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

Sexual health advocates are praising Health Canada's decision last week toremove the requirement of an ultrasound before the abortion drugMifegymisocan 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.," saidhealth 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 currentlyavailable 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," Healywrote.

"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 Frdrique Chabot, director of health promotion at Action Canada for Sexual Health andRights.

"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 inrural 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 istaken 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 byN.W.T. Health Minister Glen Abernethylast year meant the cost of Mifegymiso for uninsured women in the territory would becovered.

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

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, butthe N.W.T. does not cover Mifegymiso for women with insurance.

For anyone paying out of pocket, one dosage of Mifegymisowould 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.