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2022 Sep-Oct;10 (3): E856-E864.

Abortion services and providers in Canada in 2019: results of a national survey.

Regina M Renner, Madeleine Ennis, Damien Contandriopoulos, Edith Guilbert, Sheila Dunn, Janusz Kaczorowski, Elizabeth K Darling, Arianne Albert, Claire Styffe, Wendy V Norman
Author Information
  1. Regina M Renner: Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Qu��bec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Universit�� de Montr��al, Montr��al, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK regina.renner@ubc.ca.
  2. Madeleine Ennis: Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Qu��bec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Universit�� de Montr��al, Montr��al, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK.
  3. Damien Contandriopoulos: Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Qu��bec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Universit�� de Montr��al, Montr��al, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK.
  4. Edith Guilbert: Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Qu��bec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Universit�� de Montr��al, Montr��al, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK.
  5. Sheila Dunn: Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Qu��bec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Universit�� de Montr��al, Montr��al, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK.
  6. Janusz Kaczorowski: Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Qu��bec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Universit�� de Montr��al, Montr��al, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK.
  7. Elizabeth K Darling: Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Qu��bec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Universit�� de Montr��al, Montr��al, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK.
  8. Arianne Albert: Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Qu��bec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Universit�� de Montr��al, Montr��al, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK.
  9. Claire Styffe: Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Qu��bec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Universit�� de Montr��al, Montr��al, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK.
  10. Wendy V Norman: Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Qu��bec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Universit�� de Montr��al, Montr��al, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK.
PMID: 36167421 DOI: 10.9778/cmajo.20210232

Abstract

BACKGROUND: Since 2016, abortion care has undergone several important changes, particularly related to the provision of medical abortion using mifepristone. We aimed to document characteristics of the abortion care workforce in Canada after the update of clinical practice guidelines of mifepristone use for medical abortion.
METHODS: We conducted a national, web-based, anonymized, bilingual (English/French) survey. We collected demographics and clinical care characteristics of physicians and nurse practitioners who provided abortion care in 2019. Between July and December 2020, we distributed the survey through professional organizations, including The College of Family Physicians of Canada and The Society of Obstetricians and Gynaecologists of Canada. We present descriptive statistics.
RESULTS: Overall, 465 respondents representing all 10 provinces and 3 territories in Canada completed the survey. Of these, 388 (83.4%), including 30 nurse practitioners, provided first-trimester medical abortion, of which 350 (99.4%) used mifepristone. Two hundred and nineteen (47.1%) respondents provided first-trimester surgical abortion, 109 (23.4%) provided second-trimester surgical abortion and 115 (24.7%) provided second- or third-trimester medical abortion. Half of respondents reported fewer than 5 years of experience with any abortion care. Respondents reported providing a total of 48 509 abortions in 2019, including 32 345 (66.7%) first-trimester surgical abortions and 13 429 (27.7%) first-trimester medical abortions. In Quebec, only 1918 (12.5%) of reported abortions were first-trimester medical abortions. Primary care providers provided 34 540 (71.2%) of the total abortions. First-trimester medical abortions represented 44.4% ( = 2334) of all abortions in rural areas, as opposed to 25.6% ( = 11 067) in urban areas.
INTERPRETATION: The increased availability of medical abortion facilitates abortion access, especially in primary care and rural settings, and where surgical abortion is not available. Rejuvenation of the workforce is a critical contributor to equitable access to abortion services.

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Grants

  1. PJT-162201/CIHR

MeSH Term

Abortion, Induced
Canada
Female
Humans
Mifepristone
Physicians, Family
Pregnancy
Rural Population

Chemicals

Mifepristone
Journal Article Research Support, Non-U.S. Gov't
Article has an altmetric score of 7

Word Cloud

Created with Highcharts 10.0.0abortionmedicalabortionscareprovidedCanadafirst-trimestersurvey4%surgicalmifepristoneincludingrespondents7%reportedcharacteristicsworkforceclinicalnationalnursepractitioners2019totalproviders=ruralareasaccessservicesBACKGROUND:Since2016undergoneseveralimportantchangesparticularlyrelatedprovisionusingaimeddocumentupdatepracticeguidelinesuseMETHODS:conductedweb-basedanonymizedbilingualEnglish/FrenchcollecteddemographicsphysiciansJulyDecember2020distributedprofessionalorganizationsCollegeFamilyPhysiciansSocietyObstetriciansGynaecologistspresentdescriptivestatisticsRESULTS:Overall465representing10provinces3territoriescompleted388833035099usedTwohundrednineteen471%10923second-trimester11524second-third-trimesterHalffewer5yearsexperienceRespondentsproviding4850932345661342927Quebec1918125%Primary34540712%First-trimesterrepresented442334opposed256%11067urbanINTERPRETATION:increasedavailabilityfacilitatesespeciallyprimarysettingsavailableRejuvenationcriticalcontributorequitableAbortion2019:results

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