A series of recent news articles have shone a light on the challenges surrounding access to medical abortion across the country, pointing out some of the major differences between provinces, the concentration of access at clinics that currently provide family planning and/or surgical abortion, and the disadvantages faced by those in smaller and remote communities.
As physicians, a key priority of the Society of Obstetricians and Gynaecologists of Canada (SOGC) is to try to reduce the number of women with an unplanned pregnancy. Research suggests that unintended pregnancies remain high, with as many as 61% of Canadian women having had at least one unplanned pregnancy. Free access to effective contraception has been shown to reduce abortion rates. We are strong advocates for awareness and access, and a national contraception access plan is required to reduce barriers to access as well as to support a range of family planning services with safe, modern methods of contraception. The personal, health care, and social costs of a single unintended or mistimed pregnancy are substantial. A comprehensive but targeted plan would address women in need of contraception who are not covered by private insurance or government assistance plans, and who could not otherwise afford contraception.
We believe that Canadians would be well served by a policy for national, equitable access to contraception and healthy family planning, and the promotion of gender equality and empowerment of women and girls to have full control over their bodies and lives, consistent with the important commitments that Canada has made globally.
Regardless of the situation, it is always a woman’s choice whether to continue with a pregnancy or not. When this choice is limited by personal resources or by where in the country she lives, her access to care or choice is clearly neither easy nor equitable and we have a problem requiring action.
Pregnancy and pregnancy termination are complex decisions not entered into lightly. Abortion is a necessary option; the only question is whether it will be accessible and safe, or restricted to those with means. Our goal is to ensure equal access to safe abortion for all Canadians and to have well-trained and prepared health care providers offering a choice of medical or surgical termination in a secure network of care, close to home. The SOGC, the College of Family Physicians of Canada (CFPC), and the Canadian Pharmacists Association worked together to create a comprehensive online training course for health care providers and, upon completion, the clinician is invited to join a network of providers to be able to consult, share clinical experience, and learn about research advances. So far, 2,904 providers have completed training. Both the SOGC and the CFPC have offered well-attended workshops at our annual conferences, which were open to licensed health care providers in Canada.
Although the health care providers who have taken this course come from all parts of the country, currently, access to medical abortion is predominantly in existing clinics providing family planning services. The entry of Mifegymiso into the Canadian market was attended by numerous restrictions and, initially, mandatory training. While this may become more normal in the future, it was the first medication to have such requirements thereby creating an aura of complexity and risk. Those restrictions have been eased as experience has shown the safety of the medication. It is not going too far to suggest that that safety record may, in part, be due to the cautious introduction, with a small cadre of doctors – family doctors and gynaecologists – and nurse practitioners that gained the necessary knowledge and experience, which now needs to be widely shared.
Adoption of change is slow. Although education and training are necessary, they are not sufficient to effect a major change. We need to work across many sectors to understand the local environment and those factors that will support or inhibit the introduction of medical abortion services, and find solutions specific to each community. Safe care requires a team. We recognize the reality that, while those living in small or large, urban or remote communities have the same need for access to pregnancy termination, there may be deeply felt opposition to abortion that impacts both women’s willingness to seek, or practitioners to provide care in the smaller communities.
If we only focus on clinical skill, we will see slow progress. To expedite implementation, we need to attend to all the dimensions; at a community, facility, and health systems level. Professional societies play a key role in continuing medical education, but the provincial government does indeed have a major opportunity to improve access, as it has done with procedures such as hips and knees.
Canada has long been at the forefront of ensuring its population has the freedoms, opportunities, and equalities that all people seek. However, we believe that we can do better in this case and must do what is right to provide sexual health education, free access to contraception, and access to all pregnancy options by removing barriers to access for medical termination of unwanted pregnancies.