Before mifepristone became available in January 2017 in Canada, only physicians provided
abortion, and most abortions were surgical and in the largest cities. Risk Evaluation
and Mitigation Strategy (REMS)-like restrictions were removed in November 2017, so
that mifepristone became a normal prescription. We hypothesized this would increase
the size and distribution of the workforce.
We used interrupted time series analyses on Ontario's population-based administrative
data to compare abortion workforce trends before mifepristone (January 2012–December
2016) to when mifepristone was a normal prescription (November 7, 2017–March 10, 2020).
We defined a most responsible provider (MRP) for each abortion and calculated MRPs
per 100,000 females aged 15–49, with Risk Differences (RD) and 95% CI.
We identified MRPs for 98.3% (311,742/315,447) of all abortions. Compared to the expected
trend, the number of MRPs increased from 11.1 to 45.3 per 100,000 reproductive-aged
females (RD, 34.3; 95% CI, 29.3–39.2). This increase was greatest in rural areas,
rising from 1.8 to 48.7 (RD46.9, CI42.0-51.8). By 2019, most MRPs were GPs (66.5%)
providing >80% of abortions, with 23.2% obstetrician-gynecologists, and 9.1% nurse
practitioners. MRPs providing fewer than 10 abortions per year rose from <120 to over
600, while the number of MRPs in all categories providing over 30 annual abortions
When mifepristone was available without REMS-like restrictions, physicians and nurse
practitioners rapidly implemented mifepristone medication abortion in both urban and
rural primary care. The abortion workforce in Ontario quadrupled within two years
of the policy change, including more providers per reproductive-age female in rural
than in urban locations. This policy improved access to confidential abortion care
closer to home.