A Review of Therapeutic Abortions and Related Areas of Concern in Canada

Sabourin, Jeanelle; Burnett, Margaret

doi:10.1016/s1701-2163(16)35269-0

Cited by 32 publications

(29 citation statements)

References 28 publications

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“…Our respondents reported providing medical abortions as 15% of all abortions. This is significantly higher than analyses of administrative databases, which estimate fewer than 4% of abortions in Canada are medical abortions [6], [10], [13]. As medical abortion provision is difficult to capture through administrative database analysis for a number of reasons, our findings may represent a more accurate reflection of the provision of medical abortion in Canada.…”

Section: Discussionmentioning

confidence: 67%

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Barriers to Rural Induced Abortion Services in Canada: Findings of the British Columbia Abortion Providers Survey (BCAPS)

et al. 2013

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BackgroundRural induced abortion service has declined in Canada. Factors influencing abortion provision by rural physicians are unknown. This study assessed distribution, practice, and experiences among rural compared to urban abortion providers in the Canadian province of British Columbia (BC).MethodsWe used mixed methods to assess physicians on the BC registry of abortion providers. In 2011 we distributed a previously-published questionnaire and conducted semi-structured interviews.ResultsSurveys were returned by 39/46 (85%) of BC abortion providers. Half were family physicians, within both rural and urban cohorts. One-quarter (17/67) of rural hospitals offer abortion service. Medical abortions comprised 14.7% of total reported abortions. The three largest urban areas reported 90% of all abortions, although only 57% of reproductive age women reside in the associated health authority regions. Each rural physician provided on average 76 (SD 52) abortions annually, including 35 (SD 30) medical abortions. Rural physicians provided surgical abortions in operating rooms, often using general anaesthesia, while urban physicians provided the same services primarily in ambulatory settings using local anaesthesia. Rural providers reported health system barriers, particularly relating to operating room logistics. Urban providers reported occasional anonymous harassment and violence.ConclusionsMedical abortions represented 15% of all BC abortions, a larger proportion than previously reported (under 4%) for Canada. Rural physicians describe addressable barriers to service provision that may explain the declining accessibility of rural abortion services. Moving rural surgical abortions out of operating rooms and into local ambulatory care settings has the potential to improve care and costs, while reducing logistical challenges facing rural physicians.

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Section: Discussionmentioning

confidence: 67%

“…With declining rural access to surgical abortion, abortion induced using medication (“medical abortion”) could be an available alternative. However several sources currently estimate medical abortions are fewer than 4% of all Canadian abortions [6], [10], [13].…”

Section: Introductionmentioning

confidence: 99%

Barriers to Rural Induced Abortion Services in Canada: Findings of the British Columbia Abortion Providers Survey (BCAPS)

et al. 2013

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“…The International Confederation of Midwives has added abortion as a core competency for basic midwifery practice, initiating research and policy discussions related to registered midwives as abortion providers in Canada . The Society of Obstetricians and Gynecologists of Canada notes that restricting abortion provision to gynecologists alone and failure to train registered midwives is perpetuating a potential access barrier in Canada . Furthermore, the Canadian Association of Midwives released a statement in 2016 in support of reproductive rights for all people, stating that reproductive health care includes access to safe abortion care…”

Section: Introductionmentioning

confidence: 99%

Medical Abortion in Midwifery Scope of Practice: A Qualitative Exploration of the Attitudes of Registered Midwives in British Columbia

Dowler

Rushton

Kornelsen

2019

J Midwife Womens Health

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Introduction Across Canada and internationally, access to abortion remains challenging, particularly for those living in rural and remote communities. International research and policy call for the training of advanced practice clinicians, including midwives, to provide abortion services to fill the ever‐increasing access gap. Research in other jurisdictions has examined the attitudes of midwives toward this potential expansion of scope of practice, but such studies have not been undertaken in British Columbia. This qualitative research study explored the attitudes of registered midwives toward expanding their scope of practice to include the provision of medication abortion in British Columbia. Methods In‐depth qualitative interviews with British Columbia registered midwives were conducted and analyzed using thematic analysis. Results Fifteen interviews were conducted. Analysis of the interviews identified 5 primary themes: the incorporation of medication abortion into the midwifery scope of practice to increase access, the congruence of the midwifery model of care and provision of medication abortion, the role of registered midwives as guardians of reproductive rights, the need for a paradigm shift in how the profession is viewed, and the practicalities of potential scope expansion. Discussion This study shows some British Columbia registered midwives are interested in including medication abortion in their scope of practice. Midwives have the potential to bridge some of the health care delivery gaps in areas underserved by abortion providers and communities where medication abortion is not available. Further research is needed to more fully understand the perspectives of registered midwives in British Columbia as a whole.

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“…Treatment for incomplete miscarriage with misoprostol is an acceptable alternative to surgical evacuation . Medical methods are especially feasible in settings with limited healthcare facilities, but is often not offered because of legal restrictions and a lack of knowledge and training among existent providers …”

Section: Introductionmentioning

confidence: 99%

Effectiveness, safety, and acceptability of first‐trimester medical termination of pregnancy performed by non‐doctor providers: a systematic review

Sjöström

Fønhus

Ganatra

et al. 2017

BJOG

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BackgroundPrevious systematic reviews have concluded that medical termination of pregnancy (TOP) performed by non‐doctor providers may be as effective and safe as when provided by doctors. Medical treatment of incomplete miscarriage by non‐doctor providers and the treated women's acceptance of non‐doctor providers of TOP has not previously been reviewed.ObjectivesTo review the effectiveness, safety, and acceptability of first‐trimester medical TOP, including medical treatment for incomplete miscarriage, by trained non‐doctor providers.Search strategy and selection criteriaA search strategy using appropriate medical subject headings was developed. Electronic databases (PubMed, Popline, Cochrane, CINAHL, Embase, and ClinicalTrials.gov) were searched from inception through April 2016. Randomised controlled trials and comparative observational studies were included.Data collection and analysisMeta‐analyses were performed for included randomised controlled trials regarding the outcomes of effectiveness and acceptability to women. Certainty of evidence was established using the GRADE approach assessing study limitations, consistency of effect, imprecision, indirectness and publication bias.Main resultsSix papers were included. Medical TOP and medical treatment of incomplete miscarriage is probably equally effective when performed by non‐doctor providers as when performed by doctors (RR 1.00; 95% CI 0.99–1.01). Women's acceptance, reported as overall satisfaction with the allocated provider, is probably equally high between groups (RR 1.00; 95% CI 1.00–1.01).ConclusionMedical TOP and medical treatment of incomplete miscarriage provided by trained non‐doctor providers is probably equally as effective and acceptable to women as when provided by doctors.Tweetable abstractMedical termination of pregnancy performed by doctors and non‐doctors can be equally effective and acceptable

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A Review of Therapeutic Abortions and Related Areas of Concern in Canada

Cited by 32 publications

References 28 publications

Barriers to Rural Induced Abortion Services in Canada: Findings of the British Columbia Abortion Providers Survey (BCAPS)

Barriers to Rural Induced Abortion Services in Canada: Findings of the British Columbia Abortion Providers Survey (BCAPS)

Medical Abortion in Midwifery Scope of Practice: A Qualitative Exploration of the Attitudes of Registered Midwives in British Columbia

Effectiveness, safety, and acceptability of first‐trimester medical termination of pregnancy performed by non‐doctor providers: a systematic review

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