Local access to abortion services expanded with mifepristone in community pharmacies, Canadian study finds

Before 2017, abortions were generally performed as procedures in fewer than 100 hospitals and clinics mostly in urban centers, leading to delayed care, particularly for people living in rural areas. Medication abortions, mainly via off-label use of methotrexate, were infrequent.

Researchers looked at population data from ICES to examine abortion service availability changes in Ontario from January 2017 to December 2022. The research, “Changes in local access to mifepristone dispensed by community pharmacies for medication abortion in Ontario: a population-based repeated cross-sectional cohort study,” has been published in the Canadian Medical Association Journal.

Between 2017 and 2022, there were more than 226 000 abortions provided to 175,091 people. The proportion of regions with a pharmacy that dispensed mifepristone increased from 20% in 2017 to 82% in 2022. Only 37% of abortion service users lived in a region with either a mifepristone-dispensing pharmacy or procedural provider in 2017, but this increased to 91% by 2022.

Access to abortion services increased in both urban and rural areas.

“Despite these rapid gains in access to procedural or medication abortion services, in 2022, 6% of regions had no pharmacy at all, nearly 20% of regions with a pharmacy still lacked a pharmacy that dispensed mifepristone, and roughly 9% of abortion service users lived in a region without a local procedural provider or a pharmacy that dispensed mifepristone,” writes Dr. Laura Schummers, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, with co-authors.

The authors note that the expansion of mifepristone to community pharmacies shifted the delivery of abortions from procedural abortions to more accessible mifepristone abortions, a trend they expect to continue.

“Abortion service needs are time-sensitive, as risks of abortion complications increase exponentially with increasing gestational age. It is likely that the proportion of abortions provided by medication in Ontario will continue to increase beyond our study period, mirroring trends elsewhere.”

Before 2017, abortions were generally performed as procedures in fewer than 100 hospitals and clinics mostly in urban centers, leading to delayed care, particularly for people living in rural areas. Medication abortions, mainly via off-label use of methotrexate, were infrequent.

Researchers looked at population data from ICES to examine abortion service availability changes in Ontario from January 2017 to December 2022. The research, “Changes in local access to mifepristone dispensed by community pharmacies for medication abortion in Ontario: a population-based repeated cross-sectional cohort study,” has been published in the Canadian Medical Association Journal.

Between 2017 and 2022, there were more than 226 000 abortions provided to 175,091 people. The proportion of regions with a pharmacy that dispensed mifepristone increased from 20% in 2017 to 82% in 2022. Only 37% of abortion service users lived in a region with either a mifepristone-dispensing pharmacy or procedural provider in 2017, but this increased to 91% by 2022.

Access to abortion services increased in both urban and rural areas.

“Despite these rapid gains in access to procedural or medication abortion services, in 2022, 6% of regions had no pharmacy at all, nearly 20% of regions with a pharmacy still lacked a pharmacy that dispensed mifepristone, and roughly 9% of abortion service users lived in a region without a local procedural provider or a pharmacy that dispensed mifepristone,” writes Dr. Laura Schummers, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, with co-authors.

The authors note that the expansion of mifepristone to community pharmacies shifted the delivery of abortions from procedural abortions to more accessible mifepristone abortions, a trend they expect to continue.

“Abortion service needs are time-sensitive, as risks of abortion complications increase exponentially with increasing gestational age. It is likely that the proportion of abortions provided by medication in Ontario will continue to increase beyond our study period, mirroring trends elsewhere.”