Reproductive health care evolving in Alberta: Data

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

Since becoming available in 2017, Mifegymiso, commonly called the abortion pill, has transformed reproductive health care in Canada.

Before the drug’s legalization, medical abortion was a relatively rare procedure, and surgical abortion services were often only available through hospitals and specialized clinics in major urban centres.

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Because any physician or nurse practitioner in Alberta can prescribe Mifegymiso, the medication has helped eliminate geographic barriers to services for patients in rural and remote communities.

Limitations in data reporting from health care professionals have made tracking this expansion of services in the province difficult, but statistics from Alberta Health obtained through an access-to-information request shed some light on the evolving state of reproductive health care in the province.

Between 2020 and 2022, about 25 per cent of abortions performed in Alberta were medical, or roughly 3,000 procedures per year, according to the Canadian Institute for Health Information (CIHI).

However, data from Alberta Health shows the number of Mifegymiso doses dispensed is significantly higher than the total medical abortions reported, with 4,152 doses dispensed in 2022 and 5,850 in 2023.

This discrepancy is due to Alberta lacking a dedicated physician billing code for medical abortion, "resulting in some ongoing underestimation of total/medical abortion volumes," a spokesperson for CIHI said in an email.

While these procedures may be performed by doctors outside of abortion clinics, because the drug can be used for other purposes like treatment of miscarriages, "additional diagnoses information is required to limit to induced abortions. This diagnostic information for Alberta is currently unavailable at CIHI."

Mifegymiso is the brand name for two drugs, mifepristone and misoprostol, taken in sequence to terminate early pregnancies. Alberta is one of three provinces and territories with no billing code for the medication.

Dr. Luanne Metz, Alberta NDP health critic, said the apparent increase in the rate of medical abortion indicated by the prescription data is a positive sign, "but we still have a way to go."

"Alberta is low compared to what it should be, because medical abortion is the safest kind of abortion. It's the least expensive, and it should be utilized at a much higher rate than it is in Alberta," Metz said.

"But it's very difficult to get access, particularly for women that live in rural areas. And it's even more important for them, because then they don't have to travel into the city for the procedure."

The lack of a physician billing code, aside from complicating data collection, also means these procedures aren’t being properly funded and supported, Metz said.

The use of medical alternatives to surgical abortion has been inconsistently adopted across Canada, as well as other jurisdictions where the abortion pill has been available for decades.

A 2021 study published in the Sexual and Reproductive Health Matters journal found European and Scandinavian medical abortion ratios ranged from 97.7 per cent in Finland to 24.4 per cent in Italy. The study also noted that medical abortion was more frequently used in countries with higher levels of gender equality, and "markers of economic and political gender equality seemed to drive the correlations."

Dr. Regina Renner, clinical professor and researcher with the Canadian Abortion Research Team, said that while she would like to see medical abortion continue to increase compared to surgical procedures, there isn’t an ideal ratio that could be established when it comes to providing appropriate care for pregnant people.

"I think it is important that women or people who are pregnant who seek an abortion still have the option to choose between medication and procedural abortion. And that, in addition, we make sure from an access perspective that we have both options available. Because there will always be gestational ages or medical comorbidities or other situations that make a surgical route the safer option," Renner said.