OTTAWA — Health Canada should approve a pill that is considered the “gold standard” for inducing safe and early non-surgical abortion, according to an editorial in the most recent Canadian Medical Association Journal.
The drug mifepristone is internationally recognized as the best method to provide non-surgical abortion within the first nine weeks of pregnancy, the editorial states. Yet it is not available in Canada.
The drug can be given orally and induces an abortion similar to a natural miscarriage within one to two days.
According to the editorial, mifepristone has been in use in other countries since the 1980s. It is available in 57 countries and is listed as an essential medication by the World Health Organization.
An application now in front of Health Canada could bring the drug here and bring Canadian reproductive health care up to international standards, the editorial argues.
Canadian opinions on abortion. (Trevor Johnston / Postmedia News)
“Abortion is a significant issue for Canadian women,” said Sheila Dunn, co-author and researcher with Toronto’s Women’s College Hospital. One in three Canadian women will have an abortion in her lifetime, Dunn said, citing the findings of a 2012 study by University of British Columbia researcher Wendy Norman.
“This could really provide an option that women will want and one that would very much improve access to abortion in areas of the country where services are difficult to get,” said Dunn. “It could be provided by a primary care provider, like a nurse practitioner, family physician or midwife.”
Right now, the vast majority of abortions performed in Canada are surgical, requiring operating-room access and a greater recovery time for women.
Non-surgical abortions in Canada are available via the drug methotrexate, which Dunn said is “second rate.” Methotrexate is prescribed off-label for abortions, meaning it is not intended for that purpose, Dunn said. Additionally, it must be administered by injection, takes longer to work than mifepristone, and is less reliable. Methotrexate can also cause serious birth defects if the abortion is unsuccessful, so women must be tracked and monitored by health professionals.
“It’s more cumbersome for the provider to give it, and it’s more cumbersome for the women to experience it, so providers haven’t taken it up in a big, big way,” said Dunn.
British Columbia is the only province that keeps statistics on rates of medical abortion, the editorial states, noting a recent study showed 15 per cent of abortions in that province are non-surgical. That figure is estimated to be much higher than the average for the rest of Canada, Dunn said. Meanwhile studies have shown mifepristone accounts for 20 per cent of abortions in the United States and up to 60 per cent in some European countries.
Dunn said studies also show abortion rates do not go up in countries where non-surgical abortions are widely available, but women do tend to get abortions earlier in their pregnancy, when they are safer.
Currently, “we’re using something that is second-rate and it’s just not OK that we do that,” Dunn said.
She said a number of factors have likely kept mifepristone from entering the Canadian market. Pharmaceutical companies may consider Canada too small to justify the cost of obtaining approval, she said. The editorial also notes some argue Health Canada is biased against reproductive medications, “with more onerous requirements for regulatory approval compared with Europe and the U.S.”
A spokeswoman for Health Canada said the agency cannot comment on a pending application.