First trimester medical abortion practices in Canada: National survey.
OBJECTIVE To understand the current availability and practice of first trimester medical abortion (MA) in Canada. DESIGN 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. SETTING Canada. PARTICIPANTS A total of 94 abortion facilities were identified. MAIN OUTCOME MEASURES Descriptive statistics on MA practice and facility and provider characteristics, as well as comparisons of MA practice by facility and provider characteristics using kh2 and t tests. RESULTS 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. CONCLUSION In Canada, MA provision using methotrexate and misoprostol is consistent with best practice guidelines, but MA is rare and its availability is unevenly distributed.
Canadian family physician Medecin de famille canadien