, and even walking by the Santa Claus display in malls around Christmas. And with all of these difficult feelings comes the worst part: paying out of pocket for a procedure that is not even guaranteed to work. No one knows that better than Kerri-Lyn Jessop, 37, of Caledon, Ont., whose three IVF treatments over two years have put her more than $30,000 in debt. “Unless you’re rich, that’s a lot of money to spend to find out an answer to one question,” she says. But it’s not enough to make her want to stop trying.

“Emotionally and physically, I’m not ready to give up, but there’s only so much money in the pot.”

Cheryl Dancey, 41, of London, Ont. agrees. She had 18 IUIs and four IVF treatments, none of which were successful. “As hard as everything else is, it’s not enough to stop you from doing it again. Money is the only thing that can make you not go on.” (Since our original interview, Dancey was able to give birth to a baby girl with the help of a donor embryo.)

Dancey says if IVF was publicly funded, half the burden of the experience would be gone. “It would take all that pressure completely away,” she says. “You wouldn’t have to worry, ‘Well, if I do it, we’re not going to have the house to put the kid in.’”

Many couples struggling with infertility turn to family and friends for financial help to pay for IVF treatments, which brings up the arduous task of explaining their situation to loved ones—something that can be very difficult to do.

“People don’t believe that it’s real,” Dancey says. “They say, ‘You’re not doing it right. All you have to do is relax. So-and-so’s brother’s cousin’s wife did this and she was fine.’ People just don’t get it. Everybody’s got some stupid story that somebody that they’ve known through the grapevine relaxed, or drank a certain tea, and that’s what will fix the problem.”

“The other thing that people also do all the time is that they stop talking to you,” says Graham. “I worked at the university and I was always very open about my situation. So, I’d go missing for a few weeks and I’d come back to work and people would say, ‘Where have you been?’ and I’d be like, ‘Making babies in a petri dish.’ And so everybody knew what I was going through. And then one of them would get pregnant and she wouldn’t come to my office for nine months.”

If IVF were publicly funded, couples could go ahead with treatments privately. They would also be spared having to deal with the naysayers who think seeking such treatment is selfish.

“By the time the government decides—if they ever decide—to fund this, it will be too late for us. My time will come and go by the time that it’s covered,” says Jessop. “We are speaking up for the next group of people that are coming into this. I don’t think I will ever benefit from [it], but I might be able to help somebody else benefit.”

The Ontario government established an expert panel in 2008 to take a closer look at ARTs, especially IVF, and whether it should be funded under the province’s health-care plan. It also examined adoption: its cost and its lengthy, complicated process. The panel released its recommendations this past August, which urged the government to institute a fertility education system, provide a funding strategy for IVF procedures, and make changes to the adoption process.

Dr. Jarvi provided expert advice to the panel, which also included Dr. Arthur Leader, a professor at the University of Ottawa and a partner at the Ottawa Fertility Centre. Both doctors agree that the most important public health reason to fund IVF is to limit the number of multiple births that result from multiple embryo transfers. Leader says that transferring multiple embryos is dangerous and more of a financial burden on the health-care system than IVF procedures would be.

“What the expert panel showed was that, by limiting the multiple birth rate in Ontario, you could save the taxpayer, over a 10-year period, half a billion dollars,” he said. “Twins are more likely to have medical or surgical needs in the first four months of life. The tremendous cost associated with having high rates of twins, never mind triplets, means that caring for them is actually costing the government more than it would have cost to fund IVF for single-embryo transfers.”

One of Leader’s patients became pregnant with twins through IVF. About halfway through the pregnancy, one of the twins died in utero as a result of a congenital heart defect. “It became a highrisk pregnancy,” says Leader’s patient, Kerri Stanford, who was 34 at the time. “We knew that one of the babies wasn’t doing well and was likely not going to make it. It just meant that the whole pregnancy was very complicated and it was watched in a high-risk unit.” Those high risks, of course, entailed high costs, exponentially more than a single healthy pregnancy would have. “Economically, there is a strong argument to be made to fund fertility services,” Leader says.

Leader has another reason he believes IVF should be added to provincial health-care plans: continuity of care for patients. “One of the paradoxes of infertility is that, in almost every province of the country, it’s medically necessary to do fertility testing in order to find out why people can’t get pregnant. In other words, the health plan pays for treatments to diagnose infertility. But once the diagnosis is made, the health plan abandons people, saying it’s not necessary to treat your problem. Then, once people get pregnant, the health plan says now it’s medically necessary to care for pregnant women. There’s a disconnect.”

Months after my first conversation with Shawna, I receive an email from her. “I should be 35 weeks pregnant now,” she writes, still lamenting her miscarriage. She goes on to tell me about one of the hardest parts of dealing with infertility: the public’s misconceptions about it.

