You can't get Ontario's free abortion pill without an ultrasound - a hurdle for rural doctors

You can't get Ontario's free abortion pill without an ultrasound - a hurdle for rural doctors
From CBC - August 11, 2017

Women across Ontario can now theoretically access the abortion pill Mifegymiso for free but physicians warn there are still major barriers to access.

The Ontario government had first promised to publicly fund the medication, also known as RU-486, in its spring budget, saying it wanted to provide women with more autonomy around their reproductive health, especially those living in rural communities who had to travel hours for surgery.

Women with a valid health card and prescription from a doctor or a nurse practitioner can get it for free at pharmacies that stock it.

But Health Canada forbids doctors from prescribing the medication without first performing an ultrasound on the patient, something that requires both the equipment and the specialized training to operate it.

"I have not really seen a lot of rural family practitioners who do bedside ultrasounds in their clinics, so that would be a limiting factor," said Dr. Kaitlin Dupuis, a physician with Planned Parenthood Toronto. "I would say the idea is great, but there's logistical stuff that still needs to be worked out."

It's an issue at Planned Parenthood Toronto as well. The health centre does not have an ultrasound machine at its site, but it's trying to partner with a local ultrasound clinic.

The diagnostic step is one that'scritical both to the success of the procedure and to the patient's health.

That's because the drug has only been approved for use in Canada for pregnancies of fewer than 49 days, or seven weeks. The drug's manufacturers have applied to Health Canada to extend the timeline to nine weeks' gestation.

Calculating the risks with an ultrasound

An ultrasound is considered "the gold standard" when it comes to dating a pregnancy, Dupuis said, as it far more accurate than basing it on a person's last period.

Calculating the gestational age is critical. There are risks associated with taking Mifegymiso later in pregnancy, including not completely expelling the fetal tissue, which can cause heavy bleeding and infection, according to Health Canada.

'Sometimes in more rural and remote areas it may be challenging even to access an ultrasound in a timely fashion.' - Dr. Ashley Waddington, gynecologist

An ultrasound is also the only way to make sure a woman is not having an ectopic pregnancy, something that can only safely be treated with a surgical abortion, Dupuis said.

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