Removal of ultrasound requirement could improve access in remote communities to abortion drug

Health Canada lifted an ultrasound requirement on the Mifegymiso abortion pills. The N.W.T. health department is determining what that will mean in the territory.

Rule made access to drug difficult in rural and remote communities, says advocate

The decision to lift a requirement for an ultrasound before getting a prescription for the abortion drug Mifegymiso could improve access to the drug in the N.W.T., a sexual health advocate says. (Linepharma International)

Sexual health advocates are praising Health Canada's decision last week to remove the requirement of an ultrasound before the abortion drug Mifegymiso can be prescribed. They say removing that restriction will improve medical abortion access in rural and remote communities.

But what that federal decision will mean for communities in the Northwest Territories is not yet clear.

The Northwest Territories government is working to "determine what the changes mean for the N.W.T.," said health department spokesperson Damien Healy in an email.

The drug, which is used to terminate a pregnancy up to 63 days past the last menstrual period, is currently available in communities with ultrasound diagnostic capabilities. 

Despite Health Canada's removal of the ultrasound requirement, "medical practitioners must still be confident" the pregnancy is below 63 days and to rule out ectopic pregnancy (a pregnancy outside the uterus) to "minimize possible serious health risks to the patient," Healy wrote.

"Access to Mifegymiso for women who live in smaller communities is being discussed at a national level and this will help inform the work going forward." 

Rural Impact

The restriction was an "unnecessary" barrier to a time-sensitive procedure and its removal is based on science, said Frédérique Chabot, director of health promotion at Action Canada for Sexual Health and Rights.

Frederique Chabot, director of health promotion at Action Canada for Sexual Health and Rights, said the requirement was an unnecessary restriction. (CBC News)

"It was definitely a barrier in rural regions [that] we're happy does not stand in the way anymore," she said.

One in three women will have an abortion in her lifetime, but access to medical abortion is limited in rural and remote communities where women face financial strain, privacy concerns and incur child-care costs if they must travel to end a pregnancy, Chabot said.

Mifegymiso is seen as an antidote to several privacy and cost concerns associated with surgical abortion. It can be prescribed by family doctors and nurses without the same infrastructure demands and is taken discreetly.

"It means breaking down historical gaps in access, especially outside of major urban centres," said Chabot.

Cost coverage still a barrier

An interim directive by N.W.T. Health Minister Glen Abernethy last year meant the cost of Mifegymiso for uninsured women in the territory would be covered.

The Midwives Association of the Northwest Territories and FOXY (Fostering Open eXpression among Youth) asked the government to go one step further and offer universal coverage to all women, regardless of financial or insurance status. 

N.W.T. Health Minister Glen Abernethy gave an interim directive to the health department last year to cover the cost of Mifegymiso for women without private insurance or coverage under Non-Insured Health Benefits. (Alex Brockman/CBC)

The groups wrote that deferring to insurance companies creates privacy concerns for women under a parent or partner's health plan. It could also delay a patient's treatment as they navigate complex insurance structures, they wrote.

Many women in the North are covered by the federal government's Non-Insured Health Benefits Program, but the N.W.T. does not cover Mifegymiso for women with insurance. 

For anyone paying out of pocket, one dosage of Mifegymiso would cost between $300 and $450. In the Northwest Territories, the drug is available in Yellowknife, Inuvik, Fort Smith and Hay River through Northern Options for Women. 

Yukon is the only territory with universal cost coverage. All provinces except Saskatchewan and Manitoba have universal coverage.

"If we don't cover the cost, if we don't make it easy for health care practitioners to offer it, if we don't remove policy barriers … then it doesn't make the difference that it could make," Chabot said.

Cost-coverage is a major barrier to people experiencing job insecurity, poverty, homelessness, domestic violence or with child-care responsibilities, she said.

"Many people end up having to pay out of pocket and that's a steep price that puts it out of reach for many people. This is who doesn't get access to abortion if we don't do anything," she said.


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