Exploring barriers and facilitators to medical abortion practice: A qualitative study with Canadian healthcare providers who choose not to provide mifepristone
Awarded 2017
Small Research Grants
Sarah Munro, PhD
University of British Columbia

Approximately 100,000 abortions occur annually in Canada, of which 96% have been provided using surgery to date. Mifepristone, the gold standard for medical abortion, was made available for the first time in Canada in January 2017. The availability of mifepristone has particular potential to improve care for women in rural and remote communities, who currently have limited or no access to medical or surgical abortion. Mifepristone may for the first time facilitate abortion care close to home for this underserved, vulnerable population. However, several regulations are in place for mifepristone that are unusual for drug prescribing and dispensing in Canada, including requiring prescribers and dispensers to complete an online certification module. These barriers may discourage healthcare providers from adopting medical abortion practice, as similar factors have led to minimal uptake of mifepristone in other high-income countries. This study seeks to answer the question, What are the barriers and facilitators to uptake of medical abortion among healthcare providers who are engaged in women’s reproductive healthcare but choose not to complete certification? This study is embedded within a larger mixed methods program of research to explore health policy, system, service, and attitudinal barriers and facilitators to adoption of mifepristone. We will use qualitative methods founded on Diffusion of Innovation theory and conduct semi-structured interviews with a national sample of healthcare provider non-certificants to identify factors that influence adoption of mifepristone abortion practice, with particular attention to rural/urban disparities. Findings will illuminate the determinants of implementing abortion practice in underserved communities and may be relevant for other high-income countries including the US.