Abortion pills are slowly returning to some pharmacy shelves after a shortage that left Canadian women and people who can get pregnant across the country in a lurch for more than two weeks.
Linepharma, which manufactures mifepristone and misoprostol — the drugs sold together under the brand name Mifegymiso in Canada — has confirmed product is being shipped out to providers across the country.
“The product was (quality assured), released on Monday and is now available for sale. Most back orders were fulfilled yesterday,” a spokesperson for the company said.
The delay was the result of multiple issues that the company says came to a head “simultaneously.”
“This is a very niche product that cannot be produced in the same volumes as most drug products, so when a delay occurs, it is felt acutely,” the spokesperson told Global News on Friday.
While the manufacturing issues appear to have been resolved, abortion care providers say their access to Mifegymiso hasn’t quite gotten back to pre-shortage levels.
“We are seeing some stock returns today. Today is the first day that we’re hearing from our pharmacy partners that they will have some stock in,” said TK Pritchard, executive director of The Shore Centre, a reproductive health clinic in Waterloo, Ont.
“However, that is still a limited number of pharmacies, and we’re expecting that more will have stock by the end of the week at the latest.”
Jill Doctoroff, the executive director of the National Abortion Federation (NAF), echoed Pritchard’s cautious optimism.
“I think it’s a bit too early to say,” she told Global News in an interview.
“I do know that when I sent out a message to the abortion clinics and providers that I work with, everyone was thrilled and basically getting in touch with pharmacies that they work with to make sure that they were adequately supplied over the holidays and beyond.”
The abortion pill can be taken up to 10 weeks into a pregnancy. And delays in access to the medication over recent weeks, Doctoroff noted, mean it may already be too late for some pregnant people to access a medication abortion.
Each day without access to the abortion pill can push people out of the 10-week window during which they’re able to access a non-surgical abortion.
And for people who passed the 10-week pregnancy mark during the more than two-week shortage of the abortion pill, the logistical hurdles for accessing abortion care grow.
“There was definitely people who were no longer able to have a medication abortion, because there is no supply available to them,” Doctoroff said.
People who can no longer access a medication abortion will have to go the in-clinic route — which isn’t offered in every city in Canada. That means they’ll have to overcome hurdles such as getting time off work, finding child care, and travelling whatever distance is needed to find a city with surgical abortion services.
It doesn’t help that the abortion pill shortage has hit at a time when many clinics are set to close for the holidays.
“Medication abortion is a time-sensitive issue,” Pritchard said.
“It’s really important that people have timely access at any point in the year, but particularly coming into a time where many of the clinics are closed,” Pritchard said.
While Pritchard said they were able to access Mifegymiso for all their clients, it wasn’t without serious struggles.
“It’s taken a lot of work, a lot of background calling pharmacies all over the place, trying to find out who has stock, going outside our community when we’re supporting people in rural communities, going significantly outside those communities,” they explained.
Providers out west, however, weren’t so lucky. Pritchard said some areas had “nothing.”
“They couldn’t get any help,” Prichard said.
Why would someone prefer a medication abortion?
There are many reasons why someone might prefer a medication abortion to an in-clinic option.
Some might simply prefer the privacy of that kind of abortion. For others, it’s about convenience — it can be far more difficult to arrange child care so a person can head into a clinic to undergo a surgical abortion. For many people, it might make more sense to stay in the comfort of their own home and take the medication.
Medication abortion can also be “a bit more discreet,” Pritchard said.
“Sometimes we support people who are experiencing intimate partner violence, or have unsupportive families and accessing medication abortion allows them to have a more discreet experience that we can safely plan around and provide support.”
Other patients have experienced some form of sexual trauma and “might not feel comfortable with a surgical abortion.”
“I know medication abortion can be an option and that feels a little bit more in their control, a little bit less invasive in some ways,” Pritchard explained.
Issues with abortion pill access exist beyond shortage
While access to Mifegymiso is set to return to normal levels, abortion care providers are sounding the alarm that access to the abortion pill remains a challenge — even when there isn’t an official shortage.
A key problem, they said, is not all pharmacies stock the medication.
“We definitely have challenges at the pharmacy level around medication abortion,” Pritchard said.
“Those mostly stem from pharmacies who don’t stock and, you know, stocking was another piece that could have mitigated some of this issue.”
For some pharmacies, the issue is cost. Mifegymiso is an expensive medication with a shorter shelf life — meaning it can get expensive for pharmacies to maintain a larger stockpile.
However, most pharmacies have found a way around that issue.
“We’ve seen most of our pharmacy partners mitigate that by keeping a limited number of stock on hand or ordering it when they need it,” Pritchard said.
Another problem Doctoroff has encountered at the pharmacy level is a lack of education around Mifegymiso.
Many pharmacists, she said, don’t realize the requirements to provide the abortion pill to a person have loosened over the years — and others don’t realize it’s covered through provincial health care.
“We’ve also heard about some pharmacists charging people for the medication because they don’t realize that it’s covered for people who have valid health insurance from the province or territory where they’re accessing it,” she said.
“There’s definitely a need for some additional education and support for pharmacists.”
The biggest issue abortion care providers encounter, however, is pharmacists who are anti-abortion.
“Most commonly, what we have run into is pharmacies that disagree with abortion and won’t stock,” Pritchard said. “Similar to doctors, pharmacists have their right to refuse.”
This moral objection can create massive hurdles for pregnant people who are trying to access a medication abortion — especially in rural areas.
“If you’re the only pharmacy in town, this is an essential medication,” said Doctoroff.
“It needs to be carried regardless of the personal opinion of the pharmacist.”