“If I had a medical condition that prevented me from being able to walk,” she said, “and there was an effective medical treatment available, society wouldn’t question whether or not I should be able to access it. When someone is paralyzed, people think, ‘Oh my gosh, I could never imagine what that would be like.’ Nobody ever thinks, ‘What would my life be like if I didn’t have my fertility?’”

Advocates for IVF funding see it as positive that the Ontario government commissioned an expert panel to look at the issue, and Quebec’s new law is definitely a step forward. But it’s taking the rest of the country a while to catch up. Medical organizations have questioned Canada’s attitude toward funding, especially in comparison to other countries around the world, many of which do provide funding. Manitoba offers couples who have undergone treatment a tax credit for 40 percent of treatment costs. British Columbia now has the Hope Fertility Fund, which provides financial assistance to residents of the province who can’t afford treatment—commissioned by the UBC Centre for Reproductive Health, the Vancouver General Hospital, and the UBC Hospital Foundation, not by the government. The Nova Scotia government has previously deemed it not medically necessary to provide funding, and the rest of the country seems to agree.

Still, supporters remain hopeful. Beverly Hanck, executive director of the Infertility Awareness Association of Canada, believes all provinces will eventually cover treatment. “I suspect what’s going to happen, and this is my guess, is that they will put it on their platform for the next election,” says Hanck. “It’s a matter of time. But time is important for some of these couples.”

Time is indeed the enemy in the infertility battle. Women feel pressured by time because fertility decreases with age, and after an IVF treatment is performed, waiting to find out if they are pregnant can be excruciating. The burden of infertility is essentially a race against time. And so far, time is winning by a long shot.

Providing midwifery in a public health system presents challenges, but they're worth it. Creative Commons photo by Flickr user limaoscarjuliet.

In March 2009, Nova Scotia became the seventh province to incorporate midwifery into the public health care system. Instead of paying and arranging for the service privately, residents now have it covered and regulated by the provincial government.

Midwifery should be seen as the progressive (yet traditional) and cost-effective method of childbirth in Canada. But the upfront cost of creating a regulatory body for midwives, especially in smaller provinces with few practitioners, is offputting for governments. Still, this community-based model of birth, with its decreased hospital time (due to homebirths, shorter hospital stays for hospital births, and less frequent obstetrical interventions) and on-call services, creates significant long-term savings for the health care system.

Nova Scotia’s example offers important lessons to New Brunswick, Newfoundland and Labrador, the Yukon, and Nunavut, all of which will soon regulate midwifery. (New Brunswick will institute legislation and begin hiring midwives in just a few months.) Nova Scotia’s transition hasn’t come without kinks: there remains a shortage of midwives, a lack of public funds allocated to midwifery and the entire health care system faces geographical challenges—rural communities still have trouble accessing public services.

On the positive side, the change means that midwifery services will now be free in Nova Scotia, as they are from British Columbia to Quebec. “Just the very fact of covering midwifery in a provincial health plan and making that known will attract women of all different backgrounds,” explains Aimee Carbonneau, a Toronto midwife who has only ever worked in a public system. Ontario was the first province to regulate midwifery, in 1994. “If it is not supported and paid for by the government, you end up seeing a clientele that is mostly white, middle-class and up, with post-secondary education,” she says.

Maren Dietze, past president of the Association of Nova Scotia Midwives and a practicing midwife in Nova Scotia’s South Shore District, says regulation also gives midwives a new level of legitimacy: “Before we couldn’t deliver in hospital and we couldn’t order ultrasounds. Now we are accepted as part of the team.”

Midwife groups in Nova Scotia have struggled with successive governments since the early ’80s for public care, yet it remains available in only three of the province’s nine health districts. The other six District Health Authorities did not respond to the province’s call for model midwifery sites. According to Jan Catano, co-founder of the Midwifery Coalition of Nova Scotia, “The province didn’t want to roll out midwifery to the whole province at once because there were not enough midwives.”

Instead, a two-year budget for seven fulltime midwives was created. They work from sites in Halifax, Antigonish, and Bridgewater, leaving most of the province without access. Even if more midwives become available to Nova Scotia, from new graduates and a strong pool of internationally trained talent, the money isn’t yet budgeted to hire them.

Consequently, some midwives were essentially forced out of business in the transition.

To create universal access, Dietze says, “We would need more funding for midwives and we would need to be promoting midwifery to all the health districts,” so that local District Health Authorities demand the service and funding.

In the meantime, any Nova Scotian mother living outside the model districts in the centre of the province will lack access. And the situation is not unique to Nova Scotia. “I think for most of Canada, geography represents a big challenge,” Carbonneau says. “Many northern and especially Aboriginal northern communities are trying to bring birth back, but it’s quite tricky juggling the low numbers with the allocation of resources.” The Association of Ontario Midwives, for example, estimates its members serve only 60 percent of their demand.

