‘No longer extraordinary’. Self-administration of the abortion pill in Canada: implementation research informing policy change
Fewer than 300 physicians provided induced abortions in Canada in 2012, and care was largely provided in surgical facilities in large southern cities. The January 2017 introduction of mifepristone had the potential to address the geographic disparity if prescribing the abortion pill could be feasible for normal primary care encounters. However, regulatory restrictions to distribution, prescribing and dispensing presented substantial barriers to primary care providers, a crucial element for equitable abortion access. We designed a national implementation research study to identify and mitigate these barriers. We found and mitigated health policy, system and service barriers to mifepristone abortion access, accelerating its implementation across Canada. Within a year the regulatory barriers to primary care were removed, so that the Chief Medical Officer of Health Canada declared “[The abortion pill] is now regulated the same as any other medication”.
The rapid uptake of our study findings into practice and policy demonstrate the impact of integrated knowledge translation on implementation and dissemination of new practices, and may facilitate increased access to equitable, safe, confidential abortion care closer to home.
Wendy V. Norman, MD, MHSc, CCFP, FCFP, DTM&H, is a family physician with a family planning focused practice in Vancouver, Canada. She holds the Chair in Family Planning Public Health Research from the Canadian Institutes of Health Research and Public Health Agency of Canada; is an Associate Professor, in the Department of Family Practice at the University of British Columbia; and a Scholar of the Michael Smith Foundation for Health Research. In 2015 Dr. Norman was awarded the prestigious Guttmacher Darroch Award for advancing reproductive health policy research. She founded and leads the national collaboration: Canadian Contraception and Abortion Research Team. (www.cart-grac.ca) She began part time PhD studies in 2017 at LSHTM in PEHR, Public Health and Policy with Dr. Kaye Wellings.