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How the latest U.S. abortion pill attacks may have ripple effects in Canada

The escalation of attacks on access to abortion in the United States since the fall of Roe v. Wade last year should “spur” Canada to get its own house in order to provide safe and stable access, experts warn.

In a high-stakes case on Friday, the U.S. Supreme Court rejected an attempt by a lower court to restrict access to mifepristone, one of the two drugs used in the abortion pill. While the move preserves access to the drug that is used in more than half of all abortions in the U.S., the case has put the spotlight on the next chapter of attacks on access to abortion in that country.

The new line of attack comes less than a year after the Supreme Court’s conservative majority overturned Roe v. Wade and allowed more than a dozen states to effectively ban abortion outright.

Abortion rights advocates and experts in Canada say what is happening across the border could have implications here, with a rise in the spread of misinformation amid a growing anti-abortion movement.

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“I think we should be very concerned about these legislations going forward, these regressive bans that really hurt abortion access in the United States to affect how abortion care will be done in Canada,” said Farrah Khan, executive director of Action Canada for Sexual Health and Rights.

“This case is a direct attack on reproductive rights and will have devastating implications for pregnant people to be able to access support, access abortion care — and we should be very concerned about this,” she told Global News.

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The most recent case stemmed from the decision of a federal judge in Texas to suspend the approval of mifepristone’s safety, done by the U.S. Food and Drug Administration two decades ago.

The drug, along with misoprostol, can be taken at home and together they form the two-drug combination known colloquially as the abortion pill.

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Mifepristone dilates the cervix and blocks the action of the hormone progesterone, which is vital to continuing a pregnancy. Misoprostol causes contractions that empty the uterus. Typically, mifepristone is taken by mouth first, followed by misoprostol a day or two later.

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Decades of studies show medication abortions are safe and effective, with a 95 to 99 per cent success rate around the world.

But the latest case also emphasizes what Canada should and should not be doing, said one Canadian historian who studies access to abortion.

“Canada should be looking to the United States as an example of what not to do,” said Christabelle Sethna, a University of Ottawa professor at the Institute of Feminist and Gender Studies.

“Canada should be looking to the United States as a spur to get our own house in order in terms of legal, safe, affordable and available contraception and abortion in the country.”

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Abortion access in Canada

Women seeking to end their pregnancies without more invasive surgical abortion can take mifepristone, along with misoprostol, as a two-dose regimen.

Health Canada approved mifepristone, which along with misoprostol is packaged under the brand name Mifegymiso, in 2015. It has been publicly available for use in the country since 2017.

The drug can be prescribed for on-label use in the first nine weeks of pregnancy, and off-label up to 10 weeks.

Even though the top U.S. court has blocked the Texas judge’s order revoking the FDA approval of mifepristone from taking effect, there is still uncertainty as the lawsuit — and others in the future — from abortion opponents moves forward.

The court’s action Friday almost certainly will leave access to mifepristone unchanged at least into next year as appeals play out, including a potential appeal to the high court, The Associated Press reported.

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Khan said this is an ongoing issue and there will be continued attacks on reproductive health, which is why it is important for Canada to step up.

“I think our federal government has an opportunity here to take a strong stance about abortion rights,” she said.

In its 2023 budget, the federal government has committed to investing $36 million over three years to make sexual and reproductive health-care services, including abortion, more accessible for vulnerable populations.

The federal government also warned in March that it will withhold millions in health-care transfers from provinces that force Canadians to pay for health-care services, including medical imaging as well as abortions, which is medically necessary under the Canada Health Act.

The act lays out which services must be covered under publicly funded health-care systems across the country.

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Khan said more needs to be done to counter barriers to access, including better information sharing and allowing midwives to prescribe abortion medication.

Currently, only doctors and nurse practitioners are able to do so in Canada.

In the United States, mifepristone has been used by more than five million women since the FDA approved it in 2000. AP Photo/Allen G. Breed, File

Even though Canada’s anti-abortion movement has not gained the same level of traction as that in the U.S., this latest case could give that momentum, raising suspicions around medication abortion, Sethna said.

“We should be investing a lot more in things like sex education, contraception, abortion, approaching the field of reproduction in a more holistic and accessible fashion.”

What about Canada’s mifepristone supply?

In Canada, pharmacists have also been keeping a close eye on the mifepristone case in the U.S.

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If U.S. restrictions are imposed, this could throw into question Canada’s mifepristone supply, especially if more Americans cross the border to access abortion services – concerns that were also raised when Roe v. Wade was overturned last year.

Last year, Canadians also faced a shortage of abortion pills due to issues with the manufacturer.

Joelle Walker, vice-president of public and professional affairs for the Canadians Pharmacists Association, said a potential spike in demand for the drug with more Americans turning to Canada is a “huge concern.”

“A sharp demand for Canadian drugs would be a challenge for our supply here in Canada,” she told Global News.

Even before the U.S. Supreme Court ruling Friday, Walker said pharmacist groups were planning “proactively” with provinces to make sure the supply in Canada is not “jeopardized.”

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Each year, roughly 50,000 to 80,000 doses of Mifegymiso are used in Canada, according to Walker.

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In the United States, mifepristone has been used by more than five million women since the FDA approved it in 2000.

Sethna said Canada should prepare for cross-border abortion travel.

“It’s quite possible that those who are living close to the border may be coming to Canada for some kind of abortion service.”

— with files from Global News’ Sean Boynton and The Associated Press

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