Winnipeg abortion providers oppose federal abortion pill requirements

A drug for medical abortions is set to be available in Manitoba this fall, but some are worried those who need it most won't be able to access it.

Community says doctors-only approach limits access, increases doctor workload

The abortion-inducing drug RU-486, actually a two-pill therapy, has been approved for use in Canada. (Charlie Neibergall/Canadian press)

A drug for medical abortions is set to be available in Manitoba this fall, but some are worried those who need it most won't be able to access it.

Health Canada approved Mifegymiso in July 2015. The drug can terminate a pregnancy up to 49 days old without surgery. The Canadian distributor, Celopharma, released a statement last week saying that the drug should be available to Canadians in the fall.

But one of the federal safety requirements is that doctors are the only health professionals who can prescribe and dispense the drug. They can only do that once they complete voluntary online training.

This doctors-only approach is concerning to some in the abortion-providing community, according to Joan Dawkins.

"Most physicians don't have their offices set up to buy and sell drugs," the executive director of Women's Health Clinic (WHC) said. 

"They're not set up to do it because pharmacists do that. What we're afraid of is, if doctors must set themselves up to buy and sell this drug, they won't. It will become a disincentive."

WHC and the Health Sciences Centre are the two places where the vast majority of surgical abortions happen in Manitoba, according to Dawkins. Mifegymiso can give women outside Winnipeg easier access to abortion services. 

"For women who need to come to Winnipeg now, it's very difficult to maintain privacy," Dawkins said. 

"In some cases, women often need approval to travel. That means they have to reveal an unplanned pregnancy to people in their community. If you brought the availability of a medical abortion closer to where they live, they might be able to get a ride or take a bus to where that service might be available. And they'd maintain their privacy."

But Dawkins said many doctors might not want to take on pharmaceutical responsibilities like purchasing, stocking and dispensing Mifegymiso. That leaves women living far from Winnipeg, women who might benefit the most from medical abortions, at risk of not getting the drug at all. 

'This stuff expires'

"For example, this stuff expires," Dawkins said. "[Doctors] would have to stock it and dispose of expired stock whether they use it or not. In a small community, that's going to cost them money they probably won't be willing to spend."

Celopharma says the reason for this doctor-only approach is because it increases patient safety.

According to an Aug. 3 release, "this restrictive administration program is in place in order to give the appropriate medical and psychological support to women, to ensure that the drug is not taken too late during the pregnancy and to be able to schedule a follow-up appointment in the appropriate delay."

But this seemingly helpful requirement won't work, Dawkins said, if doctors don't agree to take the training in the first place.

"I don't think there's a problem with the doctors prescribing it, but the question is who actually buys it, dispenses it," Dawkins said. "It makes more intuitive sense for us to have pharmacists be the primary dispensers of the drug."

CBC asked both the College of Physicians and Surgeons of Manitoba and the College of Pharmacists of Manitoba about this Health Canada requirement. Both bodies told CBC they believe pharmacists should be the ones dispensing the drug in this province.

College of Pharmacists backtracks, says it has no position on matter

But on Tuesday evening, the College of Pharmacists backtracked on that sentiment saying it has no official stance on the distribution and administration of Mifegymiso.

Registrar Susan Lessard-Friesen said the college has no official position and will discuss the matter with the college's council at a meeting in October. 

For now, Dawkins said the WHC is interested in doing medical abortions using Mifegymiso. She also said they'll try to communicate with any new doctors or doctors who aren't providing abortions to consider this new option. 

"I do think the colleges are on the right track," Dawkins said. "The pharmacists are doing the things they're experts at, and the doctors continue doing the things they are experts at. We have the right people doing the right part of the work."

But if the doctors-only requirement isn't lifted, the abortion-providing community still faces barriers.

"We'll do the best we can with it," Dawkins said. "But access will continue to be very limited and most of the activity will continue to be here in Winnipeg."