ST. JOHN'S, N.L. — Newfoundland and Labrador — the only province that does not provide at least partial coverage of the abortion pill — is under renewed pressure to do so.
Medical students and practitioners have written an open letter to the premier and health department asking for universal coverage of Mifegymiso, as well as supportive resources for physicians prescribing the drug.
The letter is a follow-up to a meeting between medical students and Health Minister John Haggie in March.
"The government has a responsibility to uphold everyone's right to health and that includes access to abortion services that are comprehensive and accessible," Maggie O'Dea, a medical student at Memorial University who met with Haggie, said Wednesday.
"We have such a rural and remote population that this is ultimately a huge potential win for the government to be able to provide that care and uphold their rights."
The two-drug combination terminates pregnancies of up to nine weeks, as an alternative to surgical methods that are currently covered by the province.
Activists say the province has a unique need for the alternative abortion access.
Mifegymiso costs approximately $350, while a surgical abortion can cost as much as $1,500, not including travel costs to a clinic.
The province's year-round abortion clinics are located in St. John's, putting it out of financial reach for many low-income patients outside the capital.
"In (Atlantic Canada), it's been definitely a place where access issues have been quite acute," said Frédérique Chabot of Action Canada for Sexual Health and Reproductive Rights.
Chabot's organization has been monitoring the rollout of the drug across the country, and she said some provinces have been more effective than others at making the drug available.
B.C., Alberta, Ontario, Quebec, New Brunswick, and Nova Scotia have implemented universal coverage, but some of these provinces still have restrictions.
Chabot said the rallying from the medical community in Newfoundland and Labrador has been "quite wonderful to see."
She hopes the provincial government will consider universal coverage along with a billing code, partnerships with medical colleges, and training and guidelines for practitioners, similar to what has been done in Alberta.
Robin Whitaker, an anthropology professor at Memorial University who has studied abortion access in Newfoundland and Labrador, said consideration of the circumstances of patients in remote communities is often overlooked since abortion has been de-criminalized in Canada.
"There's no criminal law on abortion in this country and that's a good thing, but politically sometimes there's still some hesitation," said Whitaker.
Rolanda Ryan, owner of Athena Health Clinic in St. John's, said her clinic has performed 1,121 procedures since Mifegymiso rolled out at the end of January last year. Fifty of those used the drug — 38 of them in 2018 as word of its availability spread.
Ryan has worked with physicians in remote communities to prescribe the drug and says her clinic is happy to provide support to any practitioners — including access to the 24-hour phone line required after taking the pill.
She said she's not sure whether the government will fully fund the pill given its financial situation, but hopes for at least a partial coverage plan to help low-income patients access the drug.
"I honestly don't know what the outcome will be, but it has to be in such a way that people aren't out of pocket, or that they're minimally out of pocket," said Ryan.
"It has to be so that nobody falls through the cracks because of the price tag of the pills."
Every other province in Canada now offers some coverage of medical abortions using pills, with costs varying depending on a patient's income, private health benefits and other factors, to full universal coverage for all residents.
"The universal access that was requested is like, gold standard, it's kind of the best thing you could ask for," said Ryan. "I don't know what they're ultimately gonna do, but ask for sky. Because why not?"
Holly McKenzie-Sutter, The Canadian Press