Abortion access in Ontario rose to over 90% after the pill was approved: study

Mifepristone tablets are seen in a Planned Parenthood clinic Thursday, July 18, 2024, in Ames, Iowa. (AP Photo/Charlie Neibergall, File)

A new study finds that access to abortion services expanded greatly in the five years after the abortion pill was approved and pharmacies began dispensing it in Ontario, but that surgical abortion services declined and need to be preserved.

Research published in the Canadian Medical Association Journal Monday says that most people in Ontario did not have access to abortion services in 2017.

But they say access in urban and rural areas increased from 37 per cent in 2017 to 91 per cent in 2022.

Researchers peg that to eased regulations for pharmacists to dispense Mifegymiso, the brand name for a combination of two medications taken consecutively, mifepristone and misoprostol, approved by Health Canada in 2017.

The study looked at population-based health administrative data from 2017 to 2022.

The study found the drug was used in 56 per cent of abortions in 2022, up from about eight per cent in 2017.

“This is really the first evidence that we have in Canada of the effect of how access to abortion services have changed since the introduction of mifepristone,” says lead author Laura Schummers, an assistant professor in the faculty of pharmaceutical sciences at the University of British Columbia.

Pharmacist Anushya Vijayaraghevan says she had never seen Mifegymiso in practice until 2022, when she opened a pharmacy in Toronto to address this gap she had become aware of. At her downtown pharmacy, she receives prescriptions for patients as far as Timmins, Ont., counsels them over the phone, fills and ships the medication to them, usually arriving in one day. The service is covered by OHIP.

“Up north, these towns are very small, in terms of privacy for these patients. They don’t feel comfortable going to their local pharmacy to pick up the medication,” she says.

The increase in access in Ontario is not the case across Canada. Uptake has been slower in Alberta where recent research published in The Lancet found access has “minimally improved” in the past decade, and in Quebec, where only 17 per cent of abortions involved the pill in 2022, according to the province. In contrast, 68 per cent of abortions were medical in New Brunswick in 2022.

The study also found that as access to the abortion pill increased, local access to surgical abortion services declined – from 22 per cent in 2017 to 18 per cent by 2022. Schummers says that while access to medical abortion has improved as a whole, more effort is needed to safeguard surgical abortion.

“This is a balancing act that we’re now in,” she says.

Health Canada guidelines state Mifegymiso can be prescribed to patients who are up to nine weeks pregnant. With surgical abortions, the gestational limit depends on the clinic or hospital providing it, and can go up to about 24 weeks in rare cases.

TK Pritchard, executive director of Abortion Care Canada, formerly National Abortion Federation Canada, says most people don’t know they are pregnant until around seven weeks, which leaves a short window for a medical abortion.

Pritchard says there are also other reasons that patients might need access to a surgical abortion, including health conditions and personal circumstances.

“For folks who are experiencing intimate partner violence or have an unsafe home environment … if the people around them don’t know that they’re pregnant at all, and it would be unsafe to disclose that, procedural care can actually be much more discreet,” Pritchard says, explaining that it can be fast, usually 10 minutes.

Surgical abortion access was “inadequate” and “inequitable” even before its use declined in the five-year period examined, according to the study. The research shows procedural abortions were performed in fewer than 100 hospitals and clinics in Canada before 2017.

And now, some of those clinics are closing. Just over a week ago, Vancouver’s Elizabeth Bagshaw Clinic announced it was shuttering after 35 years. Abortion Access Canada had to cut its direct client support program by 75 per cent on April 1. New Brunswick’s only clinic that offered surgical abortions outside of hospitals closed in 2024.

Pritchard says it’s not necessarily that these clinics are closing because of an increase in medical abortion.

“However, we have not put the same emphasis on increasing access to procedural care, putting resources into procedural care, putting funding into procedural care,” Pritchard said, noting that can lead to additional closures.

“I think it’s almost a bit of a how do we keep the spotlight on both and understand that both are very important?”

This report by The Canadian Press was first published April 7, 2025.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

Hannah Alberga, The Canadian Press