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Executive Director Dawn Fowler, left, is photographed inside the procedure room with her partner and medical director Konia Trouton at the Vancouver Island Women's Clinic in Victoria, on March 19, 2019.CHAD HIPOLITO/The Globe and Mail

The only standalone abortion clinic on Vancouver Island has stopped offering the service that was once its raison d’être: Surgical abortions.

The Vancouver Island Women’s Clinic made the decision quietly last fall after it became clear that the vast majority of its patients preferred to end their unwanted pregnancies with a pill instead of a procedure.

The huge demand for mifepristone – better known as the abortion pill – at the clinic on the outskirts of Victoria came as a shock even to Konia Trouton and Dawn Fowler, the couple who founded the clinic and who worked in near-obscurity for more than a decade to help bring mifepristone to Canada.

"We were really surprised that within a year of it being funded, our surgical numbers tumbled to being under 50 per cent of what we had been doing the year prior,” Dr. Trouton, the clinic’s medical director, said.

She is now fulfilling the remaining demand for surgical abortions during her operating-room time at the nearby Victoria General Hospital.

Although mifepristone use is on the rise at other Canadian abortion centres, the Vancouver Island Women’s Clinic is believed to be the only one to have quit providing surgical abortions because of the demand for the abortion pill.

It is, in many ways, a fitting turn of events, considering the role the clinic’s founders – especially Ms. Fowler – played in Health Canada’s decision to approve mifepristone in 2015, by which time the drug was already available in nearly 60 other countries.

“I’m thrilled with it," Ms. Fowler said of the abortion pill’s success at her clinic.

Mifepristone was developed in the 1980s by the French drug maker Roussel-Uclaf. Originally known as RU-486, mifepristone blocks the hormone progesterone, causing the lining of the uterus to break down.

Women must take a second drug 24 to 48 hours later called misoprostol, which induces contractions similar to a natural miscarriage.

France approved RU-486 in 1988. That same year, the Supreme Court of Canada issued its famous Morgentaler decision, striking down the country’s abortion law.

News of the ruling reached Dr. Trouton, now 54, while she was in the operating room. At the time, the progressive-minded, third-year Queen’s University medical student was considering dropping out of medical school. She had recently come out as gay and didn’t feel a kinship with most of her classmates.

The acquittal of Henry Morgentaler gave her life a new purpose.

“I realized it was possible to be a doctor and an activist,” Dr. Trouton said. She went on to provide abortions at most of Dr. Morgentaler’s clinics, flying from city to city to help women safely end their unwanted pregnancies.

In the mid-1990s, Dr. Trouton moved to Ottawa, where she met Ms. Fowler, now 58, a sociologist who at the time held a senior role at Health Canada. They married in 2003.

Three years later, Ms. Fowler, the executive director of the Vancouver Island Women’s Clinic, became the first Canadian director of the National Abortion Federation [NAF], the Washington-based organization that represents North American abortion providers.

Ever the methodical goal-setter, Ms. Fowler made a list of the highest barriers to abortion in Canada, including the lack of mifepristone, and began plotting to topple them.

The first challenge for Ms. Fowler was finding a drug company willing to apply to sell the abortion pill in Canada.

Big Pharma, fearing a backlash, had eschewed mifepristone. None of the small companies and non-profits that marketed it elsewhere was interested in coming to Canada.

A breakthrough came when Ms. Fowler learned that André Ulmann, the former Roussel-Uclaf scientist who spearheaded the development of RU-486, was starting a company to make the drug. She and Dr. Trouton flew to Paris in 2006 for a Christmas vacation and a lunch with Dr. Ulmann, who was persuaded to submit an application to Health Canada.

When Dr. Ulmann’s company, Linepharma International Ltd., could not find a Canadian partner willing to distribute mifepristone, Ms. Fowler found one for him.

She introduced Dr. Ulmann to Paula and Marty Tenenbaum, a brother-and-sister team whose family had started a Toronto-area company called Trimedic Supply Network Ltd. to sell medical supplies to the Morgentaler clinics when nobody else would.

The siblings agreed to create an offshoot of Trimedic called Celopharma Inc. for the sole purpose of bringing the abortion pill to Canada.

“Dawn had been trying for so many years to get mifepristone into Canada. She was getting a lot of resistance,” Ms. Tenenbaum, the president of Celopharma, recalled. “Quite frankly, everyone said, ‘It will never happen.’”

It would take nearly four years of paperwork and Health Canada meetings, but finally, on July 29, 2015, the regulator approved mifepristone as part of a two-drug combination pack sold under the brand name Mifegymiso.

The results of Ms. Fowler’s efforts are now apparent at her own clinic. In 77 per cent of cases in 2018, women who chose to terminate their pregnancies at the Vancouver Island Women’s Clinic did so with mifepristone, up from 27 per cent the year before, when the pill was available but not yet free for all women in British Columbia.

With fewer than one in three of their patients requesting surgical abortions, Dr. Trouton and Ms. Fowler decided it didn’t make sense to keep paying an annual accreditation fee of more than $17,000 for the clinic to remain a designated non-hospital surgical facility.

Canada still has a long way to go to fulfill the promise of mifepristone. Family doctors in some rural and remote areas are reluctant to prescribe it. Two provinces, Manitoba and Saskatchewan, have declined to follow their counterparts in making the abortion pill free to all women, regardless of where they receive it.

But Frédérique Chabot, the director of health promotion at Action Canada for Sexual Health and Rights, an Ottawa-based advocacy group, said abortion access has improved significantly since Ms. Fowler and Dr. Trouton dined with Dr. Ulmann in Paris.

“When we consider that abortion was decriminalized 30 years ago and almost nothing budged in terms of access for so long,” Ms. Chabot said, “to see this change in a mere year or two is encouraging.”

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