Abortion pill rollout deeply flawed

Posted on March 6, 2017 in Health Debates

TheStar.com – Opinion/Commentary – Mifegymiso remains hard for doctors to prescribe, difficult for pharmacists to dispense and is too distant and costly for many vulnerable women.
March 6, 2017.   By HEATHER MALLICK, Columnist

Why is it taking so long for the abortion pill to become commonplace in Canada, just like any other prescribed medication? It is not a special drug in any sense. It works as expected. Yet it remains hard for doctors to prescribe, difficult for pharmacists to dispense and is too distant and costly for many vulnerable women.

Never attribute to conspiracy what can be blamed on inertia or incompetence. But then again, it’s easy to make that soothing remark. One can be calmer about women’s health and safety in big cities with hospitals and clinics that provide abortions.

Canadian women in smaller cities and in rural areas have been abandoned.

Mifegymiso, which costs $325 including painkillers, is given to women for free at one Calgary abortion clinic that negotiated with the province, the Globe and Mail’s Kelly Grant reports. Why was this not done nationwide, years ago?

The rules for Mifegymiso, are weird, almost retro. There are two medications dispensed as a combination. The first, mifepristone, blocks the hormone progesterone and causes the lining of the uterus to shed. The second, misoprostol, taken a day or two later, causes contractions and miscarriage. As with any miscarriage, women should see their doctor. It is not complicated.

Although the drug was approved for very early pregnancies by Health Canada in 2015, the review took three years and access remains the problem. Doctors and pharmacists, the very people unlikely to have spare work hours, must take a six-hour online course to prescribe or dispense it.

Those who have taken the course are acting out of professionalism and human decency. But why should abortion still live in the realm of charity? It is legal. It is a basic human right. When women don’t have this right, some of them die.

As the Globe reports, only five abortion clinics and a few big-city pharmacies have ordered the drug since it became officially available in January. The drug, legalized 15 years ago in the U.S. and decades ago in countries like France and China, is included on the World Health Organization’s list of essential medicines.

But in Canada, women in small towns will have to travel to make the request. They will have to pay for the trip and for a place to stay while Mifegymiso does its work. How will they be able to keep this private and secret? It’s an Alice Munro story but set in 2017. Even now, anti-abortionists still torment women quietly and successfully.

How ironic — though admirable — that Ottawa is donating $20 million to a new international fund for contraception, counselling and legal abortions in poorer nations around the world. It’s a hasty effort to counter President Donald Trump, who just killed such funding.

The previous Conservative government had not included money for such care in its “maternal health” plan, but the new Liberal government has changed course. Canada wants to help. So why the domestic delay on Mifegymiso?

At the moment, most provincial drug plans won’t reimburse the cost of the drug, even though surgical abortions are mostly covered. A federal panel will rule on the matter this spring, Grant reports.

I remain mystified by the strange initial federal rule that doctors have to give Mifegymiso to patients personally, in their offices. It is as though women are too irresponsible to handle explosive devices, as though foolish women cannot understand written instructions on a package.

Now pharmacists are being told by some provincial colleges to just dispense it with their own hands, rather than insisting a doctor do it. In B.C., hospitals will give the drug to women for free this spring.

Celopharma, which distributes Mifegymiso in Canada, is hoping for a complete rollout. But significantly, Health Canada’s chief medical adviser, Dr. Supriya Sharma, told the Star’s Zoe McKnight last month, “Whatever decision we make on this product, there will be a group of people who will say we’re being far too permissive, and a group of people who will say we’re being far too restrictive.”

Health Canada should be above this.

If women wish to take this safe drug, let them. I refer not just to Canadian women but to Americans who may see abortion banned in the next four years, perhaps nationally, but more likely state by punitive state.

Surely, Canada should make the abortion pill available — a distribution network like the Underground Railroad — at a time when desperate American women have nowhere to turn.


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