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In 2017, mifepristone became available for medication abortion in Canada and nurse practitioners became eligible prescribers. Barriers to abortion — such as rural and remote location, patient knowledge and stigma — could potentially be addressed through nurse practitioner provision. This study aimed to examine barriers and enablers to implementation of mifepristone prescribing in nurse practitioners’ practice.
We conducted a sequential exploratory mixed methods study from August 2020 to May 2021 including a cross-sectional survey of nurse practitioners in Canada followed by semi-structured interviews with these providers and with stakeholders in health administration, government, advocacy, and regulation. We used feminist and interpretive theoretical lenses for analysis and organized data thematically. Descriptive analyses were used to interpret quantitative survey data.
181 nurse practitioners completed the survey, of whom 36% (n=65) self-identified as medication abortion providers and 64% (n=116) as non-providers. Mentorship was a key enabler of nurse practitioners’ provision of medication abortion. Barriers included limited pharmacy access, lack of surgical back-up, and employer restrictions. Twenty-two nurse practitioners and 20 stakeholders participated in interviews. Enablers included clinical leadership roles, engagement in community education and communication, and interprofessional outreach. Barriers included low priority of abortion in nurse practitioners’ practices, lack of support from colleagues or employers, and infrastructural barriers to ultrasound and emergency services.
Regulatory change is insufficient to change practice. Findings support the critical role of mentorship to improve uptake of nurse practitioners’ prescription of mifepristone and address employer restrictions and resource barriers, and point to the need to augment abortion education to foster understanding among colleagues. Findings can be integrated into policy, support practice changes, and direct future research to advance equitable access to abortion.
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© 2022 Published by Elsevier Inc.