Ultrasounds no longer required in Quebec before getting abortion pill

A group of Quebec doctors has successfully pushed for a big change to how abortions are given in the province, widening access to abortions by medication.

Until now, Quebec has required patients to have ultrasounds before obtaining the two-pill regimen that induces a medical abortion.

In the rest of Canada, that measure was abandoned in 2019. But Quebec didn't follow suit until hundreds of doctors signed an open letter last week asking the rule to be changed in their province as well.

They requested the change from the Quebec College of Physicians, prompting a new policy in recent days, according to a statement from the college.

"In the last few days, the College has decided that this measure will be made permanent," the college's spokesperson, Leslie Labranche, told CTV News.

The ultrasound rule had already been made less strict -- it was no longer mandatory -- as a temporary measure in the pandemic, beginning in February 2021, she explained.

The Quebec doctor who reportedly spearheaded the open letter, which was signed by more than 300 physicians, is a young family doctor working on Rimouski, according to Quebec's health ministry's online listing for her.

IMPROVING ABORTION ACCESS

Dr. Dario Garcia, president of Quebec's association for obstetricians and gynecologists, said the change is an important step toward making abortions more accessible.

"Anything that gives our patients better access to care is something we'll always be happy about," he told CTV News.

He said ultrasound requirements for abortion pills create unnecessary barriers for those seeking to terminate a pregnancy -- especially in a health network that's already overwhelmed.

"It's really hard, nowadays especially, to get access to laboratory tests or imaging tests."

Waiting for an appointment can be risky when it comes to medical abortions, as the window of eligibility is only 63 days.

After that, patients are required to undergo more invasive procedures to end their pregnancies, he said.

SAFE WITHOUT AN ULTRASOUND

According to the latest research, it's safe to have a medical abortion without an ultrasound beforehand, Garcia explained.

In other words, whether or not a patient has an ultrasound, "it doesn't change the results."

Quebec doctors won't be barred altogether from doing ultrasounds before prescribing the pills; they'll simply have the option not to request one.

"Physicians must use their clinical judgment and decide on a case-by-case basis whether or not an ultrasound is necessary," Labranche said.

The ultrasound rule was meant to estimate the age of the fetus and verify that the pregnant person was still nine weeks along or less, the time during which the pills were originally meant to be used. An ultrasound could also show if the pregnancy was ectopic.

In 2019, when Health Canada decided to change the rule nationally, the agency said that after extensive research into how other countries were using the pills, called Mifegymiso, it decided it wasn't necessary to do the ultrasound and that the risks of doing it often outweighed the benefits.

Mifegymiso was approved for use in Canada in 2015.

'WE STILL HAVE WORK TO DO'

While Dr. Garcia applauds health authorities for making the change, he said there are still additional measures that should be taken to improve access even further.

In Quebec, general practitioners face "strict recommendations" and are required to undergo additional training in order to administer abortion pills.

"We still have work to do," he said -- work that includes making it easier for family doctors to prescribe the medication.  

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