CANADA – Perspectives among Canadian physicians on factors influencing implementation of mifepristone medical abortion: a national qualitative study
by Sarah Munro,Edith Guilbert,Marie-Soleil Wagner, Elizabeth S Wilcox, Courtney Devane, et al.
Annals of Family Medicine 2020;18:413-21.
The University of British Columbia’s Contraception and Abortion Research Team worked with Canadian federal drug regulators and health professional licensing bodies from 2016-2019 to remove restrictionson mifepristone in Canada, and are in the process of publishing a range of papers about it, including this one.
Purpose – Access to family planning health services in Canada has been historically inadequate and inequitable. A potential solution appeared when Health Canada approved mifepristone, the gold standard for medical abortion, in July 2015. We sought to investigate the factors that influence successful initiation and ongoing provision of medical abortion services among Canadian health professionals and how these factors relate to abortion policies, systems, and service access throughout Canada.
Methods – We conducted 1-on-1 semi-structured interviews with a national sample of abortion-providing and non-providing physicians and health system stakeholders in Canadian health care settings. Our data collection, thematic analysis, and interpretation were guided by Diffusion of Innovation theory.
Results – We conducted interviews with 90 participants including rural practitioners and those with no previous abortion experience. In the course of our study, Health Canada removed mifepristone restrictions. Our results suggest that Health Canada’s initial restrictions discouraged physicians from providing mifepristone and were inconsistent with provincial licensing standards, thereby limiting patient access. Once de-regulated, remaining factors were primarily related to local and regional implementation processes. Participants held strong perceptions that mifepristone was the new standard of care for medical abortion in Canada and within the scope of primary care practice.
Conclusion – Health Canada’s removal of mifepristone restrictions facilitated the implementation of abortion care in the primary care setting. Our results are unique because Canada is the first country to facilitate provision of medical abortion in primary care via evidence-based de-regulation of mifepristone.