Q: I’ve heard that the drug mifepristone will soon be available across Canada. How does that affect my options, if I want to terminate a pregnancy?
Until now in Canada, medical abortions — those that involve taking a drug as opposed to having a minor surgical procedure — have been an option only for very early pregnancies. They account for about 5 percent of terminations. That’s about to change.
In Europe, where this drug has been available for a while, up to 80 percent of abortions are medical. While we may not reach numbers that high, the availability of mifepristone (under the brand name Mifegymiso in Canada) will definitely lead to a shift here.
For one thing, there’s the potential to reduce wait times within the health care system, since the pill can be prescribed in your doctor’s office. And its arrival in Canada also increases the potential number of providers of this service — which could dramatically improve access to abortion care (especially in rural areas), as long as physicians are willing to prescribe it. Not every provider will be willing to do so, but as more doctors learn about it, I think it will become routine work in many primary care offices.
When a woman decides to terminate a pregnancy, the drug also allows her to take charge of the abortion process. In consultation with her physician, she can choose when to take the medication. It’s less invasive and there’s no need for anesthesia. There is also less infrastructure required (no need for an operating room).
Mifepristone is currently approved for use in Canada for up to 49 days’ gestational age — that’s 49 days from the first day of the last menstrual period. (This period may soon be extended, as FDA approval is up to 70 days.) It’s a pill you ingest, and then 24 to 48 hours later, you dissolve two other tablets in the pouch of your cheek.
Cramps and bleeding start within six to eight hours. It’s up to 99 percent effective, and there’s no need to be admitted to the hospital. Essentially, you have a miscarriage in your own home — something, it’s worth noting, that women do every day, all over the world.
One to three weeks later, there should be a follow-up for a blood test (and sometimes an ultrasound) to confirm the intervention was effective. Primary care providers are equipped to arrange both of these procedures.
No intervention works 100 percent of the time, and this is no different. Between 1 and 5 percent of patients will go on to need a surgical aspiration, so a woman does have to be within a reasonable distance of emergency care for 14 days. But everything else — patient education, counselling of risks and benefits, obtaining consent and writing the prescription — is done within a doctor’s office. In some parts of the country, the tablets will need to be sent to the physician’s office to be dispensed, rather than being picked up at a pharmacy.
One of the things that’s going to be a challenge is funding. Surgical abortions in hospitals and clinics are covered by most provincial insurance plans, but the drug is expected to cost about $270 per package, and it may not be covered. There’s been a lot of advocacy work by physicians and women’s groups to get ministries of health to pay for this. After all, it may well be less expensive for the health care system. And given how potentially important this advance can be for women, we want to eliminate as many barriers as possible.