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P031Mifepristone as a normal prescription rapidly increased rural and urban providers

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      Objectives

      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.

      Methods

      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.

      Results

      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 was unchanged.

      Conclusions

      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.
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