Abortion pills are often overlooked as an option, advocates say

Canadian advocates point to abortion pills as an underused option in that country amid uncertainty over the future of the procedure in the United States, highlighting its accessibility.

Any doctor who can prescribe medication is able to facilitate what is known as a “medical” or “medication” abortion, which can be performed safely at home rather than requiring a trip to a clinic or hospital,” said Autumn Reinhardt-Simpson, founder of the Alberta Abortion Access Network.

“Abortion can be safely managed at home with these pills,” Reinhardt-Simpson said. “The lack of understanding that (doctors and pharmacists) even have the ability to prescribe or dispense these things, is really holding back a lot of progress in terms of access to abortion.”

Some abortion clinics and doctors’ offices are offering “no-contact” abortions for up to 10 weeks, a service that has become more common during the COVID-19 pandemic.

There is renewed scrutiny of the issue of abortion access after a draft document leaked to Politico suggesting the US Supreme Court was set to overturn Roe v. Wade, the landmark 1973 case that legalized abortion nationwide.

In Canada, the right to abortion is decriminalized, but the procedure isn’t always easily accessible for those who can’t arrange to go to a clinic – which advocates have said the abortion pill can help .

“There are so many barriers – physical, mental, emotional – to accessing an abortion here in Canada,” Reinhardt-Simpson said. “The first is that the country is so big. And you have these big, geographically distant cities where most of the clinics are.

The abortion pill, mifepristone, became available in Canada in early 2017, but various restrictions, such as the requirement that only specially trained doctors, not pharmacists, prescribe the drug and watch the patient take the pill, were in place until that date. November.

A University of British Columbia study published in January in the New England Journal of Medicine found that in the four years before the drug went on sale, medical abortions accounted for 2.2% of procedures in Ontario.

In months when mifepristone was available but access was restricted, the number rose to 8.3%, according to the research. After the restrictions were lifted, from November 7, 2017 to March 15, 2020, the proportion rose to 31.4%.

The study found that regardless of restrictions on mifepristone, there were only “serious adverse events” in 0.04% of cases, or one in 2,500. These events include blood transfusions and admissions to intensive care. There were complications, such as infection, in 0.69% of cases after the restrictions were lifted, compared to 0.67% when they were in place.

The study examined “population-based administrative data” from Ontario on the use, safety and effectiveness of the pill.

Abortion rates in Canada have declined, and UBC research found the decline continued after mifepristone became available, although it slowed somewhat.

The data does not include medical abortions after the onset of the COVID-19 pandemic, when more medical care was withdrawn.

Joyce Arthur, executive director of the Abortion Rights Coalition of Canada, said the general trend in medicine has also had an effect on abortion.

“Ironically, the pandemic has helped give a boost to telemedicine abortion services, where people can call the doctor and get a prescription, then just go to the local pharmacy to pick it up,” he said. she stated.

“There is still a lot of work to be done to improve this access as well. But it happens. And I think it’s a work in progress, but it’s definitely going to help a lot to relieve the stress on clinics and hospitals.

Virtual care for medical abortions has received approval from medical groups.

The Canadian Pharmacists Association said in a statement Thursday

“CPhA has long called for action to close gaps in care and improve patient access to abortion services, especially in rural or remote communities,” the group said. “This includes supporting pharmacists who dispense Mifegymiso and providing equitable and universal access to medical abortion across Canada.

The Society of Obstetricians and Gynecologists of Canada released a protocol document during the pandemic guiding physicians through two-step drug prescribing and telemedicine follow-up.

If less than 70 days have passed since the patient’s last menstrual period, the whole process can be done through virtual care. If it has been more than 70 days or the patient cannot remember the date of her last menstrual period, or if there are risk factors for complications such as ectopic pregnancy, she should be referred for an ultrasound .

The protocol also calls for three follow-up appointments, one week, four weeks and five weeks after the patient has taken the two pills.

This report from The Canadian Press was first published on May 5, 2022.

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