Assessing abortion coverage in nurse practitioner programs in Canada: a national survey of program directors by Lindsay Sheinfeld, Grady Arnott, Julie El-Haddad, Angel M FosterContraception 2016;(Nov)94(5):483-88 DOI: http://dx.doi.org/10.1016/j.contraception.2016.06.020Consistent with previous studies, our survey of Canadian Nurse Practitioner (NP) program directors revealed that abortion [training] coverage is uneven and relatively limited. Compared to the coverage of contraception, ectopic pregnancy management and miscarriage management, abortion-related topics receive less coverage. Not surprisingly, clinical inclusion is less robust than didactic inclusion. And consistent with previous studies, our survey findings suggest that the single greatest barrier to inclusion of abortion-related topics is the perception that abortion is not a curricular priority.Given the prevalence of unintended pregnancy and abortion in Canada, this perception is surprising. Of course, there are many competing demands placed on NP programs and the relatively short time period for specialized training presents a challenge. However, that a common medical issue is not considered a curricular priority by so many of our respondents likely reflects additional dynamics in abortion care. Notably, the majority of abortions in Canada are now performed outside of hospitals and hospital networks, the traditional sites of clinical placements. Thus, NP educators may not expect their students to encounter abortion in their routine training and therefore do not prioritize this component of reproductive health education. Further, freestanding abortion clinics in Canada are centralized to urban areas. This can create difficulties for programs to arrange placements such that their students can receive clinical exposure. Recognizing that abortion is an essential part of comprehensive reproductive health care, fortifying relationships with freestanding clinics and their practitioners, and exploring avenues for developing clinical externships akin to those available for undergraduate medical students appear warranted.***Abortion training in Canadian obstetrics and gynecology residency programs Contraception 2016;(Nov)94(5):478-82 DOI: http://dx.doi.org/10.1016/j.contraception.2016.07.014J Liauw, B Dineley, K Gerster, N Hill, D CostescuThis study evaluated the current state of abortion training in Canadian Obstetrics and Gynecology residency programs. Surveys were distributed to all Canadian Obstetrics and Gynecology residents and program directors. Data were collected on inclusion of abortion training in the curriculum, structure of the training and expected competency of residents in various abortion procedures.ResultsWe distributed and collected surveys between November 2014 and May 2015. In total, 301 residents and 15 program directors responded, giving response rates of 55% and 94%, respectively. Based on responses by program directors, half of the programs had “opt-in” abortion training, and half of the programs had “opt-out” abortion training. Upon completion of residency, 66% of residents expected to be competent in providing first-trimester surgical abortion in an ambulatory setting, and 35% expected to be competent in second-trimester surgical abortion. Overall, 15% of residents reported that they were not aware of or did not have access to abortion training within their program, and 69% desired more abortion training during residency.ConclusionAbortion training in Canadian Obstetrics and Gynecology residency programs is inconsistent, and residents desire more training in abortion. This suggests an ongoing unmet need for training in this area. Policies mandating standardized abortion training in obstetrics and gynecology residency programs are necessary to improve delivery of family planning services to Canadian women.***“They made me go through like weeks of appointments and everything”: Documenting women’s experiences seeking abortion care in Yukon territory, Canada by Jennifer K Cano, Angel M FosterContraception 2016;(Nov)94(5):489-95 DOI: http://dx.doi.org/10.1016/j.contraception.2016.06.015AbstractResearch indicates that women still face numerous barriers to accessing care, challenges that are amplified for women living in rural, remote and northern regions in Canada. This qualitative study aimed to document women’s experiences seeking and obtaining abortion services while residing in Yukon Territory, identify financial and personal costs and explore avenues through which services could be improved. We conducted 16 in-depth semi-structured phone interviews with women who accessed abortion services on/after January 1, 2005, while residing in the Yukon.With the Yukon’s sole facility offering first trimester abortions twice a month, women experienced difficulty navigating a fragmented process and long wait times. Women found the process of attending multiple pre-procedure appointments at multiple locations with multiple health care providers, all while enduring pregnancy symptoms and handling other life commitments, physically, financially and emotionally taxing.Efforts to streamline the process of obtaining an abortion and providing women with more information at the first point of contact would improve service access and quality. Medical abortion has the potential to improve access for rural and remote populations, reduce wait times and alleviate privacy concerns, but only if the medication abortion regimen is affordable and available at a range of service delivery points and provision requirements are aligned with the global evidence.VISUAL
