First-trimester medical abortion practices in Canada: National survey

• Published in: Canadian family physician Vol. 62; no. 4; pp. e201 - e208
• Main Authors: Guilbert, Edith R, Hayden, Althea S, Jones, Heidi E, White, Katharine O'Connell, Steven Lichtenberg, E, Paul, Maureen, Norman, Wendy V
• Format: Journal Article
• Language: English
• Published: Canada College of Family Physicians of Canada 01.04.2016
• Subjects: Abortion; Abortion, Induced - statistics & numerical data; Ambulatory Care Facilities; Canada; Comparative analysis; Cross-Sectional Studies; Female; Humans; Physicians; Physicians, Family; Pregnancy; Pregnancy Trimester, First; Private Facilities; Surveys and Questionnaires; Ultrasonography; Canada
• ISSN: 0008-350X; 1715-5258

To understand the current availability and practice of first-trimester medical abortion (MA) in Canada. Using public sources and professional networks, abortion facilities across Canada were identified for a cross-sectional survey on medical and surgical abortion. English and French surveys were distributed by surface or electronic mail between July and November 2013. Canada. A total of 94 abortion facilities were identified. Descriptive statistics on MA practice and facility and provider characteristics, as well as comparisons of MA practice by facility and provider characteristics using χ and tests. A total of 78 of 94 (83.0%) facilities responded. Medical abortion represented 3.8% of first-trimester abortions reported (2706 of 70 860) in 2012. Among the facilities offering MA, 45.0% performed fewer than 500 first-trimester abortions a year, while 35.0% performed more than 1000. More MAs were performed in private offices or ambulatory health centres than in hospitals. Sixty-two physicians from 28 of 78 facilities reported providing first-trimester MA; 87.1% also provided surgical abortion. More than three-quarters of MA physicians were female and 56.5% were family physicians. A preponderance (85.2%) of providers offered methotrexate with misoprostol. Nearly all physicians (90.3%) required patients to have an ultrasound before MA, and 72.6% assessed the completion of the abortion with ultrasonography. Most physicians (74.2%) offered MA through 49 days after the onset of the last menstrual period, and 21.0% offered MA through 50 to 56 days; 37.1% reported providing MA to patients who lived more than 2 hours away. Four physicians from 1 site provided MA via telemedicine. In Canada, MA provision using methotrexate and misoprostol is consistent with best-practice guidelines, but MA is rare and its availability is unevenly distributed.