Cost coverage is a crucial first step to ensure people can access Mifegymiso. That said, right now, policies and regulations that rule abortion access or the handling of Mifegymiso can still make access to it really difficult. Can nurse practitioners prescribe Mifegymiso in your province? Do you still need to travel hundreds of kilometers to find a health care provider who prescribes it? Can abortions be accessed only in hospitals in your region? Are you able to access an ultrasound in a timely manner?
As Mifegymiso becomes available free of charge in some provinces, steps need to be taking from all fronts to ensure abortion services are accessible for all people in Canada.
Here are the steps we need to see from different actors
Provincial, territorial and federal governments
1. Follow the lead of provinces where universal cost coverage has been achieved and ensure that once a pledge is made, Mifegymiso is available in the timeliest way possible.
2. Create a billing code for medical abortion to ensure that the gold standard of abortion care can be offered by all prescribers.
3. Remove policies that compromise access to abortion. For example, New Brunswick and Prince Edward Island need to start funding abortions and ultrasounds provided outside of hospitals.
4. Provide programs that ensure Mifegymiso is accessible for all, not just a few of us, such as medical abortion by telemedicine and in clinics where undocumented or uninsured patients can access care.
5. Examine ways to support appropriate task-shifting in the provision of medical abortion, to allow and train other health professionals (such as nurse practitioners and midwives) to provide these services.
6. Ensure the safety and integrity of Mifegymiso prescribers and all abortion providers by introducing Safe Access Zone that reflect the needs and demands of health care providers working both from and outside of abortion clinics and/or hospitals.
7. Ensure health care providers (including new prescribers and other providers like those offering ultrasounds) receive the necessary support to offer Mifegymiso in a timely way, including in remote and rural areas. This means supporting practitioners who need guidance, supporting communities of practice and developing the appropriate resources for prescribers to feel empowered to offer this service. This can also look like offering easy to read evidence-based information on medical abortion on Ministries of Health’s websites to ensure the public can access reputable information on the matter.
8. Ensure the public has access to high quality, comprehensive and evidence-based information on abortion care, including medical abortion by making that information available and easily accessible on the ministry of health websites to counter misinformation and fear mongering about abortion.
Professional bodies regulating physicians and pharmacists
1. Follow the lead of the physician and pharmacy regulatory colleges in the provinces of British Columbia, Ontario, Nova Scotia, Alberta and Saskatchewan to provide guidelines that support pharmacist dispensing directly to the patient.
2. Avoid introducing additional restrictions to further control the prescribing and dispensing of Mifegymiso in addition to those already put in place by Health Canada and, in effect, restrict access to medical abortion.
3. Support members in becoming prescribers and dispensers by ensuring that they receive the training and material they need as well as ensure they are connected to communities of practice. Health care providers can help each other and share information and expertise to ensure medical abortion is increasingly integrated into primary care.
Professional bodies regulating nurse practitioners
1. Follow the lead of the College of Nurses of Ontario, the first nursing governing body to support their Nurse Practitioners to prescribe Mifegymiso. The college has stated that Nurse Practitioners who have the knowledge, skill and judgment to prescribe Mifegymiso and who can manage all possible outcomes are legally authorized to prescribe it. Similarly, Yukon, Alberta, Nova Scotia and British Columbia have announced their support of NP prescribing.
2. Support members in becoming prescribers and dispensers by ensuring that they receive the training and material they need as well as ensure they are connected to communities of practice.
Professional bodies regulating midwives
Canadian midwives are well placed to provide full spectrum reproductive health care. Follow the lead of bodies like the Association of Ontario Midwives and the Canadian Association of Midwives who are taking a pro-choice position and are vocal on their interest in adding medical abortion to their regulated practices.
1. Support members in becoming prescribers and dispensers by ensuring that they receive the training and material they need as well as ensure they are connected to communities of practice.
All health care providers
including doctors, nurse practitioners and pharmacists
1. Ensure medical abortion becomes a part of your practice so people’s access to a complete package of sexual and reproductive health goods and services doesn’t depend on where they live. It is crucial that uptake of medical abortion and its integration in primary care is taken seriously by individual providers to truly realize the potential of medical abortion in addressing historical gaps in access to abortion care in Canada. Click here to join this community of practice and get to know other professionals like you who prescribe or dispense Mifegymiso in their communities!