Skip to content
Access to abortion services increased substantially in Ontario after mifepristone became available through community pharmacies in Canada in 2017, according to new research.
Expanding the availability of mifepristone to local pharmacies shifted the delivery method from procedural abortions to more accessible medication abortions, the authors wrote, adding that this trend will likely continue.
“When reproductive health policies are guided by evidence and mifepristone practice is not limited by ideologically driven restrictions, community pharmacies can support substantial gains in abortion access, even for rural and remote areas,” lead author Laura Schummers, ScD, assistant professor of pharmaceutical sciences and director of the Epidemiology, Contraception, and Abortion Research Team at the University of British Columbia in Vancouver, told Medscape Medical News.
“Canada is a global leader in evidence-based abortion policy,” she said. “In stark contrast with rapidly eroding reproductive rights and access in the United States through regressive legislation, Canada provides a clear example of what evidence-based abortion policy can look like.”
The study was published online on April 7 in CMAJ.
Analyzing Abortion Access
Before 2017, abortions in Canada tended to be procedure-based and available in fewer than 100 hospitals and reproductive health clinics, typically located in urban areas. This situation often led to delayed care and complications, especially for those in rural areas, the authors wrote. Medication abortion, which was mostly available through off-label use of methotrexate, was rare.
In 2017, mifepristone became available as a medication abortion drug in Canada under a nationwide regulatory approach, including the key element of providing access through community pharmacies, said Schummers.
“Unlike all other countries where this medication has many regulatory restrictions that limit use to reproductive health–specific clinics, in Canada, this medication became available like any other prescription medicine,” she said. “The goal of this regulatory approach was to improve access to abortion services broadly.”
To investigate the achievement of that goal on a local level, Schummers and colleagues analyzed ICES data for changes in abortion service availability in Ontario between January 2017 and December 2022. They looked at the annual proportion of community pharmacies that dispensed mifepristone, as well as the availability and distribution of medication and procedural abortion services across geographic regions.
Between 2017 and 2022, more than 175,000 patients underwent 227,000 abortions, increasing from about 36,000 per year in 2017 to more than 41,000 per year in 2022. The percentage of medication abortions also shifted dramatically from 8% to 56%.
During that time, the proportion of pharmacies that dispensed one or more mifepristone doses increased steadily from 3% in 2017 to 20% in 2022. The proportion of regions with a community pharmacy that dispensed mifepristone increased from 19% in 2017 to 77% in 2022.
The percentage of reproductive-age women aged 15-49 years who lived in a region with a mifepristone-dispensing pharmacy or procedural abortion provider increased from 37% in 2017 to 91% in 2022. In addition, the proportion of abortion service users who lived in a region with a mifepristone-dispensing pharmacy increased from 27% to 90% for urban residents and from 17% to 88% for rural residents.
“Despite these impressive gains in access, it is important to know that many still face complex and intersecting barriers to abortion access across Canada,” Schummers said. “Our health systems must continue to improve service delivery to overcome remaining barriers.”
Overcoming Access Barriers
The research team noted several areas for ongoing improvement. In 2022, 6% of regions had no pharmacy at all, 20% of regions with a pharmacy still didn’t have one that dispensed mifepristone, and 9% of abortion service users lived in a region without a local procedural provider or a mifepristone-dispensing pharmacy.
“From the earliest of discussions prior to mifepristone approval in Canada, the focus has been on the potential for medication abortion to greatly improve access to abortion care for large swaths of the Canadian population,” Dustin Costescu, MD, a family planning specialist and associate professor of obstetrics and gynecology at McMaster University in Hamilton, Ontario, told Medscape Medical News. Costescu was not involved in the research.
“Procedural abortion facilities remain clustered in large urban centers, with inconsistent abortion service provision in smaller hospitals,” he said. “While these clinics serve an important purpose and provide high-quality care, they are of no use to an individual who cannot access them.”
Costescu has researched mifepristone policy and availability in Canada, including ongoing barriers such as lack of stock at some community pharmacies. Additional advocacy and clinician education could help ensure that mifepristone remains accessible to patients who need it, he said.
“The Canadian healthcare system’s uptake and integration of medication abortion into standard practice is unparalleled around the world, due in no small part to several of the authors of this paper,” he said. “In less than 10 years, a novel medication regimen has transformed abortion access dramatically, with 90% of rural Ontarians and 92% of urban Ontarians now having access to at least one abortion option.”
The study was supported by a project grant from the Canadian Institutes of Health Research (CIHR) and infrastructure support from the Women’s Health Research Institute of the Provincial Health Services Authority in British Columbia. Schummers was supported by a CIHR Transition to Leadership in Patient-Oriented Research Award. Costescu reported no relevant financial relationships.
Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape Medical News, MDedge, and WebMD.
