Abortion

An abortion is the ending of a pregnancy. Access to safe, legal abortion varies substantially around the world. There are no federal restrictions on abortion in Canada though in certain provinces and communities abortion is unavailable or only available until a limited gestational period.

[Op-Ed] The GNWT Must Remove All Barriers to the Abortion Pill

Op-ed published in Edge North

In November, NWT Health Minister Glen Abernethy said the territory would cover the abortion pill (branded as Mifegymiso in Canada) for residents who do not have any other form of health insurance.

FOXY (Fostering Open eXpression among Youth), the Midwives Association of the Northwest Territories,Northern Options for Women and Action Canada for Sexual Health and Rights wrote an open letter to the Premier asking him to go even further and provide universal cost-coverage for the abortion pill, and give healthcare providers other than physicians, such as midwives and nurse practitioners, the authority to prescribe it.

Some might say that partial coverage is better than no coverage. But we know from evidence across other provinces and territories that without universal cost-coverage, people can’t access the services they need and are entitled to.

In the case of the abortion pill, it means some people don’t claim the drug under their private insurance fearing disclosure to family members because they are covered through a spouse or parent. It means that some people who have private insurance may only be covered partially or not at all.

Private insurance often means dealing with co-pays, deductibles, paying upfront and filling out complicated paperwork only to be reimbursed later. This creates undue financial and administrative stress to many, especially when the abortion pill costs anywhere from $350 to $450.

We also know that the abortion pill is time sensitive, accessible only within the first nine weeks of pregnancy in Canada. There is often no time to navigate insurance claims that can delay and ultimately jeopardize access to this necessary medical procedure.

Alongside universal cost-coverage and in an effort to reduce delays, the government needs to allow midwives and other healthcare providers to prescribe the abortion pill – in addition to physicians.

This is crucial in Canada’s north where residents sparingly have access to a doctor.  Northern Options for Women is a program that provides abortion services to people in the NWT. Their mission is to provide accessible, non-judgmental, evidenced-based abortion care. With more support from the government and the expanding ability of midwives and nurse practitioners to prescribe the abortion pill they could support increased access to abortion services and care in the NWT.

We know what the harmful impact of barriers to abortion, such as cost, look like. Barriers increase the number of unsafe abortions and the burden placed on those who are forced to travel long distances to access care. This disproportionately impacts young people, low-income earners and those living in rural and remote communities.

To address these issues, the NWT government must implement universal cost-coverage for the abortion pill and expand prescribing authority of the drug. Together, this will meaningfully begin to dismantle unjust barriers that prevent access to this medically necessary service.

If the NWT government provides universal cost-coverage to the abortion pill – just as nine other provinces and territories in Canada already have – it would reduce health inequities and improve accessibility, especially for people in rural and remote communities. It would also reduce the overall health care costs for abortion procedures, given the travel required to regional hospitals as well as hospital time for patients undergoing an abortion.

If healthcare truly is universal, access to abortion shouldn’t depend on your postal code.

Beyond equal access to health, increasing access to abortion care is a gender equality issue, and a human rights issue.

Universal cost-coverage of the abortion pill, and allowing midwives and nurse practitioners to prescribe the pill, has the potential to greatly advance reproductive rights in the NWT. When reproductive rights are secured, people are best placed to decide if, when and how many children to have, to have families in supportive environments, to exercise their right to health and bodily autonomy, to live empowered lives.

Governments in British Columbia, Alberta, Ontario, Quebec, New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland and Labrador, and soon in the Yukon, have implemented universal cost-coverage programs to ensure their residents have access to the abortion pill – so why not in the NWT?

Candice Lys holds a PhD in Public Health, is co-founder/executive director of FOXY/SMASH and lives in Yellowknife. Sandeep Prasad is executive director of Action Canada for Sexual Health and Rights in Ottawa.

Universal Cost-Coverage for Medical Abortion in Northwest Territories

Letter addressed to the Honourable Bob McLeod, Premier of Northwest Territories and the Honourable Glen Abernethy, Minister of Health and Community Services

RE: Universal Cost-Coverage for Medical Abortion

Dear Premier McLeod and Minister Abernethy,

Congratulations!

