Correctional Services of Canada will be listing Mifegymiso on the CSC National Formulary as of April 1, 2018 following a listing recommendation by the Canadian Agency for Drugs and Technologies in Health (CADTH) and the CSC National Pharmacy and Therapeutics (NP&T) Committee.
Due to the time-sensitive nature of the medication, any request for Mifegymiso is to be addressed quickly and efficiently for people who are incarcerated in federal facilities. That said, while it is an important development in ensuring access to a complete package of sexual and reproductive health services, it is crucial that better access to Mifegymiso does not preclude people who are incarcerated from accessing surgical abortion care. Having access to Mifegymiso inside correctional facilities does not necessarily mean that people would want to terminate their pregnancy using Mifegymiso especially if they would have to experience the termination process inside the institution.
Barriers to Access
We encourage the government to:
People who are incarcerated have a right to health, as recognized in sections 85-86 of the Corrections and Conditional Release Act. Yet, they are often forgotten, undervalued, unconsidered, despised and deemed undeserving of quality and responsive health care. In fact, delivery and access to health care services within the federal correctional system is the number one complaint made to the Office of the Correctional Investigator, which highlights the dire situation of health care received within the federal correctional system. It is often assumed that prisoners don’t care about their health or are out to "trick us" (especially if they are people who use drugs or need pain management). It is also often assumed that the deprivation of health care services is a part of the punishment of incarceration when in fact, prisoners are entitled to receive equivalent or comparable health care to what people receive in the outside community.
Mifegymiso being added to the formulary is a step in the right direction in terms of ensuring people who are incarcerated have options when it comes to their reproductive health care but, in addition to stigmatic assumptions, overarching systemic barriers to health care remain. They include but are not limited to: bed space and capacity, limited access to regional treatment centres and psychiatric hospitals, and the arbitrary nature of decisions being made by individual service providers in each facility. It is also important to highlight how people who are incarcerated are often not afforded timely and responsive access to health care facilities and staff, continuity and consistency of care, including as it regard access to their medication.
While Mifegymiso is now on the formulary, it is very important to look at what can facilitate or hinder access to a comprehensive package of sexual and reproductive health services for people who are incarcerated.
1. Actively address what contributes to the disproportionately high rate of incarceration among low income, racialized and Indigenous populations, including Mandatory Minimum sentencing laws.
2. Ensure the equitable, easy and timely access to comprehensive a package of reproductive and sexual health services for all people in federal facilities, including cost coverage of Mifegymiso. To this end, while Mifegymiso is now the Correctional Services of Canada formulary, it must not preclude people from accessing surgical abortion care if they prefer that option. If people choose to terminate a pregnancy using Mifegymiso, accommodations must be made to ensure privacy and comfort as well as access to pain management.
3. Institute needle exchange and safe tattooing prison programs to address HIV and HCV prevention needs.
4. Ensure easy access to nasal spray naloxone kits in response to the fentanyl crisis.
5. Ensure the better access to community-based organizations that support the physical, emotional, spiritual and psychological well-being of incarcerated people during and after incarceration. Building on the progress made on the timely access to HIV and HCV treatment for people in federal facilities, we encourage the federal government to assure continuity of care and a holistic approach to health care by facilitating the building of strong relationships with community-based organizations addressing health.
6. Support peer health ambassador programs to assist incarcerated people in addressing their overall health needs.
7. Implement the recommendations included in the Mother Baby Guidelines to ensure we uphold the rights of incarcerated parents to nurse and bond with their babies.
8. Give all trans prisoners the right to choose their gendered housing and ensure policies around searching and access to medical care upholds the right of trans people, including initiating or continuing hormone therapy.