According to a new study, abortion is still safe after Canada removed restrictions on the medical abortion pill mifepristone. The study examined 315,000 abortions in Ontario between 2012 and 2020 using comprehensive government health data. An analysis found no increase in abortion-related health complications after mifepristone restrictions were lifted.
Abortion is still legal in Canada, thanks to the removal of restrictions on the medical abortion pill mifepristone. This is one of the key findings of a study led by UBC that was published in the New England Journal of Medicine.
The study examined 315,000 abortions in Ontario between 2012 and 2020 using comprehensive government health data. An analysis found no increase in abortion-related health complications after restrictions on mifepristone were lifted, which is considered the “gold standard” drug for medical abortion around the world.
Complications were already extremely rare, and we discovered that abortion remained safe and effective when mifepristone was prescribed without restrictions. This is the most compelling evidence yet that it is safe to provide the abortion pill like most other prescriptions, which means that any doctor or nurse practitioner can prescribe, any pharmacist can dispense, and patients can take the pills whenever, wherever, and however they want.
Dr. Laura Schummers
“Complications were already extremely rare, and we discovered that abortion remained safe and effective when mifepristone was prescribed without restrictions,” said Dr. Laura Schummers (she/her), the study’s lead author and a postdoctoral fellow in the department of family practice at UBC. “This is the most compelling evidence yet that it is safe to provide the abortion pill like most other prescriptions, which means that any doctor or nurse practitioner can prescribe, any pharmacist can dispense, and patients can take the pills whenever, wherever, and however they want.”
Canada was the first country in the world to remove all additional restrictions on mifepristone dispensing and administration. The previous rules, which went into effect when the drug was first approved in July 2015, required physicians to observe patients taking the medication. Furthermore, the drug could only be dispensed to patients by specially trained physicians who were registered with the manufacturer, not pharmacists.
Many of the restrictions lifted by Canada are still enforced by countries around the world, including the United States.
“Our study sends a message to other countries that restrictions aren’t necessary to ensure patient safety,” says Professor Wendy Norman (she/her), senior author of the study and professor in UBC’s department of family practice. “There is no scientific basis for mifepristone restrictions, which only make it more difficult for people to get the care they require. Canada’s experience can serve as a model for other countries seeking to increase access to family planning services in a safe and secure manner.”
The findings revealed that after the policy change, the uptake of medical abortions (those performed using medication rather than surgery) was rapid. Prior to the availability of mifepristone, medication was used in 2.2% of abortions. This figure rose to 31.4% two years after the drug became available without a prescription.
At the same time, after restrictions were lifted, the overall abortion rate fell from 11.9 to 11.3 abortions per 1,000 female residents aged 15-49 years.
“We saw that patients and their health care providers quickly began choosing medical abortion over surgical methods by offering care closer to home and earlier in pregnancy,” said study co-author Dr. Sheila Dunn (she/her), a scientist and family physician at Women’s College Hospital in Toronto. “Making abortion more accessible, as other studies have shown, does not increase the number of people seeking abortion. We discovered that abortion rates continued to fall after mifepristone became available as a regular prescription.”
The researchers created a complete picture of abortion health outcomes by linking and analyzing government health data on a secure data platform at ICES, a not-for-profit research institute in Ontario, which they claim provides the best data available on abortion safety.
“By linking together health records from all practitioner visits, hospital visits, and outpatient prescriptions, we were able to complete a robust safety profile for the entire province,” said co-author Dr. Elizabeth Darling (she/her), assistant dean of midwifery and associate professor at McMaster University, and an ICES scientist. “This is the most comprehensive picture of abortion safety to date, capturing any situation where a complication might occur. It demonstrates unequivocally that abortion pill restrictions are not required for safety.”
This study was supported by ICES and funded by the Canadian Institutes of Health Research and the Women’s Health Research Institute.
