Evidence from various healthcare systems indicates that abortion is safe and efficacious among adolescent and young women. Clinical services should promote access to safe abortion for adolescents.
Objective To evaluate practices among first-trimester surgical abortion facilities and providers in Canada in 2012 and examine the characteristics of the surgical abortion work force.Design Self-administered paper or electronic survey adapted from a survey previously fielded in the United States. Setting Canada.Participants Facility administrators and physicians. Main outcomes measuresDescriptive statistics on reported first-trimester surgical abortion practice and provider demographic characteristics. ResultsEighty-three percent of identified facilities (78 of 94) and 178 physicians responded. Of the respondents, 99% of facilities and 96% of physicians provided first-trimester surgical abortions. Responding facilities provided 68,154 first-trimester surgical abortions in 2012. This represented 96% of their reported total (combined medical and surgical) first-trimester abortions. More than half (55%) of responding facilities were community based, while 45% were hospital affiliated. Most physician providers were female (68%) and were family doctors (59%). Preoperatively, 96% of physicians routinely used ultrasound and 89% gave perioperative antibiotics. Almost half (48%) used manual vacuum aspiration, but less than 35% did so beyond 9 weeks after the last menstrual period. At most facilities, most procedures were performed under combined local anesthesia and intravenous sedation (73%); only 7% indicated deep sedation or general anesthesia were used exclusively. Postoperatively, 81% of physicians performed immediate tissue examination and 96% offered postabortion contraception on the same day as the abortion. Other assessed outcomes included medication regimens and cervical preparation, with a high degree of consistency among facilities and physicians. ConclusionFirst-trimester surgical abortion providers are mostly family physicians and most are female. Practices across Canada were mostly uniform and followed evidence-based guidelines. Uptake of the most recent Canadian practice guidelines may help further standardize patient care and improve routine perioperative antibiotic use and immediate tissue examination. Editor's key points} This survey of Canadian facilities offering first-trimester surgical abortions and physicians providing this service in 2012 is the most comprehensive account to date of the 2012 work force and their clinical practice in Canada.} Family physicians represented more than half of survey respondents, and more than 70% of first-trimester surgical abortions were provided in community-based clinics.} These data indicate first-trimester abortion services across Canada were performed in alignment with practice guidelines in important aspects such as ultrasound use, cervical preparation, use of anesthesia, and postoperative care.} These data will be helpful in interpreting abortion practice techniques and work force changes that might have occurred since mifepristone became available in Canada.
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