We are writing you today on behalf of a working group of key stakeholders including health care providers, professional organizations, medical students, and community advocates who have joined forces to advocate on behalf of the advancement of reproductive rights throughout the Northwest Territories. We are incredibly pleased to see that your government has recognized the importance of cost coverage for the medical abortion pill, Mifegymiso.

As you deliberate the details for your cost coverage program we appreciate the opportunity to offer the information below which details the best possible standards for cost-coverage. Coverage for Mifegymiso should be universal as has been exemplified by provinces and territories across Canada. It is both necessary and possible for communities like ours to have unrestricted access to medical abortion to ensure that the people of NWT have equal access to their reproductive rights.

It has been shown that restricting access to abortion care does not decrease the number of terminated pregnancies, it only increases the number of unsafe abortions and the burden placed on those who are forced to travel long distances for care. Those most affected by lack of provision are those who need it the most: young, low-income earners in rural communities. They face poorer sexual health outcomes and are most vulnerable to the compounding effects of the emotional, physical, and economic burdens of travel.

While a large number of people in the NWT are covered under the NIHB formulary, 50% are not. While providing coverage to those without insurance will help some; evidence shows that those who are insured still face multiple and confusing barriers, including co-pays, deductibles and the filling out onerous formularies. In many cases individuals are insured under their parents or spouses and the requirement to disclose to a family member will prevent them from accessing their abortion and might compromise the safety guaranteed by confidentiality. People who seek abortions are sometimes young and have fewer resources and understanding about how to engage with bureaucratic processes. As well, as you know, abortion is a time sensitive procedure, the need for which is never predictable. Medical abortion is even more time sensitive than surgical. Having to understand and navigate insurance claims will delay access to an essential medical procedure.

The NWT must join the other provincial governments working to ensure our health care system remains universal by ensuring financial coverage for medical abortion.

Thus, we call upon the Government of Northwest Territories to provide universal cost-coverage of Mifegymiso as a central part of your government’s plan to improve gender equality, and support the right to bodily autonomy, safety, and health. We thereby urge the Department of Health and Social Services to:

  • Provide universal cost coverage of Mifegymiso to all persons in the NWT
  • Support the NOW program, with both funding and capacity, to investigate options to provide Mifegymiso in communities with on site providers (MD or Midwives)
  • Facilitate the addition of Mifegymiso to the Pharmacy List for Registered Midwives in NWT

The professional signatories of this letter include a range of experts who are committed to working with your team in an advisory capacity to help ensure a comprehensive and effective approach to cost coverage rollout across the territory. The wide breadth of knowledge and expertise represented in our group will ensure collaborative, well-rounded, and comprehensive support to developing a provincial approach that will effectively reduce the current barriers in access to abortion services while maintaining high standards of care.

Universal coverage of Mifegymiso is a matter of reducing health inequities, and ensuring fairness and equity, without discrimination on the basis of income or remote location. By removing the financial barrier of Mifegymiso and in working to ensure take up of this important medical practice, your government has a momentous opportunity to fulfill an unmet responsibility to optimizing the health ad support people and families from across the territory.

We thank you for taking on this important work we look forward to your response.

Sincerely,

Candice Lys, PhD (Public Health), Co-Founder/Executive Director FOXY

Sandeep Prasad, Executive Director
Action Canada for Sexual Health and Rights

Heather Heinrichs, RM, IBCLC, President Midwives Association of the Northwest Territories

Shireen Mansouri, MD CCFP FCFP, Family physician Director of Northern Options for Women NTHSSA YK region

 

[Statement] NorthWest Territories announces coverage for Mifegymiso

Action Canada for Sexual Health and Right congratulates the government of the Northwest Territories on its commitment to cover the abortion pill Mifegymiso. The announcement comes one day after Yukon committed to covering the cost of the pill.

By making this verbal commitment, the government of the Northwest Territories is recognizing the importance of Mifegymiso for improving access to reproductive healthcare, especially abortion access in northern Canada.

As the government now deliberates on its cost-coverage program, it is of utmost importance that the territory considers universal cost coverage. In doing so, NWT would join the Yukon and 8 out of 10 provinces that offer or have committed to offering universal cost-coverage to its residents.

The abortion pill has the potential to change the landscape of access in rural and remote regions of Canada, including the northern territories. Everyone in Canada, no matter where they live, is entitled to a comprehensive package of sexual and reproductive health services, and that includes access to safe abortion and abortion care.

