Access to abortion pills in Quebec too difficult, doctors say

Quebecers looking to terminate their pregnancy can do so by way of medication, but experts say the rules in the province around access to the abortion pill are too restrictive, and they want the option to be more widely available.

Access to the pill is more strictly controlled in Quebec than in the rest of Canada, with physicians in the province required to have a certain level of training for both medical and surgical abortions before accompanying a patient through the process.

In Quebec, physicians who are deemed qualified are also required to have a patient undergo an ultrasound before prescribing the abortion pill. Most rules and regulations in the province around abortion pills are set by the Quebec College of Physicians.

It's the only provincial, professional order in the country with such powers.

The training for medical abortions must be done in person — which creates a major access barrier, according to Dr. Geneviève Bois, a family doctor who practises in Montreal, Gatineau, Que., and Nunavik.

"Physicians have to provide a lot of different care and not all of them, depending on the volume of care they would be providing, can necessarily take many days off to go do this training just in case they need to provide medical abortions," Bois said. 

Last week's reversal of Roe v. Wade by the United States Supreme Court has sparked calls to protect and expand access to abortion in jurisdictions where it is legally available, such as Quebec.

On Wednesday, one of the opposition parties at the National Assembly, Québec Solidaire, issued a statement vowing to make abortion pills more available, if it is elected as the province's next government in this fall's election.

In Quebec, the training required for medical abortions essentially makes them available only in abortion clinics, instead of at doctors' offices, where people may feel more at ease with a familiar face, who is often closer to home, Bois said.

"We should not feel smug about the fact that things are so much worse in the United States right now and not look at what are the barriers that stand in our country," she said.

The abortion pill — which is free in Quebec — has been available in the province since 2018, a year later than the rest of Canada. 

Trusting more physicians

Dr. Isabelle Leblanc, a family doctor in Montreal who is also running for Québec Solidaire in the city's Mont-Royal–Outremont riding, says she's seen several patients seeking medical abortions who were surprised to learn of the province's rules.

"People come in and they're pregnant. They want to stop the pregnancy and they think we can just prescribe the pill because that's the way it works pretty much everywhere else in Canada," Leblanc said.

"For so many other medical treatments and procedures, we trust the physicians to do what's right for their patients and to make sure they have the knowledge to do it for their patient."

According to Leblanc, the requirement for patients to undergo an ultrasound is especially restrictive, particularly outside Montreal where appointments are not as available. Abortion pills can also only be prescribed during the first nine weeks of a pregnancy. 

"It's also a lot of appointments for a person who, maybe, doesn't want their partner to know that they're requesting an abortion," Leblanc said.

"It's really, really complicated for something that could be so simple."

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

Demands being heard

In a statement, the college of physicians confirmed that it's currently reviewing its rules for medical abortions, and it expects the process to continue until the fall, stating that it has "heard the demands from certain organizations."

"In 2017, the College of Physicians put these guidelines in place because, in accordance with its primary mission of protecting the public, it is of the opinion that they allow voluntary termination of pregnancy with medication to be carried out in complete safety," the statement reads.

The college also said it is always looking for ways for its rules to "evolve."

For Bois, the rules don't make any sense.

"There's no reason to single out the issue of abortion by medication. We don't see this type of guideline be provided and those restrictions be put in place to limit other procedures that physicians do," the family doctor said.

"We don't need a set of Quebec-specific medical abortion or surgical abortion guidelines."