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Original Research Article| Volume 113, P19-25, September 2022

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Provision of first-trimester medication abortion in 2019: Results from the Canadian abortion provider survey

  • Madeleine Ennis
    Affiliations
    Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada

    Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
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  • Regina Renner
    Correspondence
    Corresponding author.
    Affiliations
    Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada

    Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
    Search for articles by this author
  • Edith Guilbert
    Affiliations
    Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada

    Department of Obstetrics, Gynecology and Reproduction, Laval University, Quebec City, Quebec, Canada
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  • Wendy V Norman
    Affiliations
    Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada

    Department of Family Practice, University of British Columbia, Vancouver, BC, Canada

    Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
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  • Helen Pymar
    Affiliations
    Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada

    Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB, Canada
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  • Lauren Kean
    Affiliations
    Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada

    Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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  • Andrea Carson
    Affiliations
    Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada

    School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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  • Ruth Martin-Misener
    Affiliations
    Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada

    School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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  • Sheila Dunn
    Affiliations
    Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada

    Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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      Abstract

      Objective

      To explore the Canadian first-trimester medication abortion (MA) workforce and their clinical care following the introduction of mifepristone in 2017, updated national clinical practice guidelines and government approval of nurse practitioners (NPs) as first-trimester MA providers.

      Study Design

      We conducted a national, self-administered, cross-sectional survey of abortion providers in 2019. Our bilingual (French/English) survey collected information on demographics, abortion number, and clinical care characteristics. The true number of abortion providers is unknown thus we cannot calculate a survey response rate. To maximize identification of possibly eligible respondents, we widely distributed the survey between July and December 2020 through health professional organizations, using a modified Dillman technique. We used descriptive statistics to characterize the workforce and clinical practices.

      Results

      Four-hundred-sixty-five clinicians responded, of whom 388 provided first-trimester MA. Physicians (n = 358) and NPs (n = 30) reported providing 13,429 first-trimester MAs in 2019 which represented 27.7% of all reported abortions in the survey. The majority of first-trimester MA respondents were primary care physicians (n = 245, 63.1%), had less than five years’ experience (n = 223, 61.3%) and practiced outside of hospitals (n = 228, 66.5%). Forty-three percent (n = 165) practiced rurally, and 44.0% (n = 136) used telemedicine for some abortion care. Ninety-nine percent (n = 350) used a guideline-recommended mifepristone/misoprostol regimen while 14.5% (n = 51) sometimes used methotrexate. Patients most commonly received mifepristone/misoprostol at community pharmacies (median 100.0%; interquartile range 50.0%–100.0%).

      Conclusion

      Our results suggest that there are many new first-trimester MA providers, an increase in the proportion of MAs since 2012 and a shift to primary care settings. Respondents widely adopted mifepristone.

      Implications statement

      Our results highlight that, following mifepristone introduction, many new primary care practitioners started providing first-trimester medication abortion throughout Canada, including the first non-physicians. This increased access to abortion particularly in rural and underserved communities. These results could inform future directions in policy, guidelines, and abortion access initiatives.

      Keywords

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