Leanne Parrish, along with hundreds of other pro-choice supporters, met at the Human Rights Monument in Ottawa to call upon the city to do more to protect those going to and working at the Morgentaler abortion clinic. Allegations that anti-abortion protesters are harassing patients and staff headed into The Morgentaler Clinic on Bank Street have attracted attention across Canada.
But an “abortion pill” that has been available since January is poised to shift the entire abortion paradigm. Mifegymiso is a two-drug non-surgical option for early-term “medical” abortion. It can be prescribed by any trained and registered physician and dispensed by a pharmacist. Mifegymiso won’t eliminate surgical abortions, but it is expected to ease abortion access for women who live in remote and rural areas, decrease wait times in cities and help reduce the threat of harassment and intimidation for patients and physicians.
“It would prevent the sort of thing that’s happening in Ottawa,” said family planning specialist Dr. Dustin Costescu, an assistant professor at McMaster University and one of the lead authors of medical abortion guidelines for the Society of Obstetricians and Gynaecologists of Canada (SOGC). A protester stands outside the Morgentaler Clinic at 65 Bank Street in Ottawa Thursday April 20, 2017. Tony Caldwell / Postmedia Network So far, more than 1,300 Canadian physicians and pharmacists have taken a required online course offered by SOGC that qualifies them to prescribe or dispense the drug. About 20 more sign up every day.
Meanwhile, a Planned Parenthood Ottawa initiative is aimed at smoothing out the barriers that prevent physicians from offering medical abortions. The program will link women seeking an abortion to physicians who are trained to prescribe Mifegymiso and pharmacists who will dispense it. It is to be launched in the next few months. “The whole thing about the abortion pill is that you don’t have to go to an abortion clinic,” said Catherine Macnab, executive director of Planned Parenthood Ottawa.
She sees a day when medical abortions are available through telemedicine. Mifegymiso will change the landscape for patients, but doctors have to see the potential first, said Macnab. “It’s a big innovative change in reproductive health. We want to be able to say, ‘You don’t have to be an abortion clinic to offer this.’ ” Lots of physicians are interested in providing the drug, but there are many “micro-barriers,” said Macnab. “We wanted to see what would happen if we dismantled all the micro-barriers.” Among those barriers: Doctors who prescribe Mifegymiso must take a SOGC course, which typically takes six hours online.
At the same time, according to the original Health Canada rules, getting the drug to the patient was a multi-step program. First, there’s an ultrasound to determine that the woman is in the early stages of pregnancy. According to Health Canada guidelines, Mifegymiso can only be administered in the first seven weeks of pregnancy, although it can be prescribed “off label” for up to 10 weeks. Second, a doctor has to prescribe the drug. And third, a pharmacist has to dispense it. Until recently, the patient would have to take the prescription to a pharmacy to be dispensed, then the drug would have to be delivered to the doctor’s office so the patient could take it there.
Doctors could also dispense Mifegymiso, but that would mean keeping a supply of the drug on hand at a cost of about $300 per dose. “It’s a lot to expect doctors to take this on,” said Macnab. Essentially, the only physicians who were prescribing it were those who already worked in abortion clinics. Last month, the College of Physicians and Surgeons of Ontario cleared away one of the barriers.
Now, patients can take the prescription to a pharmacy and receive the drug themselves. The product monograph says Mifogymiso should be “administered under the supervision of the prescriber,” but Health Canada said physicians can use their own discretion and the drug does not need to be taken in the presence of the prescriber. What’s more, in Thursday’s provincial budget, the Liberals said Ontario would publicly fund Mifegymiso some time in 2017 as part of an expansion into health care options for women. Planned Parenthood Ottawa has spent the past two years trying to build partnerships with physicians so it could offer confidential referrals to those who are willing to prescribe Mifegymiso.
“We hear that doctors don’t want to be public about this,” she said. Planned Parenthood plans to introduce a “toolkit” in June if it gets at least one physician and one pharmacist on board. Macnab is hoping for five of each, as well as a network of ultrasound clinics. Costescu agrees that confidentiality and freedom from harassment are a common concern for doctors. “The Ottawa case points this out. Clinics are often harassed.” One in three Canadian women will have an abortion. In Ottawa, abortions are available in one hospital and two private clinics. Medical abortions are available at the hospital and one private clinic.
There is typically a wait time of about two weeks in this region, but that has stretched to seven or more weeks if the clinics don’t coordinate their holiday closings, said Macnab. Aside from that, in what can be loosely defined as “eastern Ontario,” abortions are also performed in hospitals in Peterborough, North Bay and Kingston.
If every small town had a general practitioner who is comfortable with medical abortion, women wouldn’t be forced to travel long distances, said Frédérique Chabot, health information officer for Action Canada for Sexual Health and Rights. “Even a few service providers in a region makes a big impact.” The Planned Parenthood project will create a blueprint for access across Canada, she said. “We’re hoping this can be exportable to other regions.” Medical abortions don’t change the number of abortions in countries where they are readily available — but they do change the type of treatment that women seek out, said Costescu.
In France, where medical abortions have been available for almost 30 years, about 70 per cent of abortions are medical and the remainder are surgical, he said. But it depends on how the prescribing-dispensing system works. In the U.S., where medical abortions are available mostly in clinics, only about 10 per cent of abortions are medical.