The good news is that Health Canada has approved Mifegymiso for sale in Canada. Mifegymiso is a combination of drugs that, taken together, cause what’s called a medical abortion. Medical abortion can be preferable to surgical abortion for a host of reasons, not least that it can make abortion accessible to women in communities with limited access to surgical abortions (most acutely, in rural and remote communities).

The bad news is that the approval of Mifegymiso (often referred to as RU486) came with strings. As part of the approval process, Health Canada made the manufacturer agree to a set of “post-authorization commitments.” A number of these commitments are entirely inappropriate.

Only registered physicians who have completed the mandatory Mifegymiso education and registration programs can prescribe Mifegymiso. Also, only physicians can dispense Mifegymiso, and the woman must take the first of two sets of pills in the presence of the dispensing physician. These restrictions are indefensible, for a variety of reasons.

First, there is no convincing empirical evidence to justify the claim that they are required for safety.

Second, it is stigmatizing to place these restrictions on an abortion drug when they are not placed on any other drugs. No other drug has this set of restrictions. Not even opioids, at a time when there is a recognized epidemic of addiction and deaths from opioids in Canada. The only drug that has anything close to the Mifegymiso restrictions is methadone — a potent narcotic used for pain relief and for the relief of withdrawal symptoms for patients addicted to heroin or other narcotic drugs. And even that has fewer restrictions than Mifegymiso.

It is stigmatizing to place these restrictions on an abortion drug when they are not placed on any other drugs.

Third, these restrictions will create barriers to access, because many physicians will be unwilling or unable to meet them. In particular, family physicians in private practices or community clinics may not have the experience or infrastructure required to buy, stock, dispense and take payment for drugs. Furthermore, because of safety and conflict-of-interest concerns, physicians are frequently discouraged and often even prohibited by the provincial regulatory bodies from dispensing drugs.

It is discriminatory to create such barriers to access to a medically necessary treatment that only women require. The Supreme Court of Canada long ago stated that discrimination on the basis of pregnancy is discrimination on the basis of sex. Access to abortion in Canada is already a serious problem for many women —Health Canada should be removing not adding barriers to access.

Fourth, requiring women to take the pills in front of their physician interferes in the physician-patient relationship. It sends a stigmatizing message that women are not to be trusted to take the pills and to do so responsibly and properly on their own. It also puts the timing of the abortion at the mercy of the physician’s schedule. A woman will have to initiate the abortion when she can get an appointment with her physician, instead of when it is most convenient for her. So, for example, she might only be able to get an appointment on a Tuesday so she would then have to go through the abortion during her workweek. If this restriction were not in place, she could have it over a weekend and thus not compromise her income and her privacy.

It sends a stigmatizing message that women are not to be trusted to take the pills and to do so responsibly and properly on their own.

Perhaps of greatest concern is the fact that this requirement means that a woman who had to travel a great distance to access the physician might have to go through at least part of the abortion while travelling back to her home. Nobody should be made to go through the physical and psychological effects and side effects of these drugs while, for example, driving some hours from the doctor’s office to home.

Health Canada should immediately take the steps necessary to expedite removal of these conditions on the prescription, dispensing, and administration of Mifegymiso. To do otherwise is to continue to stigmatize and discriminate against women in the exercise of their reproductive autonomy. And we’ve surely had enough of that already.

Photo: hankimage9 /


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Jocelyn Downie
Jocelyn Downie is a professor emeritus in the Faculties of Law and Medicine at Dalhousie University, member of the Dalhousie University Health Justice Institute, and adjunct professor at the Australian Centre for Health Law Research at Queensland University of Technology.

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