The abortion pill is slowly changing the reproductive health landscape in Alberta, new data suggests.
When Mifegymiso came on the market in Canada in 2017, advocates and medical professionals hoped the medication would expand reproductive health care in rural and remote communities. In the years that followed, however, severe access issues in Alberta persisted and many people choosing to end their pregnancy reported having to travel to Edmonton or Calgary to find a clinic willing to prescribe the medication.
Mifegymiso is the brand name for two drugs, mifepristone and misoprostol, taken in sequence to terminate early pregnancies and for treatment during miscarriages.
In 2018, three-quarters of prescriptions for the abortion pill in the province were dispensed at a single clinic in Calgary. Four years later, the Edmonton and Calgary Zones still accounted for 86 per cent of Mifegymiso dispensations, according to data from Alberta Health obtained by Great West Media through a freedom-of-information request.
Between 2022 and 2023, the use of Mifegymiso grew by 41 per cent, from 4,152 doses dispensed to 5,850, with major increases in the north, central, and south regions of the province.
Dr. Carol Williams, a professor in the Department of Women and Gender Studies at the University of Lethbridge, said this change “may suggest to some degree that medical abortion is becoming more accessible across the province.”
Access to medical abortion improving, but barriers remain
So why is the shift that reproductive-rights advocates predicted the abortion pill would bring finally starting to materialize? And what barriers remain for people who require the medication?
“Medical abortion as an integral part of primary care is taking root because it is very much needed and increasingly, abortion as health care is discussed openly in Canada,” said Frédérique Chabot, executive director of Action Canada for Sexual Health and Rights.
“It has wide public support and increasingly, people are aware that one in three women will have an abortion in their lifetime, making this an extremely common medical need.”
Health Canada’s initial approval of the medical abortion drug was accompanied by strict regulations, such as requirements that physicians take specialized training and that they observe the patient take the medication. These restrictions were lifted in 2019, and more family doctors and nurse practitioners have taken up the practice of integrating medical abortion in primary care, Chabot said.
Though primary care providers are entitled to prescribe Mifegymiso, there is still a great deal of confusion and uncertainty among healthcare providers regarding the drug.
In the spring, the Edmonton Zone Medical Staff Association (EZMSA) sent a memo to members with clarifying information on the standard of practice for the medication.
“A lot of physicians did not know that they are actually able to prescribe (Mifegymiso) and dispense it. You don't have to have a special license or a special clinic,” EZMSA manager Bobbie Jo Hawkes said.
Hawkes said the memo also outlined the College of Physicians and Surgeons of Alberta guidelines doctors need to follow if they aren’t confident in providing the service themselves, including providing the patient with information on where they can go to receive the service.
Alberta now has two clinics which provide virtual appointments for medical abortion services, the Alberta Medical Abortion Clinic in Calgary and Clinic 38 in central Alberta, as well as in-person clinics in Edmonton and Calgary.
Following the opening of Clinic 38 in 2022, the number of Mifegymiso prescriptions dispensed in Central Zone nearly tripled, from 85 in 2022 to 319 last year.
Even with the expansion of options for medical abortion, Jenn Prosser, community access coordinator for Pro-Choice YQL, a reproductive health and sexual wellness advocacy group, said the organization gets calls from doctors and patients alike who are unsure where to turn for help in southern Alberta.
“One of the greatest challenges we hear from people is that if they don't have a family doctor, they don't even know who to call to begin with. And unfortunately, even 811 is still only referring people to the Calgary or Edmonton clinics, despite the fact that medical abortion is available in every community through any doctor practicing there,” Prosser said.
Though technically available at any medical clinic, Alberta has challenging barriers that prevent doctors and nurse practitioners from providing medical abortion services, Prosser said.
Unlike other provinces, Alberta has no direct billing code for physicians who provide abortions. While other provinces compensate doctors for in-person and telehealth abortion care, paying between $177 and $349 for the service according to EZMSA, Alberta physicians instead must use a general fee code that covers patient visits up to 20 minutes.
Prosser said her group has heard from doctors who don’t feel confident these brief visits provide “enough time to go through the process with the patients, and that they are not setting the patients up for success in this self-managed care,” and so are reluctant to prescribe or dispense Mifegymiso themselves.
Finding a pharmacy that stocks the medication can also be difficult, Prosser noted. In a survey of 85 pharmacies in southern Alberta conducted by Pro-Choice YQL, only 21 reported stocking Mifegymiso, with the high cost cited as the main reason for not keeping it on the shelves. However, all but two pharmacies said they do dispense the drug and will special order it when needed.
Better option for rural patients
If doctors and pharmacists are aware of medical abortion, and open to informing their patients about it, pharmaceutical-based procedures can be a less costly solution, especially for rural patients, Williams said.
“Surgical abortion is more costly for rural clientele because it may require that the pregnant person drive their own vehicle or catch public transport to nearest clinic in addition to other expenses such as paying for day care, losing a day’s wages, and experiencing the need to stay over near the clinic before travelling home.”
The support for increased access to people’s own community has felt more urgent since the pandemic made travel trickier, Chabot said, and it “can't be decoupled from ensuring we are addressing the crisis of access to family doctors and primary care.
“We can't talk about abortion rights without a robust public health care system, nurses to staff clinics and hospitals, people not having to wait for months or years to have a doctor.”
It is estimated that between 650,000 and 800,000 Albertans don’t have a family doctor.
“Some politicians, across the political spectrum, are trying to pull abortion out as a wedge issue and while it's important to be clear on our will to protect it as an integral part of reproductive health care, what we really need are politicians who work to make sure we can go to a doctor when we need one, including for an abortion,” Chabot said.
