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Dawn Fowler is the executive director of the Vancouver Island Women's Clinic

Mifepristone, also known as the abortion pill, is a medication that was licensed in France in 1987 and since then in more than 60 other countries. Unfortunately, Canada had to wait another 25 years for it to be approved and become available. Mifepristone has a very high efficacy rate and is on the World Health Organization's list of essential medications. It is a very safe medication and can be used up to the 70th day of pregnancy (SOGC Guidelines, 2017). With this option available, there is significantly less demand for surgical termination. We see this where it has been offered universally in other provinces. For example, the demand for surgical terminations in Alberta has dropped by a third since universal coverage has been offered. It has been used by thousands of women around the world. Five provinces have decided to provide universal coverage for Mifepristone; Alberta, Ontario, Quebec, New Brunswick and, most recently, Nova Scotia. Notably, women in B.C. are not being given access to this gold-standard medication for a medical termination of pregnancy.

British Columbia is Canada's third-largest province and in the past has been one of the most progressive in its provision of women's reproductive health. Years ago, the B.C. government mandated provincewide provision of abortion care with three free-standing abortion clinics and provision of surgical abortions in several hospitals. A provincewide hot line was established and B.C. clinics and physicians have legislated protection from protesters. A pilot program is now running to provide free contraception to women. So why is it lagging behind now with medical abortion provision?

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The B.C. government has made Mifepristone available on the hospital formulary and for those on social assistance and First Nations. They think this is good enough. However, placing it on the hospital formulary sounds great in theory but does little to expand access. Most family physicians do not have offices in hospitals and it would very expensive for hospitals to establish medical abortion clinics. Furthermore, a physician cannot write a prescription for a patient in their office and then have the patient go to the hospital pharmacy and obtain the prescription. It's not allowed. This is a medication that should be dispensed in the community if any savings are to be had.

While many third-party health insurers and the government employee health-benefits program cover Mifepristone, a significant percentage of the population is still not covered, including those in minimum-wage jobs, part-time workers or women who are self-employed or work for small businesses. This creates a glaring social disparity when women who have extended health benefits are covered for the cost of the medication, but those with lower paying jobs and no benefits have to pay at least $350 for the medication or are forced to choose a surgical procedure if they cannot afford it. This makes even less sense when you consider that surgical procedures require more resources and infrastructure and therefore expense to the government purse than medical terminations do.

The B.C. College of Physicians and Surgeons licensing requirements for abortion clinics are becoming so burdensome and expensive that the facilities are finding it increasingly challenging to meet them, resulting in even more cost. A medical abortion is less invasive, allows a woman to have her abortion at her convenience, as opposed to that of a physician, and to have it at home with the comforts and supports she chooses. Medical abortion also frees up much-needed surgical time and thus puts less demand on surgical beds.

The NDP prides itself on being a pro-choice party and supportive of gender equity. However, by failing to remove barriers to the gold standard of medical abortion, the Premier and his Health Minister continue to do disservice to the women of B.C. There really is no good reason for not providing universal coverage for Mifepristone. Why can't they provide access like Alberta, Ontario, Quebec, New Brunswick and Nova Scotia? It is the right thing to do.

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