At the time of this writing, physicians and nurse practitioners in Canada are authorized to prescribe Mifegymiso. Midwives in all provinces and territories, except for Quebec, are not authorized to prescribe Mifegymiso but can provide medication abortion care when working closely with nurse practitioners or physicians.
Providers of medication abortion can be found through:
- Find medication abortion services portal by Action Canada for Sexual Health and Rights (please click the hyperlink and then select the option “Medical Abortion”)
- The list of abortion clinics by Action Canada for Sexual Health and Rights.
- The Choice Connect Abortion Referral App.
Counselling and clinical assessments are required prior to prescribing Mifegymiso. Counselling is to help patients make an informed decision by understanding their options (abortion versus term pregnancy, and medication abortion versus procedural abortion). Clinical assessments are to confirm that the gestational age does not exceed the threshold (63 days by Health Canada, 70 days by the Society of Obstetricians and Gynaecologists of Canada), rule out serious conditions such as ectopic pregnancy and anemia, and determine the need for bloodwork such as Rhesus testing[6].
In cases of virtual or hybrid provision of medication abortion (also called no-touch or low-touch medication abortion), the number of visits is minimized by carrying out counselling, screening and follow- up appointments virtually over the phone or through video. The purpose is to reduce the need for patients to travel long distance or wait for days or weeks to receive abortion. However, the virtual provision of medication abortion may put patients at risk due to the lack of ultrasound screening that can provide accurate assessment of the gestational age or about the presence of ectopic pregnancy. In addition, virtual medication abortion may involve more frequent (phone) follow- up to monitor the symptoms and risk of ongoing pregnancy and ectopic pregnancy, and thus it often requires more clinical resources. For these reasons, whether virtual provision of medication abortion is possible depends on prescribers’ experiences, clinical resources, patients’ needs and patients’ safety[7].
