Access to the abortion pill | Ultrasound will no longer be required, confirms the College of Physicians

Nearly 300 doctors, mostly women, sent an open letter to the College of Physicians asking for the lifting of restrictions on prescribing abortion by medication in Quebec.

Lila Dussault
The Press

The requirement for an ultrasound to obtain a medical abortion in Quebec — the only Canadian province to still require such a measure — will no longer be necessary, says Dr.^r Mauril Gaudreault, president of the College of Physicians of Quebec. A timid advance, according to experts consulted by The Press.

“Because of the pandemic, we stopped requiring an ultrasound before the abortion, explains the D^r Gaudreault, in interview with The Press. We intend to make this measure permanent. »

The College of Physicians had already announced last week that it was in the process of revising its guidelines concerning the prescription of abortion by medication in Quebec. A statement made in the wake of the reversal of Roe v. Wade by the Supreme Court of the United States and a request to that effect from Québec solidaire MP Manon Massé last Tuesday.

The details of the new recommendations, says the D^r Gaudreault, will be unveiled “during the summer”.

On Wednesday, 262 Quebec doctors, mainly women, sent the College of Physicians an open letter asking for the lifting of all restrictions on access to medical abortions in Quebec, including mandatory training and ultrasounds. A few days later, the letter had obtained 298 signatures.

“For me, that so many doctors are mobilizing for something like this, it’s unheard of”, is surprised at the end of the line one of the signatories, the D^D Geneviève Bois, assistant clinical professor of medicine at the University of Montreal and who performs abortions in particular.

Canada and Quebec: two weights, two measures

There are two ways to obtain an abortion in early pregnancy in Canada: the surgical method, performed in a clinic, or the drug method (abortion pill). This can terminate a pregnancy of 9 weeks or less after the prescription of a drug called Mifegymiso.

However, Quebec stands out from the rest of Canada. Here, doctors must first receive in-person training from the College of Physicians to perform both forms of abortion. Women wishing to obtain a medical abortion also had, until the pandemic, to undergo a dating ultrasound.

However, as of 2017, the majority of restrictions on access to the abortion pill, including the training of prescribers, were lifted by Health Canada.

Two years later, the federal agency also ended the requirement for a dating ultrasound, notably because it was not supported by evidence and due to accessibility issues.

Doctors in other Canadian provinces have complied with new Health Canada guidelines. Result: the deployment of the abortion pill in Quebec has been slower than elsewhere, according to a 2019 study. The accessibility gap has widened further during the pandemic, reveals another study, published in 2021.

“Yes, we are a distinct society, but we do not have separate wombs, denounces the D^D Wood. We don’t need separate abortion practice lines! »

Guidelines

The instigator of the open letter sent to the College of Physicians, the D^D Marily Pépin, received a response on June 30 that The Press was able to consult. In it, the College announces that “the relaxation announced in the context of a pandemic with regard to ultrasound must be made permanent”.

But, according to this letter, physicians in Quebec must always rely on the College’s latest opinion on the matter, updated in May 2022. It states that “given certain factors (delays, limited accessibility to ultrasound , hatching in a medium, etc.), the doctor could recommend other approaches [qu’une échographie] to determine gestational age […] “.

In other words, an ultrasound is no longer mandatory in Quebec, but still recommended.

This guideline risks favoring a “grey zone”, according to Mélina Castonguay, a midwife involved with the Society of Obstetricians and Gynecologists of Canada. “The ideal would be for the College of Physicians to withdraw its abortion guidelines, period,” she believes.

The College’s response also notes that “Quebec is one of the places in Canada where surgical abortion is the most accessible”. An affirmation that makes the D jump^D Wood. “So it is acceptable to reduce women’s choice and restrict access to one type of abortion because access to instrumental abortion exists? she asks.

Not to mention that mandatory training continues to limit the number of doctors able to support women in the process: “If you are lucky enough to have a family doctor, that doctor still has to be trained for you prescribe both pills, notes Louise Langevin, a specialist in reproductive rights at Laval University. It is still a question of accessibility to abortion! »