Mifepristone availability in pharmacies has drastically changed abortion access for Canadians

Mifepristone has been available in Canada since 2017—but how it affected regional abortion access wasn't known, until now. A new study published in the Canadian Medical Association Journal looked at Ontario abortion data from between January 2017 and December 2022 to see the proportion of done with mifepristone. Before 2017, abortions were provided in fewer than 100 hospitals and clinics in Canada, mostly in urban centres. The researchers found that more than 226,000 abortions were provided in that timeframe. In 2017, 2% of Ontario pharmacies filled one or more prescriptions for mifepristone for abortion, increasing to 20% in 2022. Access has also expanded greatly. In 2017, just 19% of regions had a pharmacy that dispensed mifepristone, while 18% of regions were able to perform a procedural abortion service. By 2022, 77% of regions had access to a mifepristone-dispensing pharmacy. As of 2022, 91% of those seeking abortions have a local pharmacy that dispenses mifepristone or a procedural provider. Access was improved in both rural and urban areas in the province. Mifepristone and misoprostol are used in combination to provide safe abortions through to nine gestational weeks. Though the drug has been available internationally since the 1980s, mifepristone underwent one of the lengthiest approval processes in Health Canada's history. And, when the drug was finally approved in 2015, it came with regulations like physician-only dispensing. Health Canada has since removed those requirements so that the medication could be available in pharmacies like normal prescription drugs in 2017. Timely access is of the utmost importance regarding abortion. Risks of abortion complications increase exponentially as gestational age increases. Mifepristone is considered the "gold standard" for medical abortions and its role in abortion care is so important that the drug is on the World Health Organization’s (WHO) essential medicines list. The removal of those extra requirements and the expansion of mifepristone in community pharmacies has led to a shift away from procedural abortions to mifepristone, a trend that the researchers expect to continue. “Abortion service needs are time-sensitive, as risks of abortion complications increase exponentially with increasing gestational age. It is likely that the proportion of abortions provided by medication in Ontario will continue to increase beyond our study period, mirroring trends elsewhere,” the researchers wrote in the CMAJ article. That said, there is still room for improvement. In 2022, 6% of Ontario regions had no pharmacies, while almost all regions (>97%) required abortion services annually, defined as at least one resident seeking abortion services during the year.

Mifepristone availability in pharmacies has drastically changed abortion access for Canadians

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