Perspectives Among Canadian Physicians on Factors Influencing Implementation of Mifepristone Medical Abortion: A National Qualitative Study

doi:10.1370/afm.2562

. 2020 Sep;18(5):413-421.

doi: 10.1370/afm.2562.

Perspectives Among Canadian Physicians on Factors Influencing Implementation of Mifepristone Medical Abortion: A National Qualitative Study

Affiliations

¹ Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.).
² Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.). wendy.norman@ubc.ca.

PMID: 32928757
PMCID: PMC7489974
DOI: 10.1370/afm.2562

Perspectives Among Canadian Physicians on Factors Influencing Implementation of Mifepristone Medical Abortion: A National Qualitative Study

Sarah Munro et al. Ann Fam Med. 2020 Sep.

. 2020 Sep;18(5):413-421.

doi: 10.1370/afm.2562.

Affiliations

¹ Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.).
² Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.). wendy.norman@ubc.ca.

PMID: 32928757
PMCID: PMC7489974
DOI: 10.1370/afm.2562

Abstract

Purpose: Access to family planning health services in Canada has been historically inadequate and inequitable. A potential solution appeared when Health Canada approved mifepristone, the gold standard for medical abortion, in July 2015. We sought to investigate the factors that influence successful initiation and ongoing provision of medical abortion services among Canadian health professionals and how these factors relate to abortion policies, systems, and service access throughout Canada.

Methods: We conducted 1-on-1 semistructured interviews with a national sample of abortion-providing and nonproviding physicians and health system stakeholders in Canadian health care settings. Our data collection, thematic analysis, and interpretation were guided by Diffusion of Innovation theory.

Results: We conducted interviews with 90 participants including rural practitioners and those with no previous abortion experience. In the course of our study, Health Canada removed mifepristone restrictions. Our results suggest that Health Canada's initial restrictions discouraged physicians from providing mifepristone and were inconsistent with provincial licensing standards, thereby limiting patient access. Once deregulated, remaining factors were primarily related to local and regional implementation processes. Participants held strong perceptions that mifepristone was the new standard of care for medical abortion in Canada and within the scope of primary care practice.

Conclusion: Health Canada's removal of mifepristone restrictions facilitated the implementation of abortion care in the primary care setting. Our results are unique because Canada is the first country to facilitate provision of medical abortion in primary care via evidence-based deregulation of mifepristone.

Keywords: abortion; family planning; health policy; health services accessibility; implementation; interview; qualitative research.

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References

1. Costescu D, Guilbert E, Bernardin J, et al. Society of Obstetricians and Gynecologists of Canada . Medical abortion. J Obstet Gynaecol Can. 2016; 38(4): 366–389. - PubMed
1. Black A, Guilbert E, Costescu D, et al. Society of Obstetricians and Gynaecologists of Canada . Canadian Contraception Consensus (Part 1 of 4). J Obstet Gynaecol Can. 2015; 37(10): 936–942. - PubMed
1. Norman WV. Induced abortion in Canada 1974-2005: trends over the first generation with legal access. Contraception. 2012; 85(2): 185–191. - PubMed
1. Norman WV, Guilbert ER, Okpaleke C, et al. . Abortion health services in Canada: results of a 2012 national survey. Can Fam Physician. 2016; 62(4): e209–e217. - PMC - PubMed
1. United Nations Convention on the Elimination of All Forms of Discrimination Against Women. Concluding observations on the combined 8th and 9th periodic reports of Canada: Committee on the Elimination of Discrimination against Women. https://digitallibrary.un.org/record/3802136?ln=en. Published Nov 25, 2016. Accessed Jul 27, 2020.

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[1] Costescu D, Guilbert E, Bernardin J, et al. Society of Obstetricians and Gynecologists of Canada . Medical abortion. J Obstet Gynaecol Can. 2016; 38(4): 366–389. - PubMed

[2] Costescu D, Guilbert E, Bernardin J, et al. Society of Obstetricians and Gynecologists of Canada . Medical abortion. J Obstet Gynaecol Can. 2016; 38(4): 366–389. - PubMed

[3] Black A, Guilbert E, Costescu D, et al. Society of Obstetricians and Gynaecologists of Canada . Canadian Contraception Consensus (Part 1 of 4). J Obstet Gynaecol Can. 2015; 37(10): 936–942. - PubMed

[4] Black A, Guilbert E, Costescu D, et al. Society of Obstetricians and Gynaecologists of Canada . Canadian Contraception Consensus (Part 1 of 4). J Obstet Gynaecol Can. 2015; 37(10): 936–942. - PubMed

[5] Norman WV. Induced abortion in Canada 1974-2005: trends over the first generation with legal access. Contraception. 2012; 85(2): 185–191. - PubMed

[6] Norman WV. Induced abortion in Canada 1974-2005: trends over the first generation with legal access. Contraception. 2012; 85(2): 185–191. - PubMed

[7] Norman WV, Guilbert ER, Okpaleke C, et al. . Abortion health services in Canada: results of a 2012 national survey. Can Fam Physician. 2016; 62(4): e209–e217. - PMC - PubMed

[8] Norman WV, Guilbert ER, Okpaleke C, et al. . Abortion health services in Canada: results of a 2012 national survey. Can Fam Physician. 2016; 62(4): e209–e217. - PMC - PubMed

[9] United Nations Convention on the Elimination of All Forms of Discrimination Against Women. Concluding observations on the combined 8th and 9th periodic reports of Canada: Committee on the Elimination of Discrimination against Women. https://digitallibrary.un.org/record/3802136?ln=en. Published Nov 25, 2016. Accessed Jul 27, 2020.

[10] United Nations Convention on the Elimination of All Forms of Discrimination Against Women. Concluding observations on the combined 8th and 9th periodic reports of Canada: Committee on the Elimination of Discrimination against Women. https://digitallibrary.un.org/record/3802136?ln=en. Published Nov 25, 2016. Accessed Jul 27, 2020.

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Perspectives Among Canadian Physicians on Factors Influencing Implementation of Mifepristone Medical Abortion: A National Qualitative Study

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Perspectives Among Canadian Physicians on Factors Influencing Implementation of Mifepristone Medical Abortion: A National Qualitative Study

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