Mifepristone, marketed in Canada under the brand name Mifegymiso, is a pill that, when taken with another drug called misoprostol, induces an abortion. It’s a method used in almost 60 countries worldwide, including the U.S., and is included on the World Health Organization’s list of essential medicines.
However, according to numerous health experts, a number of flaws, especially gaps in access, are tempering the new drug’s effect and need to be corrected.
Access to Canada’s abortion services “patchy”
Under Conservative leadership, Health Canada took an unusually long period of time — since December 2012 — to approve the drug and when it did, advocates celebrated its potential for expanding abortion access.
But upon closer inspection, some say the details of the regulatory decision mean access won’t change much after all, practically speaking.
And the issue is complicated. In the last 20 years, there has been a major shift in how and where Canadians are able to access abortion, going from mainly hospital-based abortion services to standalone abortion clinics.
Now, only one in six hospitals provides abortion care, and both standalone clinics and remaining abortion-providing hospitals are concentrated in urban centres.
That means women in rural and remote areas of Canada often have to travel long distances to access an abortion, covering travel costs and taking time off work to do so.
In February, the federal health minister called Canada’s abortion services “patchy” and said the Trudeau government will be looking into possible solutions.
Deep flaws in decision negatively affect access
Sandeep Prasad, the executive director of Action Canada for Sexual Health and Rights, says among the many flaws in Health Canada’s decision one in particular is that only physicians are authorized to administer the drug. Meanwhile, in many countries where medical abortion is widely used, nurses, midwives, pharmacists and other community health professionals are able to do so.
Canadian pharmacists agree with Prasad. When Health Canada made its decision public last July, the Canadian Pharmacists Association stated that it was “disappointed” that pharmacists would be unable to help provide access to medical abortion.
All in all, Prasad says, “right now, family physicians hold the biggest potential in terms of increasing rural and remote access [to abortion].”
But even so, he says the training requirements laid out in Health Canada’s decision could prove prohibitive. As of now, they require physicians to complete a six-hour training module. That may not sound all that cumbersome, but Prasad says that, for a busy MD, taking an entire day out of work could mean many will forego the training.
“With most drugs, information is made available for the physician and the physician uses their clinical judgement to prescribe the drug,” he says. Mifegymiso “should be no different than that.”
Anti-choice rhetoric, privacy politics and high costs
Another issue Prasad raises is that medical abortion providers will be on a private registry, making it difficult for patients seeking the service or doctors who want to refer their patients to find providers near them.
“The necessity of it is highly questionable,” he says. “It’s a decision that perpetuates abortion stigma, frankly.”
“Sadly, if such a list were made public, I am sure there would be an increased risk to any doctor on that list,” she says. “At the very least, I have no doubt anti-choice organizations would target doctors on such a list with harassing protests, phone calls and emails.”
Webster says this kind of resistance is especially true of the current political climate in the Maritimes. P.E.I. announced in late March it would soon provide access to abortion services in-province for the first time in almost 35 years after pro-choice advocatesannounced they would file a legal challenge against the provincial government.
“There are many anti-choice doctors in the province, and, I am sure, across Canada, who will have no interest in prescribing Mifegymiso or even referring to a doctor that will,” Webster says. “I think it will take time.”
And even if all other access hurdles are cleared, the drug is fairly cost-prohibitive for people with low incomes, at $270 per package. “Of course, we’re hoping the provincial governments will cover the costs of this medication,” says Suzanne Newman, a Winnipeg family physician and abortion provider, but provinces will be implementing their individual policies on the drug in the coming months.
The good news, Webster says, is that people might soon no longer have to rely on the pro- or anti-choice sentiment of their closest physicians. “Interestingly, there are a few states in the U.S. now using telemedicine to provide patients with the abortion pill. I think this could be a fantastic way to help people in rural areas access the service.”
Newman agrees. “The logistics haven’t, as far as I know, been worked out yet, but I believe this will open up access to women in the north or rurally.”
Push for further change
More good news, Prasad says, is that Health Canada’s July decision isn’t the end-all-be-all of medical abortion access in Canada, and his organization will continue to press the government for further changes — one of those being a government-mandated minimum requirement for all Canadian hospitals to provide either surgical or medical abortion services.
In a 2002 study from the Guttmacher Institute, a U.S.-based reproductive justice think tank, found that in many European countries, “it has taken a decade or longer for mifepristone to be fully recognized and integrated as a method of abortion.”
“Only time will tell if Health Canada will work in cooperation with national and international experts in the field to really enable Mifegymiso to become a game changer in terms of more equal access to abortion services across Canada,” Webster says.