Written by: Dr. Sonika Kainth (she/her), MD CCFP.
Edited by: Shelby MacGregor (she/her).
Mifegymiso, a combination of mifepristone and misoprostol, also known as “MIFE” for short, was approved by Health Canada in 2015 (1). Statistics from 2019, four years after approval in Canada indicate that 69% of MIFE prescriptions came from abortion clinics in large urban centres (2).
Let us work together to get more providers – medical doctors and nurse practioners – comfortable with medical abortions, as one in every three people with a uterus in Canada will have an abortion at some point in their lifetime (3). Let’s increase MIFE access in Canada, not only in rural areas but also for individuals who are low-income, working many jobs, or busy with taking care of many children.
MIFE was developed in the 1970s when looking for a medication for Cushing’s syndrome, and thus has been around for more than fifty years (4). Some people with uteruses prefer a medical abortion because it focuses on them and their choice. They don’t have to lie flat on an exam table and give others access to their private parts. They can get an abortion as soon as they decide that they do not want to carry the pregnancy to term. They can take charge of this process, own it themselves and not have to go to the operating room, which also saves our public health system’s operating room time.
When MIFE first came out in Canada, physicians were the only prescribers and they had to take a special course. Then, the medication needed to be dispensed by the same physician and the swallowing needed to be observed. Now, thankfully, anyone wanting medical abortions can have the pills dispensed for them by a pharmacist and swallow them at home. MIFE can also be prescribed by nurse practitioners and there is universal coverage for it in most provinces.
SexAndU talks about abortion pills for patients (5), and the Canadian Family Physician (CFP) came out with an awesome 3 pager in January 2020 for prescriber use, including a one page handout for patients (6). The only item I recommend doing in addition to what the CFP recommends is call the patient in the first few days of their medical abortion. It only takes me five minutes to call them, yet it prevents them from worrying, going to a walk-in clinic or even the emergency room.
Often, when it’s our first time doing something medical, we tend to worry if we are doing the right thing and want to check off all the boxes.
Let’s remember that with some rural or marginalized populations, checking off every single box – like getting an ultrasound – is not possible.
The Journal of Obstetrics and Gynecology of Canada notes that “in the absence of readily accessible ultrasound, gestational age can be estimated using the last menstrual period (LMP), clinical history, and physical examination, in women who are certain of the date of their LMP. Ultrasound is needed when uncertainty remains. The probability of ectopic pregnancy among [people with uteruses] requisting abortion is consistently lower than in the general population”(7). Even though I work in Toronto, a handful of my patients have not been able to go for their ultrasound due to other aspects in their lives affecting them – their social determinants of health. We as medical practitioners need to consider the lived experiences of our patients and increased access to MIFE helps remove one barrier from their lives.
In March 2020, during wave 1 of COVID-19, phone calls to “Action Canada for Sexual Health and Rights” increased by 30% (8). Many of their calls were from clients who had questions about all the barriers – those existing prior to the pandemic and additional barriers caused by the pandemic – to abortion access (8). We are now in wave 4 of COVID-19, and have gotten used to the routine of primary care during Covid-19. We have been helping prevent people from having to go to the emergency room, hospitals, or even other packed clinics.
Let us support patients and physicians in one more way: being more comfortable with prescribing medical abortion. The next time someone comes to you wanting a medical abortion, prescribe it to them. It is safe and easy to do. Try not to send them elsewhere and overwhelm the sexual health clinics. Let’s help our patients not have to wait a few more days, miss work, take long public transit for a few hours, or even have to take all of their current children with them to a special clinic. Let’s help our patients with an easy to prescribe and manage medical abortion too.
References:
1. FAQ: The Abortion Pill Mifegymiso | Action Canada for Sexual Health and Rights [Internet]. Actioncanadashr.org. 202. Available from: https://www.actioncanadashr.org/resources/factsheets-guidelines/2019-04-06-faq-abortion-pill-mifegymiso
2. Weeks C. Abortion-pill obstacles: How doctors’ reluctance and long-distance travel stop many Canadians from getting Mifegymiso [Internet]. 2021. Available from: https://www.theglobeandmail.com/canada/article-abortion-pill-obstacles-how-doctors-reluctance-and-long-distance/
3. Norman W. Induced abortion in Canada 1974–2005: trends over the first generation with legal access. Contraception. 2012;85(2):185-191.
4. Staff I, Hanna K. Biomedical Politics. Washington: National Academies Press; 1991.
5. Unplanned Pregnancy – Sex & U [Internet]. Sexandu.ca. 2021. Available from: https://www.sexandu.ca/pregnancy/unplanned-pregnancy/#tc4
6. Bancsi A, Grindrod K. Update on medical abortion. Canadian Family Physician [Internet]. 2020;66(January):42-44. Available from: https://www.cfp.ca/content/cfp/66/1/42.full.pdf
7. Costescu D, Guilbert E, Bernardin J, Black A, Dunn S, Fitzsimmons B et al. Medical Abortion. Journal of Obstetrics and Gynaecology Canada. 2016;38(4):366-389.
8. Kappler M. Abortion Is An Essential Service, But The Pandemic Is Making It Harder To Access [Internet]. HuffPost. 2021. Available from: https://www.huffpost.com/archive/ca/entry/abortion-access-coronavirus_ca_5e8b54d5c5b6e7d76c6805c7?utm_hp_ref=ca-health
