Objectives: Mifepristone has been available in Canada since 2017. National guidelines recommend its off-label use for second/third trimester medical abortion (STMA/TTMA) by labor induction. The objective of this study was to explore 2019 Canadian STMA/TTMA provision and the role of mifepristone from a physician perspective.
Methods: We conducted a national, cross-sectional, self-administered, English and French anonymized survey of physicians who provided abortion care in 2019. The survey was distributed online through health professional organizations and networks. We used a modified Dillman technique to maximize participation. The survey included sections on workforce and clinical care, including use of mifepristone. Using R-statistical software we described and compared the provider demographics, volume of STMA/TTMA performed, and characteristics of clinical practices.
Results: Of the 477 survey participants, 107 (22.4%) provided STMA and 62 (13.0%) provided TTMA. Most STMA/TTMA providers were general or maternal-fetal-medicine subspecialist obstetrician-gynecologists (87.0%), women (80.9%) and had a mean age of 47 years old. The majority (61.1%) provided STMA/TTMA in an academic hospital, and performed fewer than 5 deliveries in 2019 for STMA (59.4%; maximum 50) and TTMA (76.1%; maximum 15). Most required an indication beyond patient request to perform STMA/TTMA (97.2%/98.6%). 51% percent reported having used mifepristone/misoprostol for STMA. Among mifepristone users, 47.4% used it for TTMA.
Conclusions: Our results will inform knowledge translation activities aimed at health policy and service delivery leaders to further increase mifepristone use for STMA/TTMA in Canada and internationally.
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