The group representing Canada’s family doctors turned down an offer from a national abortion group to provide physicians with a training course designed to help more women get prescriptions for the abortion pill without going to other health-care providers.
The National Abortion Federation (NAF) asked if it could host a one-day training course for doctors at the coming conference of the College of Family Physicians of Canada (CFPC). The college bills the Family Medicine Forum, being held this fall in Vancouver, as “the largest gathering of family physicians in Canada.”
The CFPC sets standards for training and education of family doctors, including accrediting the curriculum of residency training programs and providing continuing education courses for physicians.
Jill Doctoroff, Canadian director of the National Abortion Federation, said she was told the college could not accommodate the course because it doesn’t endorse training from outside groups. But Ms. Doctoroff and other abortion-rights advocates say this is just the latest example of how the CFPC is standing in the way of better abortion access throughout Canada.
“I’d like to see them take more leadership in this area, for sure,” Ms. Doctoroff said.
A recent Globe and Mail investigation revealed that the majority of abortion-pill prescriptions in Canada are written at abortion clinics, which are primarily in large urban centres. In Alberta, for instance, nearly three-quarters of prescriptions came from a single abortion clinic in Calgary. In Manitoba, 95 per cent of prescriptions came from abortion clinics in Winnipeg and Brandon. This means many women who live outside those cities must travel hundreds of kilometres to get a prescription that any family doctor could write. While some doctors have an ethical objection, numerous clinic directors told The Globe the main reason many don’t prescribe is that they don’t want to be seen as abortion providers and that some believe the care involved with prescribing the pill is too complex.
Mifegymiso, known as the abortion pill, came on the market in Canada in 2017 and can be prescribed to end pregnancies safely in the first nine weeks. It is 95 to 98 per cent effective.
The Globe investigation prompted several medical organizations and abortion providers to call on the college to take a bigger role in helping to ensure more family physicians receive the training to prescribe the medication.
In an e-mail statement to The Globe on Monday, the conference committee co-chair wrote that the event will feature three sessions relating to Mifegymiso: one on abortion care, one on using the medication in care for women experiencing miscarriage and one focused on a secure website where physicians prescribing the pill can get advice and support.
“The CFPC is committed to providing continuing professional development to support comprehensive knowledge of women’s health and abortion care,” Stephen Hawrylyshyn wrote in the statement.
The statement said the conference committee did not have a record of rejecting an application to give an abortion-pill training course. But Ms. Doctoroff said she did not apply to have a session; she exchanged e-mails and phone calls with a conference organizer about bringing NAF’s one-day training course to the conference.
Ellen Wiebe, medical director of the Willow Women’s Clinic in Vancouver, will lead the conference’s two-hour session on abortion care using the pill. Dr. Wiebe said she has been allowed to offer similar sessions at past conferences, and that 50 to 100 doctors typically attend.
Ms. Doctoroff said NAF’s course is more in-depth.
Dr. Wiebe said the CFPC could do much more to ensure broad access to the abortion pill across the country, eliminating the need for women to travel long distances and pay out of pocket. Dr. Wiebe said the college should mandate that abortion care be included in family medicine residency training. While doctors who have a moral objection could opt out, including it in the curriculum would normalize abortion care and broaden access, Dr. Wiebe said.
Ms. Doctoroff said leaving the full-day training course off the conference schedule is a “missed opportunity." The course is designed to give providers an in-depth understanding of some of the complicated issues of abortion-pill prescribing, such as patient counselling and the logistical challenges for providers that work alone, in family practices and walk-in clinics. She said NAF plans to offer the training on its own, but it doesn’t have the resources to cover every part of Canada.
Dawn Fowler, who was director of NAF from 2006 to 2017, said she tried many times to meet with CFPC leaders to talk about abortion access, but was typically turned down.
“The college is silent," she said. "They’re not pro-active. I think they’re doing a disservice to their membership by not ensuring that there are ongoing opportunities for [doctors] to get training.”