Study shows unequal access to abortion pill mifepristone in British Columbia

Study shows unequal access to abortion pill mifepristone in British Columbia

Most pharmacies in British Columbia can offer the abortion pill mifepristone within days, but unequal access still leaves some women facing hurdles to this time-sensitive drug, according to a new study.

The study published on November 6thJAMA network openedprovides the first national look at access to mifepristone at the pharmacy level in BC

Mifepristone is used for medical abortions and can be prescribed by any doctor or nurse across Canada and filled in community pharmacies. Originally only available from pharmacists who had completed a training module and pharmacies registered with the manufacturer, Health Canada removed these requirements in 2017 to improve access to abortion care. The new study shows that while access has improved dramatically, gaps remain.

“When it comes to abortion care, every day counts,” says lead author Dr. Elizabeth Nethery, a postdoctoral researcher in the Faculty of Pharmaceutical Sciences at UBC. "The drug is approved for use up to nine weeks of pregnancy, but most people realize they are pregnant around six to seven weeks. Therefore, timely access is important to maintain and respect a person's decision to have an abortion."

Additionally, maintaining access to medical abortion is important as people in BC can access it from primary care or through telemedicine without having to leave their community.

Access is good overall, but not universal

The UBC-led team conducted a “mystery shopper” survey in the summer of 2024, calling more than 1,400 pharmacies across British Columbia while posing as patients looking for mifepristone. Two-thirds, or 67 percent, were able to fill the prescription within three days - a time frame considered acceptable for timely treatment.

Geography played an unexpected role: rural pharmacies performed slightly better than urban ones. The researchers theorized that pharmacists in smaller communities often know who has what medications and coordinate informally.

In cities where pharmacies are plentiful but may be less connected, callers were more likely to be told to try elsewhere.

The study found no clear relationship between access and affiliation with a pharmacy chain. Independent pharmacies, franchise pharmacies and big brand pharmacies performed similarly, suggesting that corporate structure does not impact availability.

When the system stalls

Of the pharmacies that could not deliver the medication within three days, only one in three offered a valid referral, which meant transferring callers to another pharmacy that could deliver within the acceptable treatment timeframe. Researchers say weak referral practices cause unnecessary stress and inequities, particularly for people in marginalized or lower-income communities.

In Vancouver, for example, a patient may have to call five or six pharmacies before finding one that has mifepristone available. This wastes valuable time and creates even more stress for something that should be straightforward.”

Dr. Laura Schummers, senior author, assistant professor in the Faculty of Pharmaceutical Sciences at UBC

Close gaps

The researchers say better communication between pharmacies, clearer referral systems and refresher training could close the remaining gaps.

"What we've found is a success story in many ways. When mifepristone is treated like a routine prescription, British Columbia pharmacies largely support local access to this important health service," says Dr. Schummers.

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