The perspective of Canadian health care professionals on abortion service during the COVID-19 pandemic

Abstract

Background The COVID-19 pandemic and pandemic response created novel challenges for abortion services. Canada was uniquely positioned to transition to telemedicine because internationally common restrictions on abortion medication were removed before the pandemic. Objective We sought to characterize the experiences of abortion health care professionals in Canada during the COVID-19 pandemic and the impact of the pandemic response on abortion services. Methods We conducted a sequential mixed methods study between July 2020 and January 2021. We invited physicians, nurse practitioners and administrators to participate in a cross-sectional survey containing an open-ended question about the impact of the pandemic response on abortion care. We employed an inductive codebook thematic analysis, which informed the development of a second, primarily quantitative survey. Results Our initial survey had 307 respondents and our second had 78. Fifty-three percent were family physicians. Our first survey found respondents considered abortion access essential. We identified three key topicss: access to abortion care was often maintained despite pandemic-related challenges (e.g. difficulty obtaining tests, additional costs); change of practice to low-touch medication abortion care and provider perceptions of patient experience, including shifting demand, telemedicine acceptability and increased rural access. The second survey indicated uptake of telemedicine medication abortion among 89% of participants except in Quebec, where regulations meant procedures were nearly exclusively surgical. Restrictions did not delay care according to 76% of participants. Conclusions Canadian health care professionals report their facilities deemed abortion an essential service. Provinces and territories, except Quebec, described a robust pandemic transition to telemedicine to ensure access to services. Podcast An accompanying podcast is available in the Supplementary Data, in which the authors Dr Madeleine Ennis and Kate Wahl discuss their research on how family planning care and access to abortion services have changed during the COVID-19 pandemic.

Provision of first-trimester medication abortion in 2019: Results from the Canadian abortion provider survey

“…Similarly, 46.5% of our respondents were less than 40 years of age, compared to 25.8% in 2012 [3]. Other evidence describing growth in the abortion workforce is emerging [15][16][17][18]. Our results indicate that Health Canada's approval for NPs to provide first-trimester MA has further contributed to this growth, as observed in other countries [19].…”

Telemedicine for First-Trimester Medical Abortion in Canada: Results of a 2019 Survey

“…The adoption of telemedicine increased to 88.9% according to a survey of abortion providers in Canada during COVID-19. 18 Of those providing care through telemedicine, most had experience providing initial consultation, prescription, and follow-up care, though not all three components might have been provided for all patients via telemedicine by individual survey respondents.…”

“… 17 Respondents to a survey of first-trimester medical abortion providers in Canada during COVID-19 reported some adoption of the low-/no-test protocol. 14 , 18 The majority ordered ultrasound only as indicated (81.2%), but still always ordered serum hCG or hemoglobin (59.6% and 55.6%, respectively). 18 The survey, however, did not explore details of the care the respondents provided nor barriers to telemedicine, which continue to be understudied in Canada.…”

“… 14 , 18 The majority ordered ultrasound only as indicated (81.2%), but still always ordered serum hCG or hemoglobin (59.6% and 55.6%, respectively). 18 The survey, however, did not explore details of the care the respondents provided nor barriers to telemedicine, which continue to be understudied in Canada.…”

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

“…Strengths of our study include the participation of pharmacists from across the country, which included participants from both rural and urban regions and diverse practice settings. Limitations to our study include that our data were collected pre-COVID-19 and are not reflective of pandemic-associated changes, although we note that the positive pharmacist uptake and readiness to dispense mifepristone pre-COVID-19 is likely to have been a facilitator for the rapid uptake of virtual medical abortion in Canada noted over the first pandemic year 36. Further, our sample was not proportionally geographically representative: while we aimed to have pharmacist responses from all 10 provinces and 3 territories, we received less than six responses from the provinces of Newfoundland, Prince Edward Island and Quebec, and the territories of Yukon Territory, Northwest Territories and Nunavut.…”