Access to abortion in Canada: will RU-486 make a difference?

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On Wednesday, July 29, 2015, Health Canada officially approved the pharmaceutical agent RU-486 (Mifegymiso). This drug can cause medical abortions, and is used as an alternative to surgery for early abortions. It will be marketed as Mifegymiso in Canada and as approved, contains two active ingredients – mifepristone and misoprostol. Mifepristone blocks the production of progesterone, which is required to sustain a pregnancy. Misoprostol causes uterine contraction. Studies show that the combination drug Mifegymiso is 95-98% effective in causing a miscarriage (1).

RU-486 has been legally available for 25 years in France, and was approved for use in the United States in the year 2000 (2). In Canada, Mifegymiso will be available to women up to 7 weeks into their pregnancy, as measured by the last day of their previous menstrual period. The drug will require a prescription from a doctor, as well as a follow-up medical visit (1). It is strongly recommended that women who take Mifegymiso have access to emergency care to treat rare complications, such as pelvic infections and vaginal hemorrhages, that may arise from its use.

This development has been a long time coming. The Supreme Court struck down previous Canadian abortion laws in its 1988 Morgentaler v  The Queen decision (3). Since that time, no political party  has been successful in passing new laws to limit abortion, so there are currently no legal restrictions on abortion in this country. According to the federal government’s interpretation, the Canada Health Act considers abortion as a medically necessary procedure. This means that the government provides funding, and provinces must deliver the service. Be this as it may, there are significant problems regarding access to abortion in Canada (4).

Table 1: 5 Principles of the Canada Health Act

PUBLIC  ADMINISTRATION Administration of provincial health insurance must be carried out by a public authority on a non-profit basis. They must also be accountable to the province or territory, and their records and accounts are subject to audits.
COMPREHENSIVENESS All medically necessary health services must be covered.
UNIVERSALITY All insured residents are entitled to the same level of health care.
PORTABILITY A resident that moves to a different province or territory shall continue to be covered by their home province for a minimum waiting period, after which time their coverage is to be assumed by the new province.
ACCESSIBILITY All insured residents must have reasonable access to health care facilities.

Source : http://www.canadian-healthcare.org/page2.html

It is true that the approval of this drug will improve access to abortion, however only for some Canadians. For example, women in Waterloo will soon be able to choose between having a surgical or a medical abortion in their own community. Previously, they had to go to Toronto for at least two visits to obtain a medical abortion (5). Resources (physical capital, consumables, human resources) also affect the accessibility of abortion services. There are only 3 healthcare centers that perform abortions in the Yukon, NWT, and Nunavut (6). Due to distance, these centers are not easily accessible to large segments of the Northern population, thus access to safe and timely abortions is an issue. One innovation that has been used to try to maximize physician coverage in low population density areas is telemedicine.

The World Health Organization has defined telemedicine as:

“The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities” (7).

Whether or not Mifegymiso can be prescribed remotely will make a difference to the impact this drug will have on access to abortion in the North. In addition, some are already looking to a possible future where regulations are relaxed, and nurse practitioners and/or pharmacists are allowed to prescribe the drug. Unfortunately, for many others, the issue of access to abortion is complex and won’t be immediately resolved through the arrival of Mifegymiso.

Lastly, access issues start with funding. For example, Prince Edward Island provides no funding for abortion clinics, so women on the island must travel to approved clinics in New Brunswick or Nova Scotia to have an abortion (6). Moreover, the approval of Mifegymiso may improve the availability of abortion services on PEI – provided that there are doctors willing to prescribe it. There is also the question of who will be responsible for the bill.

In short, the approval of Mifegymiso will provide more options and better abortion services where they already exist, as well as in areas with good physician coverage; however, more work will be needed to improve access to this procedure in remote/rural areas.

 

References

  1. Health Canada (2015). Regulatory decision summary Mifegymiso. Retrieved from http://hc-sc.gc.ca/dhp-mps/prodpharma/rds-sdr/drug-med/rds_sdr_           mifegymiso_160063-eng.php

 

  1. Encyclopaedia Britannica (2015). RU-486. Retrieved from http://www.britannica.com/science/RU-486

 

  1. AbortionLaws.ca (2013). Abortion Law in Canada. Retrieved from http://www.abortionlaws.ca/1980s.html

 

  1. Canadian Medical Association Journal (2006). Abortion: ensuring access. Retrieved from http://www.cmaj.ca/content/175/1/9.short

 

  1. Canadian Broadcasting Corporation (2015). RU-486 pill to improve abortion access in Waterloo region. Retrieved from http://www.cbc.ca/news/canada/ kitchener-waterloo/ru-486-pill-to-improve-abortion-access-in-waterloo            region-1.3174825

 

  1. Abortion Rights Coalition of Canada (2015). List of abortion clinics in Canada. Retrieved from http://www.arcc-cdac.ca/list-abortion-clinics-canada.pdf

 

  1. World Health Organization (2010). Telemedicine: Opportunities and developments in member states. Retrieved from http://www.who.int/goe/publications/goe_telemedicine_2010.pdf
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Nicole Haywood

Associate editor for the IJHS. Bachelor of Health Sciences, class of 2014, University of Ottawa.

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