Source: Hamilton Spectator | Margaret Shkimba
Last September I attended a women’s health conference here in Hamilton hosted by the Federation of Medical Women of Canada. Each presentation could be a column on its own, and I’ll write more about those other topics in future columns. But today I want to talk about the drug Mifegymiso.
One of the first speakers was Mr. Sandeep Prasad, executive director of Action Canada for Sexual Health Rights. As I sat listening to his presentation, I wondered if I had travelled back in time to the late 1990s; he was talking about a therapy that’s been in use for over 30 years in other countries but one which Canadian women still don’t have access to, despite it’s being the “gold standard” of care as defined by the World Health Organization.
Mifegymiso is the renamed and reformulated RU486, the so called “abortion pill.” It’s a combination drug therapy of mifepristone and misoprostol which, when used together, induce a medical abortion. A surgical abortion is when a woman goes to a clinic or hospital and has the procedure done by a doctor. A medical abortion is less invasive, less costly, and provides greater privacy to the patient.
Mifegymiso was approved for use by Health Canada in July 2015 after a three-year approval process, one of the lengthiest approval processes on record. However, that approval carries with it controversial practice restrictions which will restrict its access to the Canadian women who need it most — women living in rural and remote communities.
Currently, only one in six hospitals provides abortion services. Most are located in urban areas and are within 150 km of the U.S. border. Medical abortions are now provided using methotrexate “off label,” which means the medication is being used in a way for which it was not approved. Medical abortions count for about 4 per cent of all abortions.
Even though Health Canada has now approved this drug for use, almost 18 months ago, it is still not available for Canadian women. It should be pointed out that this therapy has been in use in other countries for nearly 30 years and is approved for use in over 60 countries. It is considered the “gold standard” of care. Why are Canadian women so special? Do we need extra protection? Are our bodies different from women in other countries?
Well, let’s look at just a couple of those controversial practice restrictions Health Canada put in place and see if they have anything to do with it.
•Use. Mifegymiso is approved for up to 7 weeks after a woman’s last menstrual period. In the U.S., under the name Mifeprex, it can be used up to 70 days — that’s 10 weeks, three extra weeks. Celopharma has submitted a request this be revised to nine weeks. Delay.
- Dispensing. Health Canada demands that this medication be administered under the supervision of a health professional. It’s a pill that apparently Canadian women are unable to take without the watchful eye of a health professional present. Unless there’s risk of imminent death, this seems a bit overkill, and incredibly paternalistic. Physician groups are fighting the restrictions. Delay.
- Cost. The cost of this therapy is about $300 and will not be covered by provincial plans, despite the potential cost savings to the system. This will be a barrier to many women. There are negotiations underway to try to resolve the funding issue. Delay.
- Physician training. Physicians who wish to prescribe Mifegymiso are expected to undergo training. In addition, these physicians will have their names added to a registry of physicians authorized to prescribe this therapy, unheard of with any other medication. Anyone see a problem with this in our highly politicized anti-choice environment?
Dr. Anne Niec, president of the Federation of Medical Women of Canada and a professor at McMaster University, is quoted in the Medical Post: “These barriers need to be revealed and eliminated. They are over and above what is medically necessary and they appear to be a means of injecting opposing ethical debate into what is and should be a free and basic human right for women’s access to safe reproductive choices”.
An announcement of availability is expected sometime this month.
I started working in the Women’s Health Office in the late 1990s. One of the first books I read was on RU486 and the promise it held to eliminate many problems with abortion provision: physician reticence, public knowledge and the high cost of surgical abortions. It centred the choice as one between a woman and her physician.
I’m now retired from that position after almost 20 years working in women’s health and Canadian women still don’t have access to this “gold standard” therapy.
2017 has to be the year we join the rest of the world.