Access to abortion pill in Sask. unclear

Saskatchewan remains the only prairie province where women have to pay out of pocket to access the abortion pill — something advocates and public health experts believe must change.

The Alberta government recently announced universal coverage had been extended to Mifegymiso — more commonly called the abortion pill — which costs about $ 300.

New Brunswick became the first province to do so, with the governments of Quebec and Ontario pledging to do the same. Recently, the pill was also made free of charge to women who access it from centres in certain health regions in Manitoba. 

In Saskatchewan, however, the Ministry of Health says the process is still underway to review whether the drug, approved for sale by Health Canada in July 2015, should be listed under the provincial drug benefit plan.

“We’re seeing our neighbours both to the east and west stepping up and covering the cost. Saskatchewan government should be doing the same,” said Nicole Sarauer, interim leader of the NDP.

“We’ve seen this government fall behind on other things and we wouldn’t want this to do anything to impede women’s reproductive choices in this province, limit them in comparison to what we’re seeing happen in other provinces.”

The province anticipates the review to conclude later this summer. The cost of the medication should be reimbursed by provincial drug plans, according to a recommendation from the Canadian Drug Expert Committee — an independent panel of experts that provides advice to governments on publicly-funded drug plans.

Sask. ‘one of hardest places to get abortion’

Dr. Wendy Norman, an associate professor at the University of British Columbia and chair of family planning resarch for the Public Health Agency of Canada, said research shows in that in the Prairies, 96 cent of surgical abortions are done in large cities.

In Saskatchewan, abortions are only available in Regina and Saskatoon. In Regina, the procedure is available at the women’s health centre at the Regina General Hospital, and in Saskatoon, at the Saskatoon City Hospital and two other clinics.

“Saskatchewan is one of the hardest places to get an abortion,” said Darrah Teitel, public affairs officer for Action Canada for Sexual Health and Rights.

She said it’s challenging for women living outside cities where abortion services are not available to terminate a pregnancy, because they must drive long distances to access the service, and potentially incur travel, accommodation, or child-care costs.

That effectively creates a two-tier system for abortion access, adovcates say.

Unclear where pill is available

Shipments of Mifegymiso began arriving in Canada this January.

Celopharma, the Canadian distributor, says a number of boxes have been shipped to a pharmacy in Saskatoon, but would not specify which one.

How the abortion pill works:

Mifegymiso, or the abortion pill as it’s commonly called, is two-drug combination of mifepristone and misoprostol.

Mifepristone blocks the hormone progesterone from preparing a woman’s uterine lining for pregnancy, then misoprostol induces contractions.

Saskatoon’s Dr. Brian Fern explains the procedure as an induced miscarriage.

Neither the province, the Saskatchewan College of Pharmacy Professionals or the Society of Obstetricians and Gynaecologists of Canada keeps track of where the pill is available.

“The listing process [under the provincial drug plan] will allow the province the mechanism to gather this information,” said Karen Hill, a provincial government spokesperson.

In the meantime, CBC News contacted the health regions to ask if it’s available through its hospitals or clinics.

Nine out of the thirteen regions responded to the request in a timely manner.

Only the Regina Qu’Appelle Health Region confirmed the pill is offered as an option to patients at the Regina General Hospital through eight physicians who have completed the required online training to become a prescriber.

Abortion Pill

Bottles of the abortion-inducing drug RU-486 in Des Moines, Iowa, which Planned Parenthood of the Heartland clinic doctors can remotely prescribe using a telemedicine terminal. (Charlie Neibergall/Associated Press)

43 trained prescribers

Women must access the pill through a prescription from a physician. As of mid-June, 57 doctors and pharmacists in Saskatchewan had signed up to complete the training and 43 had done so, according to the Society of Obstetricians and Gynecologists of Canada.

The society was unable to provide information about where in the province these health professionals practise.

“We expect that once the provinces commit to cost coverage, the demand for medical abortion is going to increase significantly,” said Darrah Teitel, public affairs officer for Action Canada for Sexual Health and Rights.

“So once that demand increases, we expect that more and more family physicians will start to educate themselves as to how simple it is to prescribe and will start becoming prescribers of it.”

Doctor-dispensing a problem, says prof.

For Dr. Wendy Norman, an associate professor at the University of British Columbia and chair of family planning research for the Public Health Agency of Canada, increasing access to the pill — especially for women in rural areas — lies in empowering pharmacists to dispense the medication as opposed to strictly doctors.

Dr. Wendy Norman

Dr. Wendy Norman is an associate professor at the University of British Columbia. (University of British Columbia)

Health Canada guidelines advise that physicians who prescribe the pill be the ones who dispense or hand the box directly the woman, citing patient safety.

Norman believes this is flawed, arguing that the physician-dispensing stipulation restricts access to the pill because it effectively requires doctors become mini-pharmacies, which they are not equipped to do.

“This is so far outside of their usual practice that they aren’t willing to take on offering this medication to their patients or prescribing it because the huge burden to become a dispensing physician is outside of what they can take on.”

Norman said, “The main hope for Canada so that your postal code doesn’t dictate whether or not you can have choices for normal reproductive health services lies in being able to facilitate easy practice among family doctors in rural areas.”

Why the abortion pill coming to Canada matters1:42

Pharmacists soon to get go-ahead

Despite the federal terms of approval for the pill, colleges of pharmacists, physicians and surgeons in Ontario, B.C. and Nova Scotia have since confirmed to their members that it’s within a pharmacist’s scope of practice to dispense the abortion pill.

Ray Joubert, registrar with the Saskatchewan College of Pharmacy Professionals, said he will send a similar message to pharmacists in the province by mid-month, confirming pharmacists can distribute the pill and offering guidance on how to do so.

Number of abortions paid for by the province of Saskatchewan

  • April 1, 2016 to March 31, 2017: 1,803 (267 performed out-of-province, mostly in Alberta).
  • April 1, 2015 to March 31, 2016: 1,967 (292 performed out-of-province, mostly in Alberta).

“This is one of the best advances for access for women in Saskatchewan for abortion care in many, many years,” Norman said.

“Across Canada we can see that in provinces where pharmacists are supported to work to their full scope as dispensers … women in rural areas and outside of big cities have better access because their family doctors are more likely to engage when they know they can write a prescription in the usual way, the woman can take to the pharmacists in the usual way.”

In April, the College of Physicians and Surgeons of Saskatchewan issueda message to its members in a newsletter, clarifying three options for how a patient can access the pill. According to the message, a woman can take a prescription for Mifegymiso to a pharmacist, who in turn sends the medication to their doctor’s office; a pharmacist can dispense the medication directly to the woman; or a dispensing-doctor can hand the box to the woman.

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