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Srinivasan S, James SM, Kwek J, Black K, Taft AJ, Bateson D, Norman WV, Mazza D. What do Australian primary care clinicians need to provide long-acting reversible contraception and early medical abortion? A content analysis of a virtual community of practice. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024:bmjsrh-2024-202330. [PMID: 38960413 DOI: 10.1136/bmjsrh-2024-202330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/04/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Uptake of long-acting reversible contraception (LARC) is lower in Australia compared with other high-income countries, and access to early medical abortion (EMA) is variable with only 11% of general practitioners (GPs) providing EMA. The AusCAPPS (Australian Contraception and Abortion Primary Care Practitioner Support) Network is a