The Politics of Mifegymiso in Canada

There are two types of abortion in Canada: surgical abortion and medical abortion. Medical abortion uses medication rather than an internal procedure to end a pregnancy. Both are safe procedures with exceptionally low complication rates and are not known to affect future pregnancies.

In July of 2015, after one of its lengthiest drug approval processes on record, Health Canada approved the abortion pill Mifegymiso. Mifegymiso is the Canadian brand name for the combination of the medications Mifepristone and Misoprostol. This combination of medications is set to replace the regimen that has been used in Canada up until now to provide a medical abortion. Before the approval of Mifepristone, health care providers who offered medical abortion care were using a combination of Methotrexate prescribed off-label and Misoprostol. While the overall success rates, side effects and low complications rates are similar for both regimens, abortions induced with Mifepristone are offered ‘on-label’, can be offered later in gestation and complete faster than those induced with Methotrexate.

The combination of Mifepristone and Misoprostol is the World Health Organization’s recommended method for medical abortion and has been on its list of essential drugs since 2005. Mifepristone has been used for close to 30 years with an outstanding safety and efficacy record and is available in over 60 countries around the world. Making it available to people in Canada is an important step in ensuring access to the best possible care when it comes to sexual and reproductive health services.

Is Mifegymiso available in Canada?

The short answer is YES.

Mifegymiso can be prescribed by health care providers such as physicians and, in some provinces where professional colleges have issued practice guidelines, other primary care providers such as nurse practitioners. Pharmacists can dispense it and many pharmacies stock it. In principle, everyone who wants to access medical abortion care to terminate a pregnancy and who has access to a health care provider who can prescribe medication should be able to obtain a prescription for Mifegymiso. That said, the reality is that access is still compromised; how easy it is to get Mifegymiso depends on where you are.

Why is that?

Following the July 2015 Health Canada approval, it was anticipated that Mifegymiso would be available to the public in the Spring of 2016 but its distribution faced several roadblocks, including manufacturing delays. The wait period can also be attributed in part to the need to accommodate some of the restrictions Health Canada had originally included in its approval of the drug, one of them being a mandatory training for prescribing physicians and pharmacists (which had to be developed).

The training, which is no longer mandatory (Health Canada lifted that specific requirement in May of 2017 and then, all but one of the rest of the original stringent restrictions on November 2017) is (still) offered through the Society of Obstetricians and Gynaecologists of Canada (SOGC). Action Canada for Sexual Health and Rights continues to encourage health care practitioners to take the SOGC training to get better acquainted with medical abortion service provision and for prescribers and pharmacists to list themselves on directories connecting providers, dispensers and the public. We also encourage prescribers and dispensers to join a community of practice to receive the support of other health care providers who offer medical abortion or stock Mifegymiso in their region. Check out CAPS to connect with medical abortion experts and fellow prescribers for support.

Mifegymiso finally hit the shelves in January 2017 and while that was a positive step forward, many unnecessary barriers still make it difficult for the public to access the medical abortion drug. For one, the price tag for Mifegymiso hovers between $300 and $450. For many individuals who must pay out of pocket, this continues to put it out of reach.

Action Canada has therefore been calling on all provincial and territorial governments, as well as the Federal government, to promptly ensure that the cost of medication abortion is covered under public health care. As of November 2018, British Columbia, Alberta, Ontario, Quebec, New Brunswick, Nova Scotia, Newfoundland and Labrador, PEI, Yukon and the North West Territories have responded to the call. The residents of the provinces that have gone ahead with a universal cost coverage program can now access Mifegymiso free of charge by showing their valid health card or, in Alberta, a proof of address. Federal programs have also added Mifegymiso to their list of benefits which is a start in terms of making sure federal patients can also access medical abortion care.

If you live in Nunavut, Saskatchewan or Manitoba, universal cost coverage is not in place. Depending on where people are located, partial coverage is in place for some people if they are on social assistance, or the medication is offered free of charge in limited locations. That said, the reality is that many people are still left without financial coverage and must pay out of pocket. This creates a two-tiered system of access to abortion care across the country where your ability to access Mifegymiso depends on your postal code and what's in your bank account.

Of course, cost coverage for Mifegymiso matters but it is not the only thing standing in the way of people being able to access it. There are many other barriers that stand in the way of making Mifegymiso available for everyone in Canada, even where cost coverage is promised or in place.

Posted on 2018-04-05