Canada is the first country to facilitate provision of medical abortion in primary care settings through evidence-based deregulation of mifepristone, which is considered the 'gold standard' for medical abortion. A Canadian study investigated 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 the country.
Results suggest that Health Canada's initial restrictions discouraged physicians from prescribing mifepristone and were inconsistent with provincial licensing standards, thereby limiting patient access. During, and after removal of, these restrictions, researchers identified four barriers to utilizing/prescribing the drug, including the initial federal restrictions which made mifepristone "more complicated than it needs to be"; navigating the "huge bureaucratic process" of organizational implementation; challenges with diffusion and dissemination of policy information; and adoption by physicians as "a process rather than an event."
This study, the authors write, is relevant to other nations experiencing challenges to accessing family planning services. Amidst the COVID-19 pandemic, U.S. policies restricting access to mifepristone have reached the Supreme Court after a federal district court judge temporarily suspended strict FDA regulations that require patients to visit a hospital or clinic in-person to obtain mifepristone. In Canada, ongoing implementation of mifepristone will require organizations to create tailored solutions to barriers, which may include creating new medical billing codes, provincial policy advocacy efforts, specifically in Quebec, which added its own restriction requiring accredited training in surgical abortion for any mifepristone provider, and conducting physician engagement to raise awareness to access barriers.
Perspectives Among Canadian Physicians on Factors Influencing Implementation of Mifepristone Medical Abortion: A National Qualitative Study
Sarah Munro, PhD, et al
University of British Columbia, Department of Obstetrics and Gynaecology, Vancouver, British Columbia, Canada