Abstract
Objectives
Following the 2017 introduction of mifepristone in Canada and both ensuing regulatory
changes and increased demand for medication abortion care, Planned Parenthood Ottawa
created the Medical Abortion Access Project (MAAP). This study aimed to document outcomes,
identify facilitators and barriers, and distill learnings from an initiative that
sought to recruit and support primary care clinicians in providing mifepristone/misoprostol
in Canada's capital.
Study design
We employed a multi-methods evaluation strategy that included reviewing MAAP-related
documents, evaluating the project log, and conducting in-depth interviews with clinicians
at 5 sites. In the final analytic phase, we integrated the findings from the different
evaluation components.
Results
From May 2017 through July 2018, the MAAP helped 14 primary care facilities in Ottawa
become medication abortion providers; 9 began providing mifepristone/misoprostol to
existing patients and 5 began offering mifepristone/misoprostol to the public. The
program recruited 4 new pharmacies to stock the combination package and trained 2
sonography clinics in abortion-related protocols. Program participants identified
patient demand as a key driver of medication abortion provision but required information
and logistical support from the MAAP to operationalize service delivery. New abortion
providers reflected positively on the community of practice that the MAAP created,
which enabled them to offer and receive technical and emotional support from colleagues
across the city.
Conclusions
A number of primary care clinicians in Ottawa were able to successfully integrate
medication abortion care into their practices with MAAP support. Future research should
explore whether this type of community-based intervention can be replicated in other
settings.
Implications
Evidence-based regulation of mifepristone by health authorities is a critical step
to increasing access to medication abortion care. However, deregulation alone was
insufficient to integrate medication abortion services into primary care in Ottawa.
Community-based programs like the MAAP can help providers make sense of shifting regulations
and practice guidelines, overcome logistical barriers, and ultimately increase access
to this medically necessary service. Establishing and facilitating communities of
practice is especially important for new primary care providers.
Keywords
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Article info
Publication history
Published online: January 11, 2022
Accepted:
January 3,
2022
Received in revised form:
January 1,
2022
Received:
August 31,
2021
Footnotes
Declaration of Competing Interest: The authors declare that they have no conflicts of interest, financial or otherwise.
Funding: A 15K Challenge Grant from Women's XChange, funding from an anonymous donor, and a small grant from Cambridge Reproductive Health Consultants supported this project.
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