LEAF Halifax advocacy for access to medical abortion

  • March 29, 2018
  • Sarah Baddeley

Over the past several months LEAF Halifax, in collaboration with a dedicated community of lawyers, nurses, doctors, social workers, and public health experts, has worked on policy-focused advocacy to increase access to medical abortion. Medical abortions are a non-surgical method of pregnancy termination. This vital medical service is an important option for women in Canada who fear unwanted pregnancy. Health Canada’s decision in July 2015 to approve Mifepristone (sold in combination with Misoprostol under the name “Mifegymiso” in Canada) was an important recent step towards remedying this difficult issue of access. That said, there is still a lot of work to do and a lot the legal community can do to help.

Why is medical abortion important?

Mifepristone-Misoprostol could fill a gap in the availability of abortions in Nova Scotia. Abortions generally have been decriminalized in Canada since the 1988 decision from the Supreme Court of Canada in R v Morgentaler. As many members of the public know, however, accessing abortions has often been difficult or even impossible since then. Only five of Nova Scotia’s forty-three hospitals currently provide surgical abortions. Many patients need to travel hundreds of kilometers to reach one of these hospitals, and face strenuous financial and temporal burdens in the process. Family physicians can provide medical abortions using Mifepristone-Misoprostol. More access to the drug could improve access to abortion for patients across Nova Scotia, and especially those in rural communities.

Even when Canadian patients can access termination-of-pregnancy services, they often have very few choices of method. Choice can be fundamental in giving patients a sense of self-determination and dignity. This can be particularly important for those who are pregnant as a result of sexual assault, in the context of domestic violence, or as trans-persons (a group that regularly struggles to have any sense of control in Canada’s health care system). The introduction of Mifepristone-Misoprostol to the Canadian market was met with a sigh of relief from many care providers and members of the public who dreaded the prospect of facing a surgery if they ever needed an abortion.

For millions of patients around the world, surgery has not been the only option for several decades. Mifepristone is already available in at least 60 countries. France and China approved the drug in 1988. Studies also show that when patients feel they have a meaningful choice between Mifepristone and surgical abortion, the overwhelming majority—as many as 84 per cent —choose Mifepristone.Footnote1

Mifepristone-Misoprostol is not only a desirable option for many patients, but a safe and effective one. Mifepristone-Misoprostol is considered the gold standard for medical abortion, and it is included on the World Health Organization list of essential drugs. Health Canada’s decision to approve the drug cites studies where 97.53 per cent of participants had a safe and effective abortion with Mifepristone-Misoprostol.Footnote2 Another study suggests that even higher rates could be possible as patients and doctors become more educated about the drug.Footnote3

Progress in access to Mifepristone-Misoprostol

Since Health Canada approved Mifepristone-Misoprostol, advocacy has played an important role in making it publicly accessible. Health Canada initially imposed a requirement that physicians, rather than pharmacists, should dispense the drug. This requirement is not imposed on any other drug in Canada, including high-risk drugs such as methadone. Health Canada also required a doctor to supervise patients as they swallowed the first pills and required both physicians and pharmacists to take mandatory specialized training before they could administer the drug. After significant public backlash, Health Canada has since changed the drug monograph to lift these requirements.

Further, advocates such as LEAF Halifax spoke out loudly to ensure that cost would not be a barrier to access medical abortion. On Sept. 22, 2017, the government of Nova Scotia announced provincial coverage for Mifepristone-Misoprostol. This was an important step toward increasing access to medical abortion in Nova Scotia.

Aside from removing regulatory barriers, patients must be aware of the options for termination of pregnancy care in order to have a meaningful choice over their treatment. In October 2017, Action Canada for Sexual Health and Rights, Sexual Health Nova Scotia, and LEAF Halifax collaborated to publish the “Mifegymiso Fact Sheet,” which provides concise and accessible information about the on Mifepristone-Misoprostol. We publish updated versions of this fact sheet as regulatory barriers to Mifepristone-Misoprostol’s availability are lifted.

Ongoing barriers

Barriers to Mifepristone-Misoprostol remain. Currently, physicians do not have a billing code for prescribing the drug. Normally, physicians charge the services they provide to a billing code associated with a given treatment, and this billing code is designed to reflect the labour and knowledge involved. Without a billing code, it is difficult to assess how many doctors prescribe Mifepristone-Misoprostol and how many patients have elected this treatment. Some physicians who have spoken to LEAF have disclosed that they choose not to prescribe as a result of the inequitable compensation framework. What is clear to the physicians who do provide the service, and the patients who seek it, is that access remains sparse.

Further, nurse practitioners in Nova Scotia are currently unable to prescribe Mifepristone-Misoprostol. Studies from countries where nurse practitioners have the capacity to prescribe show that nurse practitioners can provide medical abortion as safely and effectively as physicians.Footnote4 The Canadian Nurses Association has publicly shared its support for nurse practitioners prescribing Mifepristone-Misoprostol.Footnote5 The College of Nurses of Ontario was the first nursing governing body to publicly support the ability of its nurse practitioners to prescribe Mifepristone-Misoprostol.Footnote6 We still wait for the College of Registered Nurses of Nova Scotia to support the ability of nurse practitioners to prescribe Mifepristone-Misoprostol as well.

How can you help?

Much of LEAF’s advocacy on access to medical abortion relies on strong research on the effect of drug-prescribing policies. To meet this need, LEAF Halifax runs a program called the Feminist Advocacy Initiative. FAI pairs law students from the Schulich School of Law at Dalhousie University and the University of New Brunswick with local practitioners in Halifax and Fredericton to work on legal research that supports feminist advocacy. We welcome lawyers with all interests, including interests in access to abortion advocacy, to contact LEAF Halifax’s Research & Advocacy Coordinator, Mary Rolf, at Halifax@LEAF.ca for more information on how to get involved.

Our members provide essential support for LEAF Halifax’s work. You can sign up for a membership through LEAF’s website.

Sarah Baddeley is Chair, LEAF Halifax