Abortion pill rarely used in rural Manitoba, new data shows

A drug that was supposed to increase abortion access for women in rural and remote areas is being dispensed infrequently, if at all, outside of Winnipeg and Brandon. 

In the nearly two years since Mifegymiso, commonly known as the abortion pill, has been available, the province says 29 prescriptions had been dispensed from retail pharmacies by June 2018. But pharmaceutical analytics firm IQVIA says as of August 2018, zero prescriptions had been filled by those centres.

Mifegymiso is available free of charge and without a prescription at three locations in Manitoba, including the Women's Health Clinic in Winnipeg, where hundreds of people have accessed it. But clinic executive director Nadine Sookermany said the hope was it would make a difference for smaller communities. 

"The numbers don't surprise me," she said. "I guess it was my hope that there was more access through the market outside of the sites that currently are funded to dispense."

Mifegymiso — a two-drug combination that induces a medical termination of a pregnancy — can cost up to $300 if prescribed away from those locations.

In Saskatchewan, nearly 400 people have received the abortion pill over the counter, while more populated provinces with universal coverage such as Alberta (2,573) and Ontario (6,612) have dispensed the drug thousands of times, according to data obtained from Canadian retail pharmacies.

Sookermany argues Manitoba must do better than only offering the drug for free where surgical abortions are already permitted.

"We are seeing people being transported, finding their ways long distance into the city. We do know, anecdotally, that people are travelling both for medical and surgical abortion."

Of the 1,566 abortions the clinic's performed so far in 2018, 53 procedures assisted patients from northern Manitoba, including as far north as Churchill. 

Last year, 70 women and girls from northern Manitoba visited the clinic for an abortion.

Travelling far for Mifegymiso

"We have women come from as far as Thompson, The Pas, Flin Flon, Norway House, Swan River, so the north is really the area that is the most challenging," Sookermany said. "The three sites that do offer abortions are in the southern part of the province."

The Health Sciences Centre in Winnipeg and Brandon Regional Health Centre also provide the abortion pill for free.

So far, 20 people from northern Manitoba have made appointments for an abortion at Women's Health Clinic but not shown up. That number was 27 in 2017.

Sookermany was cautious to say why, but said they often hear of barriers for people in northern communities to make it down to Winnipeg for a procedure.

"I don't think we're the only site that sees people travelling from across the province. It is the only option for many."

Unwilling, unable to prescribe

Barret Procyshyn, president of Pharmacists Manitoba, said the limited number of Mifegymiso prescriptions being dispensed by his colleagues demonstrates a problem.

The issues are numerous, he said: physicians may not have the training, or may be unwilling to prescribe it because of their personal beliefs on the procedure, or the price of the drug.

A pharmacist needs to see a prescription before it dispenses Mifegymiso.

"Medication coverage often dictates how much it's used," Procyshyn said. "Not everyone has approximately $300 in funds sitting around to do it." 

He said the drug has been dispensed a number of times since August in Dauphin, where he works, after a physician trained to prescribe the drug was in place.

Outside the three clinics where surgical abortions are performed, the drug is not free in Manitoba. While it has become an eligible benefit under Pharmacare, those patients would still have to pay out of pocket unless they've met their Pharmacare deductible for the year or are on Employment and Income Assistance.

Sheila Dunn, a family doctor from Toronto, understands if rural physicians are hesitant.

"If I was a physician or a prescriber out in a small community and I really had not done that and have patients who might need an abortion, have to pay for the drug, then I might use my old methods of referring people to abortion, which might mean that they have to travel," she said.

In Manitoba, the province is satisfied with the status quo.

They've reviewed Mifegymiso funding and access twice this year, and has not received any complaints or concerns about access from clinicians, health regions or the public, said a government spokesperson in an email.

The province has resolved to monitor access to the drug going forward.

"Manitoba's approach allows abortion centres to offer options to women and ensures coverage for low-income women," the statement said.

As of June, 558 women have received fully funded access to Mifeygmiso since it became available in 2017. The pill has been given to 293 individuals at the Women's Health Clinic, 238 people at HSC and 27 people at Brandon's hospital for free.

Purpose lost on government: NDP

The opposition NDP argues the province does not grasp the fundamental purpose of Mifeygmiso, if it isn't readily available in the rural, remote communities the drug is supposed to be accessible for. 

"The government's approach literally cancels out why the abortion pill is such a game-changer, by offering it at current locations," status of women critic Nahanni Fontaine said.

She added the government is also failing to inform women and girls of the drug's availability. 

Otherwise, some women are forced to go out of their way.

If "I think I have to leave my community, I have to hop on a plane, everybody knows why I'm leaving my community, everybody knows why I'm going to come back," Fontaine said. "I suggest to you that many women will not go through that because there's so many barriers."

Sookermany doesn't want Manitoba to be the last holdout that isn't providing the prescription medicine for all. Only Saskatchewan has not offered or committed to offering universal coverage, said Action Canada for Sexual Health and Rights.

"I think there needs to be political will around this issue and not be afraid to talk about reproductive rights and women's options around choice. I think that's the hesitancy," Sookermany said. "I don't think they're seeing this as a health issue, they're seeing this as a women's health issue."

With files from Kelly Malone