Leadership for success in transforming medical abortion policy in Canada

Abstract

Objectives Mifepristone was approved for use in medical abortion by Health Canada in 2015. Approval was accompanied by regulations that prohibited pharmacist dispensing of the medication. Reproductive health advocates in Canada recognized this regulation would limit access to medical abortion and successfully worked to have this regulation removed in 2017. The purpose of this study was to assess the leadership involved in changing these regulations so that the success may be replicated by other groups advocating for health policy change. Methods This study involved a mixed methods instrumental design in the context of British Columbia, Canada. Our data collection included: a) interviews with seven key individuals, representing the organizations that worked in concert for change to Canadian mifepristone regulations, and b) document analysis of press articles, correspondence, briefing notes, and meeting minutes. We conducted a thematic analysis of transcripts of audio-recorded interviews. We identified strengths and weaknesses of the team dynamic using the Develop Coalitions, Achieve Results and Systems Transformation domains of the LEADS Framework. Results Our analysis of participant interviews indicates that autonomy, shared values, and clarity in communication were integral to the success of the group's work. Analysis using the LEADS Framework showed that individuals possessed many of the capabilities identified as being necessary for successful health policy leadership. A lack of post-project assessment was identified as a possible limitation and could be incorporated in future work to strengthen dynamics especially when a desired outcome is not achieved. Document analysis provided a clear time-line of the work completed and suggested that strong communication between team members was another key to success.

Pharmacist dispensing of the abortion pill in Canada: Diffusion of Innovation meets integrated knowledge translation

“…Throughout the first year of mifepristone availability, our research team engaged in sensemaking with stakeholders from Health Canada, sharing real-time data from the present study. In turn, Health Canada updated the product label to enable pharmacists to dispense the medication, making it consistent with their usual practice [ 23 , 25 ]. Pharmacy licencing colleges and professional organizations then communicated these changes to their members, our participants.…”

“…This study was part of a national mixed-methods programme of research designed to characterize and facilitate the implementation of mifepristone medical abortion between 2015 and 2019 [ 23 ]. The research was informed by an integrated KT approach premised on the understanding that research is more relevant and useful when knowledge users are equal partners in the work [ 24 , 25 ]. Consequently, pharmacist stakeholders were members of the research team and contributed to study design, recruitment, interpretation, and dissemination.…”

Pharmacist direct dispensing of mifepristone for medication abortion in Canada: a survey of community pharmacists

“…This research represents the baseline survey results of a cross-sectional study assessing the perspectives of community pharmacists when initiating mifepristone dispensing in various practice settings during the first 24 months of availability in Canada (January 2017 to January 2019) 10. This research is a component of our larger observational mixed-methods programme of research, the Contraception and Abortion Research Team Mifepristone Implementation Study10 that also investigated perspectives of physicians and policymakers 8 11–13…”

Medical abortion is an essential service during the pandemic

“…The product combining mifepristone and misoprostol was introduced in Canada in 2017 and hailed as an important advance in equalizing abortion access. 3 The medication is 95% to 98% effective when used at up to 9 weeks' gestation, with common side effects being shortlived bleeding and cramping. 4 Yet, its uptake has been poor in primary care, with more than two-thirds of prescriptions coming from abortion clinics and with many patients reporting that their family physicians refused to prescribe it.…”