Yukon government will finance abortion pill

Palak Mangat, Whitehorse Star 

Yukoners hoping to access abortion will now have an alternative that will be fully covered by the territorial government, thanks to a partnership with the Yukon Hospital Corp.

It comes after the territory began rolling out universal coverage of Mifegymiso on Wednesday. It’s a measure the government hopes will reduce the barrier to accessing abortion medication.

Those interested will have four main hubs to choose from, with full-time resident physicians prescribing the medicine out of Haines Junction, Dawson City, Watson Lake and Whitehorse.

That means somebody living in other communities where services are not being offered will need to travel to the closest hub.

“The decision to provide coverage is about providing better service for Yukon women,” Health and Social Services (HSS) Minister Pauline Frost said Wednesday, noting that it’s also expected to lead to a decrease in overall health costs.

“By providing coverage of the medication, we are allowing Yukoners to make the choice that is right for them, regardless of the cost.”

According to the department, the costs of that are as follows: the pill will be substantially less than a surgical procedure, setting a woman back by about $300.

The alternative can range between $1,200 and $1,400, which includes the doctor’s fee, anesthesiology and operating room costs.

Coverage of the medication is also a long time coming and will help put the territory on par with other jurisdictions across the country, the minister told the legislature Wednesday.

With the territory seeing upwards of 110 abortions per year, Frost explained that “during my time here, it’s come to my attention that it’s a priority for Yukoners.

“Right now, the only way of abortion is very intrusive,” she later added.

The territory is the eighth jurisdiction in the country to offer coverage for the drug so the announcement was welcome news, said Sandeep Prasad.

Serving as the executive director with Action Canada for Sexual Health & Rights, Prasad explained this morning that offering coverage does not necessarily mean more women will begin looking at terminating pregnancies.

In fact, through his work, he estimates the split between those seeking medical and surgical options in areas where both have been offered for a longer period of time sits at about 50-50.

An additional barrier to accessing the drug was who Health Canada permitted to prescribe it.

The drug was approved by Health Canada in mid-2015 and became available to the public in 2017.

Initially approved to be prescribed up to seven weeks (49 days) into a pregnancy, Ottawa approved it an additional two weeks in late 2017.

Health Canada also permits patients to take the medication either at home or a health facility, as directed by a professional.

As per federal regulations, those prescribing are required to have “appropriate knowledge” about it beforehand.

Health Canada notes that while education programs are available, professionals are no longer required to complete it before they can prescribe the drug.

An HSS spokesperson, meanwhile, confirmed this morning that requirements and procedures for prescribing the drug in the territory are set by Health Canada.

“The training that is required (now) is basically self-studying,” Prasad said, noting that doctors are encouraged to read up and exercise sound judgment when prescribing the combination drug.

“That doesn’t require formal training or courses as Health Canada once did require, but it can be done.”

Prasad noted his group has a 24-hour access line that receives calls from all over the country from those seeking abortion but don’t know where to go to access it.

He explained that anecdotally, some callers say their doctors can’t prescribe it because they haven’t done the mandatory training (which Health Canada had since revised).

“That’s a big piece of misinformation that’s out there,” he said, which his organization and others with the help of governments are trying to curb.

Prasad’s statements were echoed in part by Stephanie Buchanan, a general practitioner in the territory who is involved in women’s health care.

Continue reading on the Whitehorse Star

[Statement] Action Canada congratulates Yukon on the coverage of Mifegymiso

Action Canada for Sexual Health and Rights congratulates Yukon for becoming the first territory to offer universal coverage of the abortion pill Mifegymiso. Yukon now joins the majority of provinces working to improve access to this medically necessary service, especially in rural and remote areas.

Mifegymiso, the Canadian name-brand for the combination of Mifepristone and Misoprostol, is the World Health Organization’s gold standard for medical abortion and has been on its list of essential drugs for over a decade. The combination has been used for over 30 years with an outstanding safety and efficacy record and is available in over 60 countries around the world.

Too many people in Canada still experience major barriers when needing to access abortion services. By covering Mifegymiso, the Government of Yukon is addressing and mitigating these ongoing barriers. It will be crucial that health care providers such as family physicians, nurse practitioners and midwives take on the practice of prescribing Mifegymiso to ensure access to reproductive healthcare for residents of Yukon.

