Accessing abortion services for all Canadians seemed to become much easier with Health Canada's 2015 approval of, and recent easing of restrictions on, Mifegymiso, commonly known as the "abortion pill."
"Seemed" is the key word here, however. It's still tougher to get access in Newfoundland and Labrador than it is in many other parts of Canada.
Why? The hefty $300 price tag.
Alberta, Ontario, New Brunswick, Nova Scotia and Québec have all pledged universal cost coverage of the abortion pill, but we are still waiting on a statement from the government of Newfoundland and Labrador regarding this issue.
Considering the geographic limitations of accessing a surgical abortion in this province — with the only two providers being located in St. John's — it's clear that the province is grossly under-serviced. The abortion pill offers a less invasive and theoretically more accessible alternative to a surgical abortion, but the cost could very well be prohibitive for some individuals in the province.
A surgical abortion can involve one or two appointments, depending on which provider an individual selects. The cost for the procedure itself is covered by the provincial health care plan, but those who live outside of St. John's are on the hook for associated expenses including travel, accommodations, child care, and so forth.
An individual from Labrador, for example, may have to pay over $100 per night for hotel accommodations and as much as $1000 for a round-trip flight to St. John's (along with meals, child care and rental car fees, of course), not to mention loss of income due to absence from work.
The abortion pill practically eliminates these costs, but still presents a financial burden of its own with its $300 price tag. Full cost coverage from the government would transform access to abortion services in rural and remote areas of the province.
Mifegymiso consists of two drugs – mifepristone, which stops the production of the hormone progesterone that is necessary for pregnancy, and misoprostol, which causes uterine contractions, essentially inducing a miscarriage. Health Canada approved Mifegymiso in July 2015 for use in the first nine weeks of pregnancy and the drug can be obtained through a prescribing health professional or pharmacist.
But the fact that the cost of Mifegymiso is covered in some provinces but not others calls into question the universality of our health care system. This has really been a prolonged question, considering the total lack of access to abortion in P.E.I. until very recently. (At the time of writing, the P.E.I.'s government has made no indications as to whether it plans to cover the cost of the abortion pill).
Universality is a key principle of the Canada Health Act, meaning that all insured residents of the Canadian health care system should be able to receive the same level of care, regardless of where they live. Yes, everyone in Canada theoretically has access to the abortion pill, but only those of certain financial means truly have access if they live in certain parts of the country.
This essentially creates a two-tiered system, which Darrah Teitel of Action Canada for Sexual Health and Rights argues is a violation of the Canada Health Act. Health Minister Ginette Petitpas Taylor said in late October that her office is prepared to "speak to all [their] provincial and territorial officials to see if [they] can move forward on this," adding that they "want to ensure that all women have access to the reproductive health services that they need."
That's a positive sign, but it means very little to those in Newfoundland and Labrador and other provinces who might need Mifegymiso now, but can't pay the cost.
Having the right to choose is only meaningful when all options are available for selection. The World Health Organization (WHO) lists Mifegymiso as an essential medicine with proven efficacy and low rates of major complications. So, the question is this: if certain provinces, the federal government and the WHO have identified Mifegymiso as essential to optimizing access to abortion services, then why hasn't the provincial government here done the same?