Alberta’s medical regulator is calling on the college representing Canada’s family doctors to help it boost prescribing rates of the abortion pill, saying the current poor access in the province is putting patients at risk.
“We can’t hide under a rock,” said Michael Caffaro, complaints director of the College of Physicians and Surgeons of Alberta. “That is a reasonable expectation … that those bodies that control the education and the work environment and represent physicians will all come together to deal with these particularly thorny problems.”
A Globe and Mail investigation on Saturday revealed that the majority of abortion-pill prescriptions across Canada are being written at abortion clinics, which are primarily located in large urban centres. This means women who live outside big cities are often forced to travel hundreds of kilometres to get a prescription that any family doctor could write.
Several doctors, medical organizations and abortion providers say the College of Family Physicians of Canada (CFPC) could address those issues by taking a leadership role in ensuring physicians receive abortion-pill training and education.
While prescribing decisions are the domain of individual doctors, the CFPC is the only national regulator whose central mandate involves family physician training and education. The college could help ensure family medical residents are trained in abortion care and could promote the availability of courses on how to prescribe the pill.
The college has declined numerous requests for comment. In an e-mail on Sunday, a spokeswoman wrote that the college has no control over how doctors prescribe and that this is not part of its mandate. The college has offered education sessions regarding the abortion pill in the past.
The poor access to the abortion pill across the country is stark. In Alberta, 73 per cent of abortion-pill prescriptions in 2018 came from one abortion clinic in Calgary. In Manitoba, 95 per cent of prescriptions came from abortion clinics and in Saskatchewan, 82 per cent came from clinics. The abortion pill, called Mifegymiso, is a combination of two medications that safely and effectively terminate pregnancies in 95 per cent to 98 per cent of cases. It can be prescribed up to nine weeks into a pregnancy.
While some doctors have an ethical objection, numerous clinic directors told The Globe that the main reason many don’t prescribe is that they don’t want to be seen as an abortion provider, and that there is a perception among some doctors that prescribing the pill is too complex.
Jennifer Blake, chief executive officer of the Society of Obstetricians and Gynaecologists of Canada (SOGC), said the organization will reach out to the CFPC to see if there is a way to promote physician training and education for abortion-pill prescribing.
”I think that there are ways forward,“ Dr. Blake said.
Nayana Suchak, a family doctor based in Markham, Ont., said the CFPC’s response is “disappointing.”
“It really does take a certain amount of push from leadership to make this an integral part of the curriculum,” she said.
Dr. Suchak said The Globe investigation has prompted her to take the SOGC training course on how to prescribe the abortion pill.
“At the very least, I should be versed in this medication and be aware and be able to prescribe,” she said.
Only 505 of the roughly 43,000 family doctors in Canada have taken the SOGC training course. While the course is not mandatory, Health Canada recommends all prescribers take it.
Dr. Suchak said she doesn’t think pill-based abortions will become a central part of her practice, but it’s important to be able to offer patients the option.
“If we believe in women’s choice, then we need to back that up with just less stigma around the teaching of it,” Dr. Suchak said.
Dustin Costescu, lead author of national guidelines on abortion-pill prescribing, said greater education and training will help ensure more patients have access to the abortion pill. Dr. Costescu, co-chair of the SOGC’s sexual-health and reproductive-equity committee, said the organization is ready to step in to help the CFPC with education and training, but that they would need to be asked first.
“If the college feels they would like OB/GYNs to help facilitate that training, we’re ready and available,” he said. “I think those two organizations can work together.”