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

Abstract

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.

Development of a Survey to Assess the Acceptability of an Innovative Contraception Practice among Rural Pharmacists

“…This is in contrast to an 85% response rate to similar studies by our team among health professionals in this province [32]. However, it is consistent with lower overall responses by pharmacists in BC to well-executed survey studies, such as that by Marra, with fewer than 10% of BC pharmacists responding [34].…”

“…As our team plans to utilize this survey among the population of pharmacies in BC, we restricted our sample for pilot testing to under 7% of all pharmacies. In prior work with similar surveys among other health professional groups our team had achieved response rates of 85% [32]. Thus, we used these assumptions to a priori set a sample size for this pilot testing that would meet the objectives of this study.…”

The acceptability of contraception task-sharing among pharmacists in Canada — the ACT-Pharm study

“…Our response rate of 39% was lower than the 85% we had achieved in our previous survey among physicians in BC [38] but still improved over that achieved in the most recent comparable pharmacist study by Marra et al [39]. Moreover, in this study, we aimed to understand if the proposed innovation could be available particularly in small towns and rural areas where there are fewer options and shorter hours at the only current facilities for access to hormonal contraception.…”

Intergenerational abortion tendency between mothers and teenage daughters: a population-based cohort study

“…Although access to abortion services can vary geographically, [20][21][22] there is no legal restriction based on a woman's age. 3 Parental consent is not required for adolescents aged 16 years or older or for counselled mature minors under 16 years of age.…”