Action Canada is looking forward to seeing improvements to access to abortion in Yukon. We now expect that all remaining provincial and territorial governments who have yet to commit to cover Mifegymiso will do so soon. This is a question of avoiding a two-tiered system of abortion access in Canada. We need universal cost coverage across all provinces and territories.

Nurse Practitioners can now prescribe Mifegymiso in Saskatchewan

Action Canada for Sexual Health and Rights congratulates the Saskatchewan Registered Nurses Association on its assertion that prescribing the abortion pill Mifegymiso is within the scope of practice of nurse practitioners in Saskatchewan. Along with midwives and physicians, nurses have skills to safely deliver abortion care. Both Health Canada and the Society of Obstetricians and Gynecologists support a range of healthcare providers in becoming Mifegymiso prescribers.

Publicly affirming that Saskatchewan nurses may adopt Mifegymiso into their general practices has the potential to improve access to to abortion services across the province, especially in rural and remote areas where it is difficult for residents to have access to surgical abortions.

Abortion is part of pregnancy care and all nurses and midwives in Canada have the ability to improve access to the full package of reproductive health services.

The Future of Abortion Rights: An Interview on Sexual Health with Sandeep Prasad

The McGill Daily Written by: Visual by: Abortion Beyond Bounds Conference

Sandeep Prasad is the Executive Director of Action Canada for Sexual Health and Rights (Action Canada). After speaking at the October 11-12 Abortion Beyond Bounds Conference, hosted by the McGill Institute for Gender, Sexuality and Feminist Studies (IGSFS) and the Centre for Research on Gender, Health, and Medicine (CRGHM), Prasad sat down with the Daily to talk about the state of abortion care in Canada, and his work in the sexual health and rights field.

The Daily: Now that 30 years have passed since the decriminalization of abortion in Canada, how easy or difficult is it today to access abortion care in Canada?

Sandeep Prasad: Practical access to abortion care in Canada, despite thirty years of decriminalization, is still difficult. There are numerous barriers that still […] hamper the abilities of those seeking abortion services to actually access them. Things like uneven distribution of services, the concentration of services in urban centres, creates large distances that people still have to travel to access these services; these are of course compounded by other factors of oppression such as poverty or young age, making it even more difficult to access care. Fortunately, there have been steps in the right direction of expanding abortion access primarily through the role of mifegymiso [the Canadian trade name for the abortion pill mifepristone] within Canada, which is the [World Health Organization] gold standard of medical abortion. But at this point, there is a lot more work to do in terms of achieving an effective rollout of mifegymiso that would transform access to this drug. So there is promise in that, but at the same time, we also have to confront the realities of anti-choice actors who create barriers to access through misleading information, biased counselling practices, and through activities that stigmatize abortion. These make it far more difficult for those seeking abortion care to actually find the information they need to terminate an unwanted pregnancy.

MD: What is the role of Action Canada in this situation?

SP: Action Canada is Canada’s national sexual and reproductive health rights organization. As such, we have a number of issues that we focus on in the sexual and reproductive health and rights field, and abortion care is one of the key areas of this focus. Abortion work relates to both helping to ensure that accurate information related to abortion is out there for the public, and that through our access line, members of the public seeking to terminate pregnancy are supported with accurate, unbiased information about abortion procedures as well as referrals to the appropriate care nearest to them. We’re helping to connect people seeking to terminate pregnancy to services that they want. Furthermore, our organization is also engaged in policy work on abortion. We see that advocacy is critical to changing the landscape of abortion and have been prioritizing within that advocacy the universal cost coverage of mifegymiso, [and] ensuring that restrictions relating to mifegymiso are removed.

MD: Action Canada in its current form has evolved out of prior organizations like the “Canadian Federation of Societies for Federation Planning” or “Planned Parenthood Federation of Canada” that carried a different language in their names. Why should we be talking about sexual health and rights rather than reproductive health and rights?

SP: When we come down to it, it’s all the same issue. Whether we’re talking about abortion, or sexual orientation, same-sex sexuality, trans rights, issues around contraception, we’re all talking about, on the one level, the right to bodily autonomy; the right of each person to do with their body as they want and to have the information and education services to support their decision making around their body. […] In a very practical way, abortion rights are sexual rights. Abortion stigma is also stigma related to sexuality. So all of these issues are fundamentally connected and we use “sexual rights” as a shorthand to describe all of these issues because we see that, traditionally, when we look at definitions of reproductive health and reproductive rights, the sexual is defined through the reproductive. We intentionally want to change that paradigm. Reproduction is an aspect of sexuality. There are numerous aspects of sexuality, but our broader frame is sexual rights which is inclusive of reproductive rights.

