Paul Tuns:

The medical journal Family Practice published a report co-authored by nine researchers led by Wendy V. Norman at the University of British Columbia, that examined how physicians in Canada maintained abortion services during the pandemic restrictions and found that they were able to continue committing abortions because they and policymakers considered abortion “essential.” They found that access “was often maintained despite pandemic-related challenges” by moving to a less hands-on approach of prescribing the abortion pill rather than relying on surgical abortions to terminate pregnancies.

The authors report that outside Quebec, which has some regulatory obstacles still in place limiting “low-touch medical abortions,” a “robust pandemic transition to telemedicine to ensure access to (abortion) services” was maintained or even increased. The shift to more chemical abortions and use of “telemedicine” – telephone or online consultations with patients – meant that more abortions could be committed in remote and rural areas.

The authors noted that several respondents said that “virtual care made abortion more accessible” during the pandemic, although others reported that obtaining timely tests or access to operating rooms for late-term surgical abortions was a challenge. Still, “many abortion providers indicated that the pandemic did not affect their ability to provide access.” Fully three-quarters of respondents said their patients did not experience any delays in obtaining an abortion during the pandemic.

The authors describe the experience of most abortionists as “seamless” and juxtaposed the availability of abortion in the United States where half of all abortion facilities reported reduced or shutting services during the beginning of the pandemic.

Campaign Life Coalition national president Jeff Gunnarson told The Interim “not even the pandemic which closed down most of society slowed down the abortion industry in Canada.”

While the abortion pill’s manufacturer encourages it to be limited to the first trimester for safety reasons, the survey found that 55 respondents prescribed the abortion pill in the second trimester and 35 did so in the third trimester. 

Health Canada approved the abortion pill regimen of Mifepristone and Misoprostol in 2015. Originally the abortion pill had to be administered by a physician who took a course on the abortion pill, was limited to seven weeks gestation and required an ultrasound to provide proof of gestational age, and needed a follow-up physician’s visit to ensure the abortion “worked.” In 2017, Health Canada lifted those and other restrictions. Most countries that allow the abortion pill, prohibit it after nine weeks gestation for safety reasons.

The study found that fewer than one in five physicians “always” require a woman obtaining a chemical abortion to have an ultrasound.

One doctor told the study’s authors that “I have offered entirely telehealth abortion care for early first-trimester pregnancies” with “minimal” tests to ensure the woman was pregnant or that the abortion was complete.

The study’s authors said the Health Canada’s pre-pandemic removal of restrictions on the abortion pill “likely facilitated” the shift to medical abortions when early COVID restrictions shuttered many doctor’s offices and hospitals to most services. But a New England Journal of Medicine report published in November found that chemical abortions were growing in popularity prior to the pandemic, accounting for about one-in-three Canadian abortions in 2019.

In the survey published in Family Medicine, more than half of respondents said the “volume” chemical abortions – which the researchers call “medical abortions” – increased during the first year of the pandemic while less than seven per cent said it decreased; the rest said there was no discernible change.

The research team sent two surveys to medical professionals (doctors, nurse-practitioners, administrators) in each of the provinces and territories and received 307 to their initial survey and 78 to their follow-up. The majority of respondents were family physicians, indicating that they were prescribing the abortion pill.