Extreme Caution : Abortion Alert

"There is no evidence in any jurisdiction that women would seek and obtain a mifepristone prescription, yet not use it."
"This requirement [that a doctor witness a woman taking the first dose] is medically unnecessary and demeaning to Canadian women."
"The single most important reason physicians from across the country are citing for not planning to offer mifepristone is the need for physician dispensing."
"The physicians we have polled -- particularly rural physicians -- have no infrastructure for this."
Dr. Wendy Norman, sexual and reproduction health researcher, University of British Columbia

"[The requirements for dispensing the new anti-abortion drug will effectively limit its availability] and its potential to transform abortion access in Canada."
"The women who call us are looking for a safe way to terminate their pregnancy that doesn't require a lot of travel to an abortion provider, and doesn't require a surgical procedure to be performed on them."
Sandeep Prasad, executive director, Action Canada for Sexual Health and Rights

"We're really trying to balance the use of the product with the potential risks and any of the adverse events that could come from it."
"You want to make sure the person prescribed the medication is [the one] taking the medication. You don't want that medication to go to somebody else."
"You don't want someone to take it at a later time where the risks can be greater."
Dr. Supriya Sharma, senior medical adviser, Health Canada

Mifeprex, a brand name of mifepristone, is available in the United States. A similar product is currently being reviewed by Health Canada. Photo, courtesy of Danco Laboratories.

Mifepristone is regarded as the "gold standard" in medical use for early-stage abortions. France and China have given access to the drug for over a quarter of a century. The drug has been available to American women in the United States since 2000. It is only now that Canadian women can look forward to being able to access this drug that blocks the hormone progesterone, a drug whose efficacy is well recognized and which is available for use in over 50 countries.

When progesterone is blocked its normal function in the preparation of the uterus lining for a pregnancy is disrupted. The lining breaks down and it sheds, a process similar to that which occurs during a woman's menstrual period. Misoprostol acts to cause the uterus to contract, expelling the pregnancy, in the second stage of the drug.

Health Canada has responded to criticism from women's groups that its guidelines for use are unnecessarily complex. They point to a single case of ectopic pregnancy reported in the United States which resulted in the death of a woman taking mifepristone and misoprostol, as well as a few instances of blood infections, including fatal sepsis. A single case of a non-fatal heart attack was also attributed to the use of the abortifactant.

Whether or not there is an actual direct cause-and-effect relationship between these health crises and the use of Mifepristone, however, is unknown. But those in the medical community calling for greater options to be available to women feel Health Canada's restrictions are unhelpful. Dr. Norman and her colleagues recently published a study showing that abortion facilities are located in large urban centres only for most jurisdictions, with the exception of British Columbia and Quebec.

This is a two-step regimen which pairs one drug, mifepristone, with a second, misoprostol. Used within 49 days of pregnancy, the combination induces abortion that is patterned similarly to a natural miscarriage. The drug will not be available over the counter, only through a physician's prescription, and that doctor must be prepared to carry through to witnessing the first dose being taken by the women he has prescribed it for.

Along with that dedication to following a patient's progress with the abortion pill whose convenience of use is obviously made complicated by Health Canada's prescribed regimen, the doctor would be responsible for ordering, stocking and taking payment for the pills, a process that normally goes through a pharmacy as intermediary. The cost is expected to be $270 per package.

And doctors are expected to be registered after completion of a certified, online training program that will entitle them to prescribe and dispense the medication; with Health Canada's protocol requirements: "the patient will not have the prescription in [her] hands". For the physician, an unnecessarily cumbersome process, for the patient a prime indignity.

As it is, women will be required to undergo an  ultrasound to determine gestational age, and ruling out ectopic pregnancy before the abortion pill can be confidently prescribed with safety uppermost in mind.

Inventor of the RU486 abortion drug, French Professor Emile-Etienne Beaulieu, holds the pills in this 1995 file photo. The pills, which have been available in France for 25 years, have been approved for use in Canada.   REMY DE LA MAUVINIERE/Associated Press)