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2019 Canadian national survey on abortion shows increase in available providers and services

The survey highlighted increased services through primary care and in rural areas, and also emphasized a need for more providers to ensure equitable access.

Regina M Renner, MD, MPH, FRCSC, FACOG, of the contraception and abortion research team and clinical associate professor at the department of obstetrics and gynaecology at the University of British Columbia in Vancouver and colleagues performed the survey research. The 2019 national survey, which was conducted in English and French, was anonymized and collected in a web-based format. “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,” the authors said. Researchers gathered clinical care data and demographics of nurse practitioners and physicians.

Renner and colleagues’ analysis included 465 responses from all 10 provinces and 3 territories.1 Researchers said that 83.4% (388) provided 1st trimester medical abortions, including 30 nurse practitioners. Of these medical abortions, 99.4% (350) involved the use of mifepristone.1

“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,” Renner and colleagues reported.1

A total of 48,509 abortions were reported on the survey in 2019.1 Of these, 66.7% (32,345) were surgical abortions performed in the first trimester and 27.7% (13,429) were medical abortions performed in the first trimester.1 “In Quebec, only 1918 (12.5%) of reported abortions were first-trimester medical abortions,” Renner and colleagues noted. Researchers said primary care providers provided most abortions (34,540/71.2%).1 “First-trimester medical abortions represented 44.4% (n = 2334) of all abortions in rural areas, as opposed to 25.6% (n = 11067) in urban areas,” the authors wrote.

Co-author of the study Madeleine Ennis, PhD, research associate at the faculty of medicine in the department of obstetrics and gynaecology at the University of British Columbia BC Women's Hospital, Women's Health Research Institute in the Musqueam, Squamish & Tsleil-Waututh Traditional Territory spoke with Contemporary OB/GYN® on the research survey. She said the most important takeaway from this study for providers in practice is that the survey highlighted an increase in availability of first trimester medical abortions to 27%, which facilitates abortion access, especially in rural settings. “Abortions were increasingly being provided in primary care and office-based settings, rather than predominantly by specialists or in dedicated abortion facilities,” she said, adding that nurse practitioners were independently providing first trimester medical abortion services. “Half of our respondents reported fewer than 5 years of experience with abortion care, suggesting rejuvenation of the workforce, which is a critical contributor to equitable access to abortion services,” Ennis said.

Ennis noted that what was most significant about this particular study is that it was a national survey of medical and surgical abortion providers and the first since mifepristone became available in Canada in 2017. “We had respondents from every province and territory in Canada,” she added.

Ennis said the survey is now closed, and researchers are in the process of publishing the results. “We will continue to convey our research results to our national collaborators, including provincial governments and health professional organizations. This will include evidence briefs and virtual meetings, health professional development, and contributing to updated clinical practice guidelines,” she said.

Ennis added that for health care providers in Canada who are interested in providing first trimester medical abortion care or learning more, The Society of Obstetricians and Gynaecologists of Canada have published detailed guidelines.2,3 “There are also support platforms and information available through the Canadian Abortion Provider Support community and The National Abortion Federation Canada,” she said.4,5

More information about the survey, including additional publications, is listed on the website at:https://cart-grac.ubc.ca/caps-2019/.

References

  1. Renner RM, Ennis M, Contandriopoulos D, et al. Abortion services and providers in Canada in 2019: results of a national survey. CMAJ Open. 2022;10(3):E856-E864. September 27, 2019. doi:10.9778/cmajo.20210232.
  2. Costescu D, Guilbert E, Bernardin J, et al. Medical abortion. Journal of Obstetrics and Gynaecology Canada: 2016;38:366-89.
  3. Guilbert E, Costescu D, Wagner M-S, et al. Canadian protocol for the provision of medical abortion via telemedicine. SOGC COVID-19 Resources. Canada: Society of Obstetricians and Gynaecologists of Canada. 2020.
  4. CAPS CPCA Forum. https://caps-cpca.ubc.ca/index.php?title=Main_Page. Published April 8, 2021. Accessed October 7, 2022.
  5. NAF Canada Home. National Abortion Federation Canada. https://nafcanada.org/. Accessed October 7, 2022.