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.