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Two decades after mifepristone, the so-called abortion pill, became available in Europe, the option of a drug-induced abortion is still not open to Canadian women.

Why? Why are women being denied a relatively safe, inexpensive and accessible alternative to a surgical procedure?

Abortion is legal in Canada, but access to surgery remains inadequate.

Fewer than one in five hospitals perform abortions. Women, especially in rural areas, must travel a long way and waits are far too long. (If there is one area where we should have a waiting-time guarantee, it is abortion.)

This is a scandalous failure of our publicly funded health system to provide a medically necessary procedure in a timely manner.

Where there are private clinics, the procedure is expensive -- in excess of $300 on top of what providers can bill the public system. The cost of abortion, when done in a private clinic, should be reimbursed in toto, as the Quebec Superior Court ruled last week.

In European countries with similarly liberal laws on abortion (including those, like Canada, that have no law at all), up to one-third of women opt to terminate pregnancies with prescription drugs rather than surgery.

Women can have abortions at home -- not at a hospital or clinic -- using a drug prescribed by their doctor.

Mifepristone (brand name Mifeprex) works by blocking production of the hormone progesterone, which nourishes the fetus and is required to sustain a pregnancy. It is taken in conjunction with another drug, misoprostol, which induces contractions. An abortion results.

(The abortion pill is not to be confused with the morning-after pill, levonorgestrel, commonly known as Plan B, which prevents a fertilized egg from latching on to the uterus, and thus preventing pregnancy.)

In the United States, the approved regime allows mifepristone to be used for women pregnant as long as 49 days, and requires three doctors visits. Since it was approved in 2000, almost 600,000 women in the United States have taken the drug.

Also known by its laboratory name RU-486, it is also available in all countries of the European Union except Portugal, Italy and Ireland, plus China, India, Russia, Australia and South Africa, among others.

It goes without saying that abortion remains controversial. The drug has been a target of anti-abortion zealots, and that is the only reason it is not more widely available.

The manufacturer, Roussel-Uclaf, created a spinoff company to produce the abortion pill. It also decided that it would not market the drug in a country unless it was invited to do so.

The U.S. Food and Drug Administration did so after then-president Bill Clinton intervened and a company, Danco Laboratories LLC, was created because big-name drug companies don't want the grief associated with marketing an abortion pill.

Canada needs to follow a similar process. But current Canadian law does not allow the regulator, Health Canada, to extend an invitation, and Canadian governments, Liberal and Conservative alike, have not had the backbone to intervene to improve women's access to health services.

The excuse, presumably, is that there are doubts about the drug's safety.

A Canadian researcher conducted a clinical trial of mifepristone but it was shut down on Aug. 28, 2001, after an unidentified woman died after taking the drug.

The woman, it turns out, died of a rare bacterial infection, Clostridium sordellii. Five U.S. women have died of the same infection after taking mifepristone and another died from a similar infection, C. perfringens.

Does that mean the drug is dangerous and unsafe? No, it does not.

The reality in Canada is that an estimated 12,000 people a year die of adverse events related to prescription drugs.

Far more people die after taking Viagra, penicillin and common painkillers such as acetylsalicylic acid (ASA) than would die from mifepristone.

It is important to note that in the deaths associated with use of the drug, the women took mifepristone orally (the usual method), then took the contraction-producing drug misoprostol vaginally (evidence is mixed as to whether it should be taken orally or vaginally); and some of the women took both drugs vaginally, which is unusual. C. sordellii is a bacterium that thrives in the reproductive tract.

Abortion, miscarriage, menstruation, tampon use and childbirth all create conditions that increase the risk of infection, but there is no evidence the abortion drug itself results in additional risk.

Both surgical and drug-induced abortions are extremely safe and effective procedures. Their availability should be based on science -- not politics, religious beliefs or moral judgments.

About 105,000 Canadian women undergo abortions each year. In exercising choice, they should also have choices.

apicard@globeandmail.com