When the abortion pill was finally approved by Health Canada last July – 27 years after it came on the market in France – the news was greeted with a mixture of relief and elation.
But now that Health Canada has released the regulatory conditions for the drug's use, there is consternation anew. The principal benefit of the drug, which is actually a two-drug combination sold under the brand name Mifegymiso, is convenience. To induce an abortion, you take medication rather than undergo surgery, which is particularly important outside big cities, where abortion clinics are concentrated, and for women who face religious and cultural barriers.
But the regulatory hurdles for getting the drug are numerous, onerous and, for the most part, unjustified.
Mifegymiso consists of two drugs: Mifepristone works by blocking the hormone progesterone and, without it, the lining of the uterus breaks down and the pregnancy cannot continue; the second drug, misoprostol, taken 24-48 hours later, causes the uterus to empty, similar to a miscarriage.
Under the new rules, the drug must be prescribed and dispensed by a doctor, which means they have to keep it in stock in their office. It is also obligatory for physicians to take an online course before they are allowed to prescribe.
Before they can be prescribed the abortion pill, women must undergo an ultrasound and, most troubling of all, the doctor can oblige a woman to take the drug under supervision, in their office.
No doubt these measures are well intentioned, to ensure safety, but they are also patronizing and sexist. One would be hard-pressed to identify any other drug that comes with such sweeping preconditions to access. Even the chemotherapy drug methotrexate, which is currently used off-label to induce abortion, has no such restrictions.
The abortion pill has been used for almost three decades and is safer than many drugs on the market – including Viagra, the erectile-dysfunction drug for men.
In Canada, Mifegymiso is approved for use up to 49 days after conception. An ultrasound can be used to determine the age of the fetus. However, timing of conception can also be accurately measured without an ultrasound. The other reason for an ultrasound is to detect an ectopic pregnancy (where the embryo grows outside the uterus) or molar pregnancy (where the placenta develops into a mass of cysts). These conditions are rare and, again, can often be detected by other means.
Ultrasound is not a bad idea, but it should not be mandatory, especially if it impedes access or results in additional cost. (Mifegymiso, distributed in Canada by Celopharma Inc., will cost about $300, roughly the same as a surgical abortion.)
Doctor-dispensed drugs are a rarity. This condition is usually imposed to ensure that a drug is taken and not trafficked on the streets – like methadone. There is no evidence women who want to terminate a pregnancy would try to sell Mifegymiso on the streets.
There is no reason it can't be dispensed by pharmacists, like virtually every other prescription drug, nor a reason it cannot be prescribed by nurse-practitioners or midwives, as it is in many countries.
The most worrisome rule of all is the suggestion that the abortion pill must be taken in the presence of a physician. It's not always easy to get a timely appointment with a doctor in Canada. And why would a woman be forced to sit in a doctor's office while she has the equivalent of a miscarriage?
Like all drugs, Mifegymiso has possible side effects, such as allergic reaction and severe bleeding. But these need to be treated in a hospital. The most common side effect is bacterial infection and sepsis (blood poisoning) – but those are not immediate. The risk is not from the pill per se, but from bleeding, and the risks are similar to surgical abortion, miscarriage, menstruation and childbirth, which all create conditions for infection.
We don't make women sit in doctors' offices during their miscarriages or periods, and we shouldn't oblige them to do so during medical abortions either. But they should be counselled to seek immediate emergency medical help if there are signs of infection and do follow-up to ensure the treatment worked (which it does not in about 2 per cent of cases).
Safety is important, but so is access. And right now the balance is tipped the wrong way, denying Canadian women true reproductive choice.
André Picard