Rising use of abortion pill shifting the landscape, expert says

The increased accessibility of the so-called “abortion pill” in New Brunswick is dramatically changing the reproductive-rights landscape and shifting the terms of the debate, according to an assistant professor at the University of New Brunswick. 

Medical abortions, induced by medication, now outnumber surgical abortions by more than two to one, according to new provincial data collected by Martha Paynter, a teacher and researcher in the faculty of nursing.

That means more and more abortions are happening earlier in pregnancies, making them safer and less stressful.

“This is a very dramatic change,” said Paynter, who is also part of the New Brunswick Abortion Care Network, a team of clinicians promoting access.

“This is a huge shift in the delivery of care … [It’s] much more accessible obviously. You’re having medication in your own home. It’s an experience like a miscarriage in the privacy and convenience of your own home, and it’s much less expensive.”

The Gallant Liberal government made Mifegymiso, a two-pill product, universally accessible in 2017. Medicare pays for the medication, which induces cramping that ends a pregnancy.

According to numbers provided to Paynter by the Health Department, in 2022 the province funded 896 doses.

That compares to 323 surgical abortions in the Horizon Health Network and 87 in Vitalité, a total of 410.

It means 68 per cent of abortions covered by Medicare were medical abortions.

That’s an all-time high, according to Paynter, and far above the overall Canadian rate of 37 per cent in 2021.

Before Health Canada’s 2015 approval of mifepristone, one of the two drugs that are part of Mifegymiso, only four per cent of abortions in Canada were medical abortions.

Now, any doctor or nurse practitioner in New Brunswick can prescribe the medication and send their patient to a pharmacy to get it — meaning the number of providers has also jumped, Paynter said.

“This is a wild change in the landscape,” she said.

“Not only is that convenient, but it also changes the culture and the way that abortion is normalized as part of the trajectory of reproductive health experience.”

Paynter said the overall number of abortions has remained stable. It’s the share that done by medication that has changed. 

The battle over abortion access in New Brunswick has focused for decades on Clinic 554, a private clinic in downtown Fredericton that provides abortions that the province refuses to fund, and on the number of hospitals providing the service.

The Moncton Hospital, the Dr. Georges-L. Dumont Hospital in Moncton and the Chaleur Regional Hospital in Bathurst are the only hospitals providing abortions.

In February, federal Health Minister Jean-Yves Duclos said the province’s refusal to fund the procedure at Clinic 544 “raises the obvious question of accessibility to those services.”

Ottawa clawed back almost $65,000 from federal health transfers to New Brunswick over the issue.

Paynter said that with the share of surgical abortions in New Brunswick shrinking, “it certainly changes the context” of the debate.

In 2020, Dorothy Shephard, the provincial health minister at the time, said abortions in hospitals were down 30 per cent, a number she used to push back at activists demanding the government fund the service in Clinic 554 or expand hospital access.

Clinic manager Valerya Edelman said the growing number of medical abortions doesn’t eliminate the need for surgical abortions, also called procedural abortions.

“Patients often choose an MA because it’s the only method that they can afford or access,” she said of medical abortions.

“MAs and procedural abortions are both safe, but they are different and the due to the lack of access to procedural abortions, pregnant patients don’t always get to choose the one that is best for them.”

She said limited access to abortions in hospitals affects marginalized groups the most, and some patients with mental illnesses would find it difficult to self-manage a medical abortion.

The province says it covers Mifegymiso up to nine weeks into a pregnancy and calls it a “less intrusive method.”

Surgical abortions at the Moncton Hospital are done until the 16th week and until the 14th week at the other two.

Paynter agreed there will always be a need for some surgical abortions, but with fewer patients needing them, the health authorities should be able to focus even more on supporting “the very few” who miss the window for Mifegymiso.

“We do, of course, see that the people who discover their pregnancy later along are usually those people experiencing the most marginalization,” she said.

“Those people should be supported and have transportation [to the three hospitals] provided for them. … The medication will be an option for most, but not for everyone.”

The Health Department did not respond to a question about how the numbers might affect the question of how many hospitals offer the service, saying the two regional health authorities are responsible for the delivery of services.

Paynter also said New Brunswick should do what Nova Scotia does and provide a single phone number and point of access to direct patients to the nearest provider.

And she said adding contraception to Medicare coverage would help avoid many unwanted pregnancies to begin with.

Last year the province said it would fund pharmacist fees for birth control, but patients must still pay for the medication itself.

The cost to Medicare of Mifegymiso is $320, compared to an expense of about $2,000 to 3,000 for a surgical abortion in a hospital, Paynter said.