Most pharmacies in British Columbia can provide the abortion pill mifepristone within days, but uneven access still leaves some women facing barriers to this time-sensitive medication, according to new research.
The study, published Nov. 6 in JAMA Network Open, offers the first province-wide look at pharmacy-level access to mifepristone in B.C.
Mifepristone is used for medical abortions and can be prescribed across Canada by any physician or nurse practitioner and filled at community pharmacies. Initially available only 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.
"In abortion care, every day matters," says lead author Dr. Elizabeth Nethery, postdoctoral research fellow at UBC's faculty of pharmaceutical sciences. "The medication is approved for use up to the ninth week of pregnancy, but people usually become aware they're pregnant at around six to seven weeks, so timely access is important to maintain and respect a person's choice to have an abortion."
In addition, maintaining access to medical abortion is important because people can access this from primary care or through telehealth in B.C. without travelling outside of their community.
Access is strong overall—but not universal
The UBC-led team conducted a "mystery shopper" survey in summer 2024, phoning more than 1,400 pharmacies across B.C. while posing as patients seeking mifepristone. Two-thirds, or 67 per cent, could fill the prescription within three days—a timeframe considered acceptable for timely care.
Geography played an unexpected role: rural pharmacies performed slightly better than urban ones. The researchers theorized that in smaller communities, pharmacists often know who stocks which medications and coordinate informally.
In cities, where pharmacies are more numerous but potentially less connected, callers were more likely to be told simply to "try somewhere else."
The study found no clear link between access and pharmacy chain affiliation. Independent, franchise and large-brand pharmacies performed similarly, suggesting that corporate structure doesn't predict availability.
When the system stalls
Among pharmacies unable to supply the medication within three days, only one in three offered a valid referral, meaning they directed callers to another pharmacy that could supply within the acceptable care period. Researchers say weak referral practices create unnecessary stress and inequities, especially for people in marginalized or lower-income communities.
"In Vancouver, for example, a patient might need to call five or six pharmacies before finding one with mifepristone available, losing precious time and adding more stress for something that should be straightforward," says senior author Dr. Laura Schummers, assistant professor at UBC's faculty of pharmaceutical sciences.
Closing the gaps
The researchers say better communication between pharmacies, clearer referral systems and refresher training could close the remaining gaps.
"In many ways, what we found is a success story. When mifepristone is treated like a routine prescription, B.C. pharmacies are, for the most part, supporting local access to this important health care service," says Dr. Schummers.
Interview languages: English
