Barriers to accessing abortion pills in Canada need to be addressed immediately as the procedure’s future in the United States comes under threat, advocates warn.
Pro-abortion groups have spent years pushing for universal coverage for medical abortions, which can be done safely at home instead of requiring a trip to a hospital or clinic. But with the prospect of constitutional rights for abortion being stripped away for millions of Americans, those advocates say Canada could see a spillover effect.
“We have to wait and see, but I suspect that we’ll see an increase in orders for (abortion pills) across the United States that could translate to drug shortages for the abortion pill in Canada,” said Dr. Dustin Costescu, an obstetrician-gynaecologist at Hamilton Health Sciences and an associate professor at McMaster University.
“I think people are going to start acquiring doses so that they can use the medication if they need to in the future.”
Fears over the future of abortion access in the U.S. were renewed Monday when a draft document was leaked to Politico suggesting the Supreme Court is poised to overturn Roe v. Wade, the landmark 1973 case that legalized abortion nationwide.
At least 13 states are poised to immediately ban the procedure if the court’s final ruling — expected in June or July of this year — reflects the draft decision. Over a dozen more states may quickly follow suit.
In Canada, the right to abortion is legal but the procedure is not always easily accessible for those who cannot make arrangements to visit a clinic.
Action Canada for Sexual Health and Rights says the average wait time for surgical abortions is one to two weeks, but can climb as high as five weeks for late-term abortion care, which is more rare but can be medically necessary.
Abortion pills — taken as a combined regimen of two medications, mifepristone and misoprostol — can help address those barriers, but advocates say access can also be limited.
“There is a common misconception that people can go just to their doctor or a walk-in clinic and immediately get the pill, and that is simply not the case right now,” said Action Canada access line manager Makeda Zook.
“Most providers aren’t even publicly listed, so we have to direct women to them. So just the stigma that still surrounds abortion limits access and knowledge.”
Abortion pills were approved by Health Canada in 2015 but didn’t become available until the beginning of 2017, with the two medications packaged together under the brand Mifegymiso. Various restrictions, such as a requirement that only specially trained physicians, and not pharmacists, prescribe the drug and watch the patient take the pill, were in place until that November.
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Every province and territory except Nunavut includes Mifegymiso under provincial health coverage. Federal health plans also cover the pills for Indigenous Canadians, refugees and prison inmates.
Zook said that coverage still allows some Canadians to fall through the cracks, however.
“It could be somebody with precarious immigration status,” she said. “It could also be an international student whose private insurance doesn’t cover abortion care. It could be a student with an Ontario health card but is going to school in British Columbia or Alberta.”
Without proper coverage, Zook says Mifegymiso costs between $300 and $400 per regimen.
While rural and Indigenous Canadians have faced the same barriers to accessing abortion pills that exist for clinical procedures — namely the lack of rural providers compared to urban centres — advocates say the COVID-19 pandemic has helped bridge that gap.
“Ironically, the pandemic has helped in terms of giving a boost to telemedicine abortion services, where people can get on a call with the doctor and get a prescription and then just go over to the local pharmacy to pick it up,” Joyce Arthur, executive director of the Abortion Rights Coalition of Canada, told the Canadian Press.
“There’s still a lot of work to be done in terms of improving that access as well. But it’s happening. And I think it’s a work in progress, but it’s certainly going to help a lot in terms of relieving the stress off of clinics and hospitals.:”
A study from the University of British Columbia published this January in the New England Journal of Medicine found that medication abortions accounted for 31.4 per cent of all abortions in Ontario from Nov. 7, 2017 — when restrictions were lifted — through March 15, 2020. Before the pills were approved, only 2.2 per cent of abortions were medical.
Use of abortion pills has also been rising in the U.S., where mifepristone has been available since it was approved by the Food and Drug Administration in 2000. More than half of U.S. abortions are now done with pills, rather than surgery, according to the Guttmacher Institute, a research group that supports abortion rights.
The FDA last year lifted a long-standing requirement that women pick up abortion pills in person. Mail delivery is also now allowed nationwide.
But several conservative-leaning states, spurred by the prospect of Roe v. Wade being overturned, have moved to restrict or ban access to abortion pills amid concurrent crackdowns on surgical abortions and their providers. A total of 19 states require a medical clinician to be physically present when abortion pills are given to a patient.
“Medication abortion will be where access to abortion is decided,” said Mary Ziegler, a professor at Florida State University College of Law who specializes in reproductive rights. “That’s going to be the battleground that decides how enforceable abortion bans are.”
Public Safety Minister Marco Mendicino said on Wednesday he will be speaking with the Canada Border Services Agency to make sure its staff know Americans seeking abortions can come to Canada for care.
Before any influx occurs, Zook says Canada needs to pursue universal coverage of the abortion pills, expand telemedicine services across the country and allow more health-care providers like family and walk-in clinic physicians to offer prescriptions.
“We need to take a real hard look at the access issues that are already plaguing this country … and ask, ‘Okay, how can we actually improve access for people in Canada and then meet the possible demand of folks coming from the States?'” she said.
— with files from the Canadian Press and the Associated Press
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