Counselling should be part of abortion drug coverage, says health minister

The Newfoundland and Labrador government should prioritize the implementation of a universal coverage plan for medical abortions, members of Memorial University's Medical Students' Society say in a letter addressed to key members of the provincial government.

"If [Newfoundland and Labrador| is to uphold its responsibility in ensuring everyone's right to health according to the Canada Health Act, we must provide access to abortion in a way that is universal, accessible, comprehensive, portable and administered accountably," reads the letter, which was released on the behalf of several organizations and individuals.

The signatories call on the province to provide universal cost coverage for Mifegymiso — the medication for medical abortion and that a new billing code be set up for health care providers.

They also suggest there be information for health care providers and the public, as well as support for physicians and nurse practitioners to become Mifegymiso providers, and for pharmacists to become dispensers.

Health Minister John Haggie indicated Wednesday that he's not ready to make a decision, and said it's not just about the cost of covering the abortion pill.

"The problem I have is a much greater one because you're introducing a significant element of choice, and that decision needs to be made on the basis of information," Haggie said.

"What I have heard very clearly from the other stakeholders involved is that the counselling services that go before, during and after a termination are really the main feature of the service I would like to be able to offer the women of this province."

It's about 'equal access,' says Planned Parenthood

Providing coverage for Mifegymiso is about ensuring that everyone in Newfoundland and Labrador has equal access to health care, said Elliot Chapple, executive director of Planned Parenthood NL Sexual Health Centre.

"We're creating an unequal class of health care that's accessible for people with money, it's accessible to people living in the capital city, but that is not our province," said Chapple, whose organization was a signatory to the letter.

"Our province is made up of many people living in a variety of places, and if St. John's is the only place that people can get access to abortion services we're not providing equal health care to everyone."

The letter was addressed to Premier Dwight Ball, Minister of Health and Community Services John Haggie and Minister Responsible for the Status of Women Siobhan Coady.

It was signed by Maggie O'Dea and Chris Vizena of the Medical Students' Society, on behalf of groups including the Newfoundland and Labrador Medical Association and Planned Parenthood as well as several individuals including physicians, the owner of the Athena Health Centre in St. John's and members of the Pharmacists' Association of Newfoundland and Labrador. 

What is Mifegymiso?

Mifegymiso is a prescription that contains two different medications, mifepristone and misoprostol, that when taken according to instructions will induce abortion in pregnant women. This is called a medical abortion. An abortion performed in a clinic with specialized equipment is called a surgical abortion.

The medication, which was first approved for use in Canada in 2015 but has been used for decades in other countries, can be taken up to nine weeks in pregnancy.

The two-pill medication costs about $350, Chapple said. It must be paid out-of-pocket if a person doesn't have coverage through a private health plan.

"It can be a huge barrier, especially to a young person, especially to anybody that's low income."

That cost is compared to up to $1,500 for a surgical abortion, which means the province could save money by providing coverage — both in the cost of medical abortion versus surgical, and because there are some cases where they do cover associated costs (like travel) for surgical abortion.

The province's capital is the only place to access surgical abortion. Newfoundland and Labrador's only private abortion clinic, the Athena Health Centre, is located in St. John's and offers abortion services covered by provincial health care. The Health Sciences Centre in St. John's also offers surgical abortion covered by the provincial plan.

Though Mifegymiso is available more widely than that. The pill previously had to be both prescribed and dispensed by physicians, but on Nov. 7 2017 Health Canada changed the rules and allowed the drug to prescribed by doctors and nurses, and dispensed by pharmacists. 

• Abortion pill popular alternative to surgery, says owner of St. John's clinic
• Equal access to abortion means Mifegymiso's cost must be covered in all provinces

But there are still barriers. An ultrasound is required to confirm pregnancy before the drug is prescribed, for example, which can require travel to a larger centre. There is no central database to access a list of physicians who will prescribe the drug, or pharmacies that stock it, and some patients have privacy concerns. 

"Those most affected by lack of provision are those who need it the most: young, uninsured, low-income earners in rural communities," the letter reads.

Improving rural access

In March, medical students from Memorial University met with members of the provincial government to discuss access to Mifegymiso.

They also more broadly discussed the problem of access to abortion services in rural and remote parts of the province. If a patient has to travel to access abortion services, whether surgical or medical, the associated costs — gas for a vehicle, flights, hotels, time off work — generally must be paid out of pocket.

After the March meeting, Haggie said the government would consider funding for Mifegymiso and measures to improve abortion access, but medical abortions remain unfunded today.

There's no point in funding the drug if you don't have a framework in place for counselling, the minister said Wednesday.

"It's a huge opportunity and it's a shame to make it go to waste by simply saying, 'Here's your prescription, go get it.'"

But the letter from the medical students says Newfoundland and Labrador is the only province that has not announced some degree of coverage of Mifegymiso.

"With our large proportion of remote communities and one of the lowest rates of accessibility in Canada, the N.L. government should arguably have the greatest motivation to commit."