Meanwhile, the three midwifery centres in Nova Scotia are swamped. And demand seems to be skyrocketing in some areas, such as Dietze’s South Shore District.

“A year ago we had five or six births here; now we have 40 on our books and we’ll have 70 or 80 people next year,” she says.

But, despite the increased demand regulation brings, midwifery is still not a financial priority in the province; compared to other health issues such as senior care or, more recently, H1N1.

The irony is that midwifery is less expensive than the medical model of childbirth, which treats pregnancy as an illness requiring costly medical interventions like drugs or surgeries. Further, midwives have a rich

Canadian history of catching babies in the most remote locations, especially when doctors weren’t available. In that traditional system, midwives went where doctors couldn’t or wouldn’t.

Now, as more provinces regulate midwifery, those remote areas are being left behind. Midwifery can’t properly be called “public” until access is universal.

To make that happen, more midwives are needed and that requires more Canadian midwifery graduates and greater integration of internationally trained midwives. Provincial governments need to make a special effort to promote midwifery to rural health districts and back up their words with trained midwives ready to live in and serve rural communities and First Nations reserves. And a culture change is needed in the medical institutions hosting midwives. To do their jobs properly, midwives need the freedom, flexibility, and mobility to provide homebirths and travel significant distances when necessary.

All of these changes require upfront investments, but collectively they will save taxpayer dollars currently being wasted on unnecessary birthing interventions and hospital stays that only hurt women and their families.

A frame from Mike Holmes' new book, "This American Drive." Courtesy Invisible Publishing.

When Mike Holmes passed through Toronto on his reading tour last fall, he warned the audience, “I’m a cartoonist, not an author.”

Holmes is, in fact, both. His latest work, This American Drive, is not just a novel with pretty pictures. Weaving traditional storytelling and elements of the graphic novel with unexpected ease, the book is Holmes’s memoir of his road trip from Halifax to his then-girlfriend’s parents’ home in Texas. Along the way he passes through the America of our imagination—full of fast food joints and rock ‘n’ roll icons.

Aside from Holmes’s dry wit and and hilarious drawings, the book is also pleasant to the touch. Its thick, textured cover and smooth cream pages alert the reader that Invisible Publishing’s books aren’t your average corner-store-comics fare. Publisher Robbie MacGregor stresses the importance of making books that are as appealing to the eye as to the brain. This small Nova Scotia publishing house makes a point of finding new authors who might otherwise slip under the radar.

Holmes says he’s never really noticed a difference between Canadians and the world south of the border—a fact he drives home in his book with a humourous illustration of the first few miles beyond the Maine border: a Tim Hortons, a Walmart, and an Irving station.

“Oh Maine. Come join us,” he coaxes from the page. “We’ll treat you right.”

One of the options the C.D. Howe Institute sees to avoid a major hit to the workforce as the Atlantic Provinces's populations age is to discourage early retirement and to offer incentives to working longer like allowing RRSP contributions later in life.

We’ll all get older, and start to slow down. It’s just a fact of life. But in the Atlantic Provinces, the population as a whole is getting older, and that’s going to lead to tough times ahead unless the provincial and federal governments step-in and make some changes.

A report released Monday by the C.D. Howe Institute says the region could face a shrinking workforce as soon as next year. As the baby boomers retire, the old-age dependency ratio (people aged 65 and over relative to the working-age population) is rising. This, coupled with low birthrates, high out-migration, and a declining workforce means there will be more people using public programs, like health care, than paying in to them.

Young people grow up, go to school and leave the Atlantic provinces in droves. I know this because I’m one of them. I lasted longer than some of my friends, and only headed West, earlier this year. A lack of meaningful employment and proliferation of low-paying jobs sent me packing.

Most of the people I graduated from high-school with also left within a few years. We didn’t stay at home to work, pay provincial and municipal taxes, or buy homes. Our children won’t be attending publicly funded schools so there’s a savings, but it’s really nothing compared to the rising health care costs as the population ages.

This poses the question: if there were no jobs for those of us born in the Atlantic Provinces, why would anyone want to move there from the rest of the country or abroad? According to the Howe Institute’s report, they don’t. In the last 25 years, out-migration has topped in-migration consistently, with the exception of  2007 when the two were almost equal.

The Howe Institute has suggestions to avoid a future where the Atlantic provinces are trapped under an enormous tax-burden caused by too few workers and too many people seeking health care and government pensions. They include motivating people to retire later by changing tax laws on pensions and RRSPs, prefunding pharmacare programs, and attracting more immigrants with the Provincial Nominee Program.

Aside from the PNP, these options sound like possible temporary fixes — they won’t change the fact that people will retire eventually, and there has to be someone there to take up their job when that happens. The real solution is to offer the remaining young people a way to build a life for themselves in the Maritimes, instead of heading for Toronto  or Fort McMurray.

[Image by kiringqueen. Used under Creative Commons]