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.”