Quebec doctors demand abortion pill be made more accessible

The pressure on the province's college of physicians to make it easier to access the abortion pill is ramping up, as hundreds of doctors have signed an open letter calling for the removal of several restrictions that are in place in Quebec, but not in the rest of Canada.

The abortion pill has been available and free in Quebec since 2018.

But those in the province seeking to end their pregnancies face additional hurdles to access the abortion pill, also known as a medical abortion. Unlike elsewhere in Canada, Quebec physicians must be trained for both medical and surgical abortions to accompany a patient through the process and prescribe the pill.

Given that the training must be done in person, critics have said that doctors cannot make time due to their heavy workloads.

As of Monday morning, at least 300 doctors from across the province had signed an open letter, which was written in French. The doctors denounce the requirements for medical abortions as "unjustified."

"By putting so many restrictions around the access to the abortion pill, it is not surprising that there are few [doctors] prescribing in Quebec and that a large number of patients face long delays," the letter states. It also mentions that doctors are able to train themselves the same way they do for other parts of their practice. 

Last month's reversal of Roe v. Wade by the United States Supreme Court has sparked discussions about ways to protect and expand access to abortion in jurisdictions where it is legally available.

The rules around medical abortions are set by Quebec's college of physicians (CMQ). It is the only provincial, professional body in Canada that regulates access to abortion pills.

For years, people seeking medical abortions have also been forced to get an ultrasound. On Monday, however, the CMQ issued a statement saying it stopped requiring ultrasounds during the pandemic and it plans to permanently remove the rule altogether.

The requirements for training and an ultrasound used to apply to the rest of the country, but Health Canada has scrapped those in recent years.

Last week, the CMQ said it was in the process of reviewing its guidelines for medical abortions, and that other changes to the provincial rules could be made in the coming months.

According to a report from the CMQ published in June 2020, eight per cent of abortions in the province between Jan. 1, 2018 and May 31, 2019 were medical abortions.

"It is time to stop treating medical abortions differently and separately from other forms of care," reads the physicians' open letter. 

"As the pandemic has led to an increase in access to medical abortions elsewhere in Canada, the situation in Quebec hasn't changed."

'Nobody's in danger here'

Dr. Geneviève Bois, a family physician who practises in Montreal, Gatineau, Que., and Nunavik, signed the open letter.

She said the restrictions in Quebec essentially mean medical abortions are only available in abortion clinics and makes it difficult for many people to go that route given that such clinics are not spread equally across the province.

Bois said she's seen patients who would have preferred to get the abortion pill, but were not able to get an ultrasound or find a clinic near their home quickly enough. In Quebec, the abortion pill is an option up to the nine-week mark of a pregnancy.

Bois also said the percentage of people seeking medical abortions in Quebec is lower compared to the rest of the country. 

"Now, if it was low and access was perfect, I wouldn't mind. Nobody is aiming for a specific percentage," she said.  

"We've seen that restrictions initially put in place by Health Canada, like an ultrasound and a special training, have been removed in the past years. And we have seen in the rest of Canada that this has increased access. It not has increased complications. Therefore, it's completely safe to do so. Nobody's in danger here. And that's why the restrictions of the college just don't make sense anymore."