NWT residents who have their own supplementary health insurance still face barriers to access for the Mifegymiso abortion pill, say sexual health experts pushing for universal coverage.
“If you’re in one of the last few hold out regions, its not as accessible as if you were in any part of the country. It creates a two-tiered health care that is unjust,” said Frederique Chabot, director of health and promotion for Action Canada for Sexual Health and Rights.
With piecemeal coverage, vulnerable people, youth and people on the same insurance plans as a partner or parent are held back from unfettered choice about their reproductive health, advocates wrote in a letter penned to Health and Social Services Minister Glen Abernethy and Premier Bob McLeod, Nov. 13.
People who are precariously employed are also unable to afford medications.
Signatories to the letter include Northern sex education outfit FOXY, Action Canada for Sexual Health and Rights, the director for the Northern Options for Women program, which helps women access reproductive and abortion services in the NWT and the Midwives Association of the Northwest Territories.
The letter commends an interim directive to pay for the pill for people who have neither insurance through their employer nor coverage through Non-Insurable Health Benefits but says universal coverage is required to break down seemingly innocuous barriers to reproductive choice.
Medical abortion through Mifegymiso is even more time sensitive than surgical abortion, and navigating insurance claims can delay access to an essential medical procedure, the letter states. The pill series also costs between $300 and $450, leaving it out of reach for many women.
“It’s often women and those are the people who fall through the cracks and are not able to pay for their prescriptions,” said Chabot.
Mifegymiso is the “gold standard” for medical abortion and has been used in more than 60 countries for three decades, she said.
Vulnerable people and youth are less likely to navigate “multiple and confusing barriers, including co-pays, deductibles and the filling out of onerous formularies,” the letter states.
For people who are insured, they may have insurance under a parent or an intimate partner.
Without universal coverage, privacy concerns can “mean the difference between access to a safe medical abortion or not for some women,” said Candice Lys, executive director of FOXY.
“If the insurance is under a partner’s name, they could find out the medical abortion was accessed. That could mean potentially a risk to safety,” said Lys.
The letter asks for more support for the NOW program to investigate options for midwives and physicians to provide Mifegymiso and to add the medication to the pharmacy list for registered midwives in the NWT.
In a Nov. 15 e-mail to Yellowknifer, the Department of Health and Social Services said it is “examining options in this regard and has determined in order for midwives to provide this type of care, regulatory changes would need to be made. The Department intends to further engage with stakeholders in this regard with the understanding that legislative changes will take time.”
When it was first approved, it came with a long list of “unnecessary restrictions” that made it more regulated than some narcotics, said Chabot.
Those regulations have since been removed, save for the requirement of an ultrasound which is a barrier to access, said Chabot.
Women living in remote communities are forced to travel outside their communities, increasing privacy concerns and difficulties finding replacement care for children and family.
In a typical year, there are around 100,000 abortions in Canada, excluding Quebec, according to 2017 statistics from the Abortion Rights Coalition of Canada.
Yukon, Alberta, Ontario, Quebec, BC, Nova Scotia, New Brunswick and Newfoundland, PEI offer full coverage, leaving only NWT, Nunavut, Manitoba and Saskatchewan as holdout regions.
Those most affected by lack of provision are those who need it most: young, low-income earners in remote regions, the letter states.
Residents in communities without ultrasound machines are still limited from accessing the pill, because practitioners in the NWT must complete an ultrasound to ensure a fetus is fewer than 63 days old and to rule out ectopic pregnancy.
“Ultrasound is the last restriction still standing on the Health Canada approval of Mifegymiso,” said Chabot.
“There are other ways to identify a pregnancy with blood tests, or to identify an ectopic pregnancy,” she said.
In 2016, the Journal of Obstetrics and Gynaecology Canada published a clinical practice guideline approved by the Society of Obstetricians and Gynaecologists of Canada providing alternatives to ultrasound.
The age of the pregnancy can be estimated using the last menstrual period, clinical history and a physical examination for women who are sure of the date of their last menstrual period.
It recommends an ultrasound when uncertainty remains.
The 2016 guideline states that “the probability of ectopic pregnancy among women requesting abortion is consistently lower than in the general population.”