Federal approval of an abortion pill does not guarantee that women who wish to end pregnancies will be able to obtain the medication in all areas of the country.
Health Canada announced Wednesday that it has approved RU-486, a pill that induces a miscarriage-like process, after several delays. Considered the gold standard of medical abortion treatment, it will be sold under the brand name Mifegymiso and could be available as early as next winter.
What medical authorities can't predict is how many Canadian doctors will embrace the option, or how easily patients will be able to find the ones who do – especially in places such as Prince Edward Island where access to abortion has traditionally been difficult.
National ethics rules allow physicians to refuse to perform abortions or to refer patients for them, as long as they connect the patient with further services. In at least one province, Ontario, doctors will be able to abstain from prescribing the abortion pill as well, with rules not yet updated in some other provinces.
"I think there's lots of different, complex reasons why people don't give the care," said Robyn MacQuarrie, an obstetrician-gynecologist in Amherst, N.S. Dr. MacQuarrie previously offered to travel to PEI to provide surgical abortions, which are not available there. "I'm optimistic that now that there's a medication that limits some of those barriers, they'll be willing to appropriately treat those patients."
The drug combines mifepristone and misoprostol, which act together to stop a woman's body from producing progesterone and to force the uterus to contract. It is generally used to terminate a pregnancy at between seven and nine weeks.
RU-486 has been approved in the United States since 2000 and in France since 1988, and it's available in nearly 60 countries, including Australia, where no prescription is required. The drug's cost in the U.S. is between $300 to $800, according to Planned Parenthood.
Health Canada announced its approval two and a half years after the manufacturer's application. It won't allow pharmacies to dispense the drug without a prescription, following the lead of most countries, said Health Canada spokesman Eric Morrissette.
Fifteen years after the drug's introduction to the U.S., it is primarily available at established abortion clinics, said Vicki Saporta, president of the National Abortion Federation. However, some private physicians also started offering it, as did some health clinics in rural areas. What pattern will appear in Canada "remains to be seen," Ms. Saporta said.
Abortion has been the least accessible in PEI, in the three northern territories, and in New Brunswick, which recently removed some restrictions around the service, she said.
Women living in the remote regions of all provinces face their own hurdles. For Nova Scotia women outside of Halifax, the arrival of RU-486 will be noticed, Dr. MacQuarrie said.
"I work in a pretty rural area of the province, and they may not get care on their doorstep, but I can't think of any area where there would be an undue barrier with the access to RU-486."
In PEI, however, the difficulties come down to more than a long drive. One reason for pessimism among local pro-choice advocates is that drug-induced abortion is already available on the island, but it's nearly impossible to explain where.
Doctors across the country already combine misoprosto and a chemotherapy medication called methotrexate to create abortions, a well-known option less safe and effective than RU-486. In PEI, a handful of doctors offer the drug cocktail, but even the registrar of the province's College of Physicians and Surgeons, Cyril Moyse, doesn't know who they are. If a patient asked for information, he would likely send them to pro-choice activists for word-of-mouth wisdom, Dr. Moyse said.
"That would be the most direct way, I would think," he said
One such activist, Becka Viau, said there are rumoured to be six doctors providing the service. "I think it's social pressure," she said. "It's kept secret."
When women find doctors who will prescribe the methotrexate combination, some PEI pharmacists will refuse to fill the prescription on conscientious grounds, said UPEI professor Colleen MacQuarrie. That's within pharmacists' rights, as long as they ensure the patient has an alternate source of care, said Janet Cooper of the Canadian Pharmacists Association.
Canadian doctors who were wary of the makeshift cocktail will likely be more willing to prescribe an abortion drug that's approved by Health Canada for that purpose, said Jennifer Blake, the CEO of the Society of Obstetricians and Gynaecologists of Canada. She expects the society to provide formal training around the drug and its side effects to doctors who want to offer it, and said family doctors and obstetricians will both be able to qualify. Doctors' approaches to abortion "depends on the community," Dr. Blake said.
"I think if you look at physicians in general as coming from the fabric of Canadians society, Canadian society on the whole feels this is a decision that is best made by a woman herself, and I would expect that to be the same among health-care providers."
Editor's Note: An earlier version of this article incorrectly said Robyn MacQuarrie is an obstetrician-gynecologist in Truro, N.S. In fact, Dr. MacQuarrie works in Amherst, N.S. This version has been corrected.