MD: The Abortion Beyond Bounds conference focused on self-managed abortion. How is self-managed abortion widening access to abortion care and which barriers remain?

SP: It is important that we work towards expanding options for how individuals interact with their body, how they manage the care of their body, whether that’s about methods of contraception, methods of terminating pregnancy, we want to expand the frontiers of possibilities for them to do that and to support them in doing that, and to have the control over the level of support they want in doing that. The autonomy needs to rest with that individual who is making the decision on their own in relation to their bodies. In terms of self-management of abortion care, we need to be looking into options that remove abortion care from the medical system. There is ample evidence that self-managed abortion is safe and effective. And there are a lot of examples in many other countries that we can point to that have been using medications through community access for abortion, which we need to look at in Canada.

MD: In health care systems that are not accessible to all, how does self-managed abortion widen access to underserved communities?

SP: The geographic circumstances of the country are such that it is very difficult for individuals who live in rural or geographically remote areas to access care. […] Expanding the scope of practice for different types of providers is one important step […] but what is also important is more self-managed models of abortion care as well. So we need something that is inclusive of these parts, because we need to get to a place where access to abortion is community-based and is accessible to communities which are remote.

MD:
 You were instrumental in starting the Sexual Rights Initiative, an intersectional Global South-North coalition of organizations that work towards advancing sexual rights in the United Nations. What is the place of a Global North organization in global sexual health activism?

SP: That is a great question, thank you for asking that. There are a few places for a Global North organization. First of all, as a merged organization, we also have in our organizational history the work of Action Canada for Population and Development (ACPD), which did a lot of formative work initially within the intergovernmental human rights system on sexual and reproductive rights. Quickly, we saw the need for a Global South-Global North coalition and for that coalition to actually be of national and regional organizations doing work on these issues. Where ACDP was different though, was that it didn’t actually do domestic advocacy. So one of the appeals for ACPD for entering into this merger is that we need to be more like our partners in the Global South that are doing effective national work and that come together with us to do that kind of work as well. We wanted to model that. So our engagement with partners in the Global South fundamentally changed the structure of our organization. As Action Canada, we have lent our ability to act as coordinators. Our job has been to ensure that resources are pooled together for this work, but also to ensure that each partner is bringing its analysis from its national and regional context to that work at the global level, so now we are able to participate on that more fully, doing national work like our other partners within the coalition.

MD: Where do you see your place in a sexual health organization?

SP: I’m very fortunate because I went to law school to do human rights work globally with my law degree. And while there were a lot of individuals like me in my law school, there aren’t that many jobs within the human rights field [after graduate school]. I’m one of the lucky ones who actually gets to do human rights work in Canada and globally as a professional. My own interest in wanting to go to law school to do that [comes from when] as a young queer guy I did a lot of organizing on campus at Queen’s University, which is quite conservative and quite white as well, that was particularly focused on LGBTQ issues. When you start looking at some issues, often times you can see the relationship to other issues of social justice. That compelled me to have a broader perspective on how sexuality and gender are fundamentally interrelated, but also to go to law school to work on these broader issues professionally.

Find the interview on the McGill Daily website. 

Press Release: 150+ international parliamentarians in Ottawa to advance sexual and reproductive rights at IPCI Conference

Ottawa – Parliamentarians and development experts from around the world are meeting in Ottawa from October 22-23 for the International Parliamentarians Conference of the Implementation of the ICPD Programme of Action (IPCI).

The IPCI Conference, which was first hosted in Canada sixteen years ago, will bring together more than 150 parliamentarians who champion sexual and reproductive health and rights, including the Honourable Marie-Claude Bibeau, Canada’s Minister of International Development.

As secretariat to the Canadian Association of Parliamentarians on Population and Development, Action Canada for Sexual Health and Rights is the Canadian non-profit co-hosting this conference alongside the Government of Canada, the Inter-American Parliamentary Group on Population and Development, the United Nations Population Fund, and the European Parliamentary Forum on Population and Development.

At a time of global backlash against women’s reproductive choices, the rights of LGBTQI people, and young people’s access to sex-ed, the IPCI conference provides an international space where parliamentarians can strategize ways to advance progressive laws and policies, eliminate discriminatory laws and policies, and advocate for increased funding toward sexual and reproductive health and rights issues – domestically and globally.

“More and more, we’re seeing Canada demonstrate increased support for global and domestic sexual and reproductive health and rights,” says Sandeep Prasad, Executive Director of Action Canada for Sexual Health and Rights. Adding that, “parliamentarians in Canada and internationally have a role to play in ensuring sustained political leadership on the most stigmatized and neglected health and rights issues, namely, safe abortion care, comprehensive and inclusive sex-ed, and young people’s sexual health.”

Canadian parliamentarians have been instrumental in safeguarding access to abortion, adding gender identity and expression to the list of prohibited grounds of discrimination, and advocating for human rights-based approaches in the development of new laws and policies domestically and internationally through Canada’s development assistance.

By the end of the two-day conference, participants will generate a forward-looking, action-oriented declaration that builds upon previous IPCI commitments and provides clear direction to further realize sexual and reproductive health and rights around the world.

Action Canada is among the Canadian civil society organizations who are looking to Canada and all parliamentarians attending the conference to hold firm on their commitments to sexual and reproductive health and rights and to mobilize towards greater support for these issues as a community of champions.

– 30 –

Media Contact
Ani Colekessian
[email protected]
613.241.4474 ext. 7

NOTES TO EDITORS

  • Sandeep Prasad is available for interview before, during and after the conference.
  • Parliamentarians from Canada and other countries will be available for interviews throughout the IPCI Conference. See attachment for complete list.
  • Press passes are available for reporters on the day-of and obtained at the registration desk.
  • Visit http://ipciconference.org/pages/speakers/ for a full list of speakers and additional conference information.
  • A reception will take place on October 22, 2018 from 5:30-8:30 at the Sir John A. Macdonald Building, hosted by the Canadian Association of Midwives, the UNFPA, and the CAPPD for attending parliamentarians, in collaboration with the Speaker of the Senate of Canada, the Hon. George Furey and the Speaker of the House of Commons of Canada, the Hon. Geoff Regan. Midwives from several countries will be on hand to demonstrate midwifery procedures and answer questions about their work. Reporters who wish to attend must RSVP by email to [email protected]
  • Parliamentarians from the following states will attend: Austria, Belgium, Canada, Comoros, Congo, Costa Rica, Croatia, Democratic Republic of Congo, Dominican Republic, El Salvador, Equatorial Guinea, Georgia, Germany, Ghana, Grenada, Guatemala, Guinea, Honduras, India, Indonesia, Indonesia, Iran, Jordan, Kazakhstan, Kenya, Liberia, Lithuania, Madagascar, Malawi, Mongolia, Montserrat, Niger, Niger, Palestine, Peru, Rwanda, Saint Lucia, Senegal, Sierra Leone, Slovakia, South Sudan, St. Kitts and Nevis, Surinam, Switzerland, Tajikistan, Tanzania, Thailand, The Netherlands, The Philippines, Togo, Uganda, United Kingdom.

 

October Update: Abortion, sex-ed, human rights

Information and updates on sexual and reproductive health and rights this month:

Two-pill abortion drug Mifegymiso prescribed at least 13,000 times since becoming available in Canada

Tyler Dawson, National Post

It was Calgary’s Kensington clinic that prescribed the first dose of Mifegymiso, the two-pill abortion drug, after it became available in Canada in January 2017.

“When it arrived on our doorstep, we had a patient that day and we offered it to her; we were ready to go,” said clinic executive director Celia Posyniak.

Since Alberta began covering the cost of Mifegymiso last July, at least 2,792 doses have been prescribed — the overwhelming majority of them in Calgary — while 7,197 surgical abortions were performed in the same period. Since the drug became available in January 2017, at least 13,000 prescriptions have been written or filled across Canada, according to numbers provided to the National Post by provincial health ministries.

While the data is incomplete — Yukon wouldn’t release its numbers for privacy reasons and Nova Scotia and Prince Edward Island didn’t respond to the Post’s inquiries — it gives some insight into the rollout of the abortion pill in Canada. Long available in other countries, its arrival here was heralded as major progress for women’s health and a step towards addressing abortion shortages outside of urban centres.

But, as with the delivery of surgical abortion services, there are discrepancies between provinces, in terms of public funding for the drug. Newfoundland and Labrador just started offering Mifegymiso last month. Yukon is in the “final stages” of developing its coverage. Other provinces have complex setups, including Manitoba, where Mifegymiso is covered if dispensed by an abortion clinic, but goes through the provincial pharmacare plan if received elsewhere.

What the numbers suggest is that Mifegymiso hasn’t solved issues of access to abortion in rural and remote areas — at least not yet. In Alberta, for example, just 39 claims were made outside of Edmonton and Calgary between July 21, 2017 and June 28, 2018. This could be because rural doctors don’t want to be involved in abortion services, Posyniak said. It’s also possible that women living in rural areas would rather get an abortion in a large city.

“Some women may prefer to travel to larger centres to maintain confidentiality or to receive specialized care,” Rob Gereghty, assistant director of communications for Alberta Health, said in an email.

But, experts say, substantial progress has been made despite some unavoidable hiccups during the rollout of the drug. “Were still on the very early parts of the curve,” said Dr. Wendy Norman, a University of British Columbia professor who researches reproductive services.

The numbers give insight not only into the prevalence of the prescription as a method of abortion in Canada, but also the challenges that have faced clinics, doctors and patients since Health Canada approved it in 2015. The first doses didn’t arrive in Canada until 2017 — and there were supply issues throughout the year, Posyniak said. Even after the drug became available, it took awhile for provinces to start offering public coverage, and it’s still uneven across Canada. The pills can cost between $300 and $450, so, experts said, public coverage was essential to its appeal.

After Mifegymiso became legal, dispensing policies, educational programs, such as online courses, for physicians and pharmacists all took time, explaining the lag between approval, availability and access. Some clinics, such as the Kensington Clinic, were able to get up and running faster because they were already major providers of surgical abortions, with the experience necessary to quickly develop medical abortion practises.

“The change you see in different provinces’ uptake is very much reflective of the fact that it typically takes … between six months and nine months, even for a purpose-specific abortion facility, to agree on protocols and get the infrastructure in place,” Norman said.

In Quebec, that process led to major delays. For example, the college of physicians in Quebec initially wanted doctors prescribing the pill to also know how to perform surgical abortions, limiting the pool of potential prescribers.

By this May, that was abandoned, said Université Laval faculty of medicine professor Édith Guilbert in an email. Instead, there’s a three-day, in-person course at an abortion clinic for “all physicians who wanted to prescribe the abortion pill and had not been trained in family planning or whose training has not been put into practice for the past three years,” Guilbert wrote. “Quebec is the only province in Canada requiring such a training which may be difficult to take for most primary care physicians, obstetrician-gynecologists or nurse practitioners.”

Since the province began covering the cost last December, only 104 prescriptions were filled as of Aug. 6. The province had about 17,000 surgical abortions in that same time period.

Elsewhere in Canada, though, Mifegymiso is making significant inroads, especially after Health Canada relaxed rules around prescribing last fall.

“We are seeing in Canada a strong preference among those presenting for abortion, to choose a medical abortion if it is available,” Norman said. “Reports from centres offering both choices estimate that between half and three quarters of those eligible, will choose medical over surgical abortion.”

The available numbers offer evidence in support of this: New Brunswick, the first province to cover the cost of Mifegymiso, paid for 407 Mifegymiso prescriptions between June 28, 2017 and June 28, 2018, and, in that same time period, there were 654 surgical abortions. Manitoba didn’t have precise data, but estimated that about 15 per cent of its abortions will be done medically.

Frédérique Chabot, director of health promotion for Action Canada for Sexual Health and Rights, said British Columbia has been particularly supportive of medical abortion services. In the province, about one-third of all abortions are now medical. In Calgary, Posyniak said she expects around 40 per cent of the Kensington Clinic’s clients will eventually choose the pill, now that they’re offered the option, but that the number of annual abortions — surgical or medical — “hasn’t changed at all.”

The available data may be incomplete, but it is a “very interesting pieces of this puzzle,” Chabot said.

“We’re just at the beginning and (the numbers are) demonstrating that there is actually, there was a demand, there was a need,” Chabot said. “It’s actually changing the landscape in terms of what access to a complete package of reproductive health services can look like.”