Advocates say access to abortion pill still an issue in Nova Scotia

This file photo shows the abortion drug Mifegymiso, which is a combination of mifepristone and misoprostol.

HALIFAX -- Advocates say Nova Scotians' access to the abortion pill remains a major issue, with one student saying she had to wait nearly three weeks because of barriers including finding a doctor to prescribe the drug, testing delays and billing issues.

The woman, from the Toronto area, says she was five weeks pregnant when she took a home pregnancy test.

But she was almost eight weeks by the time she obtained the abortion pill Mifegymiso -- a wait she describes as excruciating, and advocates say fails to realize the potential of the two-drug combination used to terminate early pregnancy.

"I was having severe morning sickness and on top of that feeling a lot of shame. Trying to go through this whole process was daunting and intimidating," she says.

The student says she booked an appointment at Cape Breton University's health clinic in Sydney, N.S., as soon as she found out she was pregnant and asked for the abortion pill.

Instead, she was told to call an abortion clinic in Halifax.

"It's very overwhelming trying to figure out the health care system when you're facing an unwanted pregnancy," she says.

Inquiries by The Canadian Press have revealed that only one of six university health clinics contacted across the province will prescribe Mifegymiso, a combination of mifepristone and misoprostol tablets available in Canada since 2016 and publicly funded in Nova Scotia since last November.

The only Nova Scotia university that currently offers medical abortions -- via the abortion pill, rather than a surgical procedure -- as part of its primary care is St. Francis Xavier University in Antigonish. Students at other universities are referred elsewhere, potentially delaying access.

That's despite data that shows people aged 18-29 are the most likely to obtain an abortion, according to the Canadian Institute for Health Information.

Perhaps surprisingly, even the Halifax Sexual Health Centre -- formerly Planned Parenthood -- does not yet offer Mifegymiso, citing a physician shortage, funding issues and inadequate nursing support.

"The biggest issue continues to be that this is considered a specialized service instead of the primary care that it is," says Martha Paynter, a Halifax-area nurse and women's health advocate. "We as clinicians need to step up."

She adds: "Medical abortion is very time dependent. When you're eight weeks pregnant with an unwanted pregnancy ... that's a really difficult moment to become an advocate."

A series of stories by The Canadian Press in 2017 shone a national spotlight on barriers to abortion access in Nova Scotia, as multiple women described facing "agonizing" and "cruel" hurdles. The stories helped prompt a number of changes, including a new toll-free information line, the removal of a historical practice requiring women to obtain a referral before booking an abortion, and provincial funding for the abortion pill.

But it appears women are still facing delays in some cases.

The CBU student was told to call Nova Scotia's only abortion clinic -- the Women's Choice Clinic at the QEII Health Sciences Centre in Halifax.

It offers both surgical and medical abortions, and can also refer women to a province-wide network of health professionals that are willing to prescribe Mifegymiso.

There are currently nine family doctors, three gynecologists and one nurse practitioner on the list -- though Lianne Yoshida, the medical director of the clinic, says it's possible others are prescribing Mifegymiso to their own patients but are not part of the clinic's network.

The slow pickup could be attributed in part to early restrictions on the drug -- including a training requirement for prescribers that has since been dropped, and the lack of a billing code in Nova Scotia until last spring.

Still, demand for the abortion pill has been steady, with 670 Mifegymiso prescriptions logged in the provincial Drug Information System from Nov. 1, 2017, to Oct. 31, 2018, according to provincial data. That's nearly two women terminating early pregnancies using medication every day in Nova Scotia.

Meanwhile, the CBU student called the Halifax clinic as directed by the university health clinic, and she says she was then referred to a prescriber in Sydney.

But she faced further delays obtaining an ultrasound and blood work, and ran into billing issues as a student from out-of-province.

Although the abortion pill is publicly funded both in her home province of Ontario as well as in Nova Scotia, she found herself without any coverage for the abortion pill -- which comes with a roughly $400 price tag.

Without money to pay for the drug, she scrambled to obtain private health insurance through the university and ended up still paying about $70 out-of-pocket.

Health Department spokeswoman Tracy Barron says the billing issue stems from Ontario's coverage rules. She says if a Nova Scotia resident is studying in another province, for example, Nova Scotia would still provide coverage.

Frederique Chabot, director of health promotion with Action Canada for Sexual Health and Rights, says Alberta's coverage of Mifegymiso is considered "gold standard."

"Alberta actually anticipated this kind of issue," Chabot says, noting the province only requires proof of address to have the prescription covered.

Although still within the nine-week limit to take the drug, the student says by the time she took the abortion pill she was further along than she had hoped.

She says neither her doctor nor the pharmacist prepared her for the immense pain and nausea.

"My body went into shock, it was terrible," she says. "They told me to have maxi pads and expect a lot of blood. But it was excruciating."

The student says she was told that if she vomited, the medications wouldn't work properly and she'd have to start the process again.

"I was alone and started to throw up and I had to keep swallowing it ... I was curled up, my whole body was shaking for four hours."

She says she would have appreciated more information to make a fully informed decision about a medical abortion and to prepare for the physical pain.

Dr. Dustin Costescu, a family planning specialist, says pain increases with advanced gestational age -- and that's why timely access to Mifegymiso is important.

"There's always a wait inherent to anything in health care," he says. "But more than two weeks for a medical abortion seems long."

Shannon Hardy, an abortion doula and co-ordinator of Atlantic Abortion Support Services, says despite recent improvements there remains an "underground" element to accessing an abortion in Nova Scotia.

"People will share by word-of-mouth which doctors will prescribe Mifegymiso and which pharmacies will even stock the medication," Hardy says, pointing out another potential barrier women may face filling the prescription.