The Perspective of Rural Physicians Providing Abortion in Canada: Qualitative Findings of the BC Abortion Providers Survey (BCAPS)

Abstract

BackgroundAn increasing proportion of Canadian induced abortions are performed in large urban areas. For unknown reasons the number of rural abortion providers in Canadian provinces, such as British Columbia (BC), has declined substantially. This study explored the experiences of BC rural and urban physicians providing abortion services.MethodsThe mixed methods BC Abortion Providers Survey employed self-administered questionnaires, distributed to all known current and some past BC abortion providers in 2011. The optional semi-structured interviews are the focus of this analysis. Interview questions probed the experiences, facilitators and challenges faced by abortion providers, and their future intentions. Interviews were transcribed and analyzed using cross-case and thematic analysis.ResultsTwenty interviews were completed and transcribed, representing 13/27 (48.1%) rural abortion providers, and 7/19 (36.8%) of urban providers in BC. Emerging themes differed between urban and rural providers. Most urban providers worked within clinics and reported a supportive environment. Rural physicians, all providing surgical abortions within hospitals, reported challenging barriers to provision including operating room scheduling, anesthetist and nursing logistical issues, high demand for services, professional isolation, and scarcity of replacement abortion providers. Many rural providers identified a need to “fly under the radar” in their small community.DiscussionThis first study of experiences among rural and urban abortion providers in Canada identifies addressable challenges faced by rural physicians. Rural providers expressed a need for increased support from hospital administration and policy. Further challenges identified include a desire for continuing professional education opportunities, and for available replacement providers.

Barriers and facilitators of access to first-trimester abortion services for women in the developed world: a systematic review

“…Negative attitudes of non-physician staff restricted access to abortion 34 35. One study reported an unwillingness of nurses to deliver abortion services 34.…”

“…One study reported an unwillingness of nurses to deliver abortion services 34. Another identified staff conflicts and service delivery barriers amongst operating theatre nurses or anaesthetists unwilling to provide abortion services in rural hospitals in the USA 35. Additionally, staff attitudes impacted negatively on the women's experiences of abortion services 36 37.…”

“…One in five advanced clinicians identified fear of anti-abortion harassment as a perceived barrier to offering medical abortion 65. In rural Canada, harassment and stigma were the main reason for the resignation of doctors and nurses providing abortion services 35. Of the 163 provider and non-provider hospitals in Ontario, Canada almost half the provider hospitals reported experiencing harassment and 15% of physicians stated that harassment directly contributed to staff unwillingness to perform abortions 65.…”

“…Five studies identify lack of availability of medical abortion in the USA, Canada and New Zealand35 49 52 63 67 and one explored barriers to the provision of medical abortion in the USA 43…”

“…Six studies examined the resource issues influencing the delivery of abortion services;37 52 64 65 two focused specifically on rural issues 35 63. Lack of training, too few physicians and lack of hospital facilities were identified as factors limiting provision of abortion services.…”