Prescribing unrestricted abortion pills is a safe and effective option for women: Canadian study

Vancouver, British Columbia – Canada has removed all restrictions on mifepristonean abortion pill considered the “gold standard” medication for medical abortion globally, in 2017. Now researchers at the University of British Columbia report that widespread access to the pill has only resulted in no increase in abortion-related health complications.

The team analyzed government health data on 315,000 abortions that took place in Ontario between 2012 and 2020 for this project.

“Complications were already very rare, and we found that abortion continued to be safe and effective when mifepristone was prescribed without restrictions,” says the study’s lead author, Dr. Laura Schummers, postdoctoral fellow at UBC’s department of family medicine, in an academic statement. “This is the strongest evidence to date that the abortion pill is safe to dispense like most other prescriptions, meaning any doctor or nurse practitioner can prescribe, any pharmacist can dispense, and patients can take the pills if, when and where they choose.”

Major change in abortion after policy change

Canada was the first country to remove all additional restrictions on the distribution and administration of mifepristone. Prior to November 2017, Canadians who wanted to use mifepristone could only do so under the direct supervision of a physician. The drug was also not available in pharmacies and only specially trained doctors could administer it to patients. Most countries, including the United States, still restrict access to mifepristone in the same way.

“Our study sends a signal to other countries that restrictions are not necessary to keep patients safe,” says Professor Wendy Norman, lead author of the study and a professor in UBC’s Department of Family Medicine. “There is no scientific justification for the restrictions on mifepristone, which only make it more difficult for people to access the care they need. Canada’s experience offers a roadmap for other countries on how to safely improve access to family planning services.

Research also shows that more women chose to use mifepristone during an abortion instead of opting for abortion surgery once Canada lifted its restrictions. Before mifepristone became widely available, only 2.2% of abortions in Canada involved medication. Once the rules were changed, this percentage rose to 31.4% in two years.

Does this mean that abortions are increasing in Canada?

Importantly, however, the overall abortion rate in Canada has continued to decline since 2017, from 11.9 to 11.3 abortions per 1,000 residents aged 15 to 49. So these changes in access to mifepristone didn’t lead to more abortions overall, just fewer surgeries.

“We saw that patients and their healthcare providers quickly began to choose medical abortion, which can sometimes be preferred over surgical methods by providing care closer to home and earlier in pregnancy,” notes study co-author Dr. Sheila Dunn, scientist and family. physician at Women’s College Hospital in Toronto. “As other studies have shown, making abortion more accessible does not increase the number of people seeking abortions. We found that abortion rates continued to decline after mifepristone became available as a standard prescription. »

The study authors are confident that they have produced an accurate picture of the health outcomes and safety of mifepristone abortion.

“We were able to establish a strong safety profile for the entire province by linking health records of all practitioner visits, hospital visits and outpatient prescriptions,” concludes the co-author of study, Dr. Elizabeth Darling, assistant dean of midwifery and associate professor at McMaster University. University and ICES scientist. “It paints the most comprehensive picture of abortion safety to date, capturing any environment where a complication would arise. It demonstrates very clearly that restrictions on the abortion pill are not necessary for safety.

The study is published in the New England Journal of Medicine.

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