Quebec remains the Canadian province where the rate of use of the abortion pill is the lowest. But where some see it as a sign of barriers to accessibility, others rather denote proof that the network in place meets demand.
Between 1er January 2018 and May 31, 2019, 8% of abortions were performed using the abortion pill in the province, according to a report released in June 2020 by the Collège des médecins du Québec. By comparison, this proportion was 31% in Ontario in 2019, reveals a study by the University of British Columbia published in January in The New England Journal of Medicine.
“In British Columbia, this rate climbs to nearly 50%,” says Frédérique Chabot, director of health promotion at Action Canada for Sexual Health and Rights. There has been a real change in the abortion access landscape since the introduction of the abortion pill. »
It was in 2017 that this replacement option for curettage (procedural or surgical abortion) became available in the country, after obtaining the seal of approval from Health Canada. The abortion pill (medical or medical abortion) is actually a combination of two drugs — mifepristone and misoprostol — used in sequence to stop the pregnancy and then expel the tissues. Not to be confused with the morning after pill, which prevents pregnancy after unprotected sex.
Not all pregnancies can be terminated by medical abortion. This intervention is reserved for intrauterine pregnancies of 63 days or less, indicates the College of Physicians. In May 2019, 87% of clinics performing abortions in the province were able to offer women the abortion pill.
Two Options
With the specter of invalidating the judgment Roe v. wade in the United States, the abortion pill is seen as a solution to abortion restrictions in our southern neighbours. But it is far from being the majority choice favored by Quebec women.
There are several reasons for this trend, says France Désilets, nurse clinician and director of the Morgentaler clinic in Montreal. “What women tell me is that surgical abortion is faster. One date, and it’s over. »
A curettage takes about ten minutes, while a medical abortion requires taking two drugs within 24 to 48 hours. “So when the women leave the clinic after their appointment, it’s not over. »
Another concern that comes up regularly is that of pain, reports France Désilets. “That’s the question I get asked the most: which of the options is the most painful. But it’s very difficult to say, since pain is subjective. For surgical abortion, pain is alleviated by intravenous medication, while oral medication provides relief for women opting for medical abortion. “So it may take a little longer to take effect,” notes the nurse clinician.
Finally, the proportion of abortions that are not successful is slightly higher with the abortion pill than with curettage. If the pregnancy is not terminated with the medical abortion, then curettage might be necessary.
At the Morgentaler Clinic in Montreal, approximately 20% of eligible pregnancies are terminated by medical abortion.
Accessibility
When the abortion pill arrived on the Canadian market, it made it possible to increase access to abortion in several provinces of the country where access to abortion was limited to urban centres, emphasizes Frédérique Chabot. “Any primary health care provider, whether family physicians, nurse practitioners or midwives, can now order medical abortion. »
But not in Quebec. Only doctors who are trained in pregnancy termination can prescribe the abortion pill, specifies the College of Physicians. A requirement that can affect access, believes Frédérique Chabot.
“It’s a restriction that doesn’t exist in other provinces and has put barriers to the wider use of this method,” she says. But Quebec is the province where abortion services are the most integrated into primary health services, so there was already very good access to abortion. »
A nuance that France Désilets also brings. “Quebec is the region that has the best services for abortions in the world and where they are the most accessible,” she points out. It is not necessary in Quebec to train other professionals to offer abortions. Supervision by the College of Physicians is not an obstacle to accessibility, she believes, but rather “a quality standard that must exist”.
So is it a problem that the abortion pill is used less in Quebec than elsewhere in the country? “Absolutely not, answers France Désilets. Accessibility was already there in Quebec, so the abortion pill took longer to establish itself. What is most important is that women have the choice between the two methods and have the best possible care. The arrival of the abortion pill represented a huge gain for Canadian women, recalls Frédérique Chabot. “But you should certainly not think that there is a competition between the two options. »