After a two-year-long approval process, the abortion pill will finally be available in Canada this spring. But with restrictions and cost issues, it won't be an immediate solution to Canada's access to abortion problems.
Sold under the name Mifegymiso (known better for its US name RU-486), the abortion pill is actually two pills—Mifepristone and Misoprostol. When taken sequentially the drug mimics a miscarriage and expels a pregnancy in someone up to nine weeks pregnant. The drug is already available in over 50 countries and it's included in the World Health Organization's list of essential medicines. "We're not breaking any new ground here, we're catching up," says Sandeep Prasad, executive director of Action Canada for Sexual Health and Rights.
The drug has been celebrated as an alternative method of abortion for those living in remote areas where accessing a surgical abortion would mean travelling great distances. Even in urban settings, where abortions are more readily available, it gives anyone wishing to terminate a pregnancy the option to do so in the privacy of their own home.
But access to abortion in Canada is complex, and the newly approved method comes with many caveats. For one, Prasad says, physicians will have to take a six-hour training course, while pharmacists will be required to do a three-hour course in order to prescribe the drug. "It is a barrier that will impact how many physicians we will see taking up and prescribing and offering medical abortions that aren't currently offering either medical or surgical abortions," says Prasad.
Another puzzling restriction is the gestational age approved in the Health Canada decision. The World Health Organization states that Mifegymiso can be used up to 63 days into pregnancy, whereas Health Canada has shortened that time period to only 49 days. That two week difference is significant, says Prasad. VICE did not receive an answer about the gestational age limit from Health Canada by the time of this writing.
Prasad also expressed disappointment that only doctors and pharmacists, not nurse practitioners, will be permitted to provide Mifegymiso, again limiting the drug's scope of access. But that may change in time, says Dr. Sheila Dunn, an associate professor and clinician investigator with the Department of Family and Community Medicine at the University of Toronto, who has studied medical abortions. Dunn hopes that as the abortion pill mainstreams, we will see nurse practitioners starting to perform what she calls a "fundamental service."
"You start somewhere and then you expand when you can say, 'Look, it's safe,'" she says.
With some training, Dunn believes any nurse practitioner or doctor who has the ability to monitor a miscarriage can also monitor a person's use of the abortion pill. "That would really improve access if that were adopted throughout all reasonably-sized communities."
Still, cost remains yet another barrier. At around $270, Mifegymiso will be cheaper than a surgical abortion. However, if you're insured under a provincial healthcare plan, surgical abortions are covered. But because Mifegymiso is technically a medication, it won't be.
That too may change. If the Liberal government moves forward with its plan to develop a national pharmacare strategy, Prasad hopes that Mifegymiso would be covered under that. Both he and Dunn hope that the provinces and territories will come around to covering the cost of Mifegymiso over time as well.
It's undeniable that Mifegymiso will represent a new option for terminating pregnancies via facilities that already offer abortions. But throughout Canada, where surgical abortion is only available in one in six hospitals, and not available at all in PEI, the onus to improve access to this service will fall on the shoulders of individual doctors, for now.
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