Changes in local access to mifepristone dispensed by community pharmacies for medication abortion in Ontario: a population-based repeated cross-sectional study

BACKGROUND: Although mifepristone for medication abortion has been available in Canada since a regulatory change in 2017, leading to its rapid uptake, the effects of this availability on regional access to abortion are unknown. We sought to examine how community pharmacy dispensation of mifepristone affected distribution of abortion services over time in Ontario, Canada. METHODS: We used linked health administrative data to identify a cohort of all medication and procedural abortions provided in Ontario from 2017 to 2022, defined by outpatient mifepristone dispensations and abortion billing, diagnostic, and procedure codes. We evaluated changes over time in the annual proportion of community pharmacies that dispensed mifepristone and the availability and distribution of medication and procedural abortion services across geographic regions, defined by postal code forward sortation areas. RESULTS: In 2017, 2% of Ontario pharmacies filled 1 or more prescriptions for mifepristone, which increased to 20% in 2022. In 2017, few regions contained a mifepristone-dispensing pharmacy (19%) or procedural abortion service (18%). By 2022, most regions had local access to a mifepristone-dispensing pharmacy (77%), with geographically distributed abortion services across Ontario. Although only 37% of abortion service users lived in a region with either a mifepristone-dispensing pharmacy or procedural provider in 2017, this increased to 91% by 2022. INTERPRETATION: Access to medication abortion across Ontario increased substantially within 5 years of mifepristone's availability as a normally prescribed and dispensed medication. This regulatory approach appears successful for achieving widespread access to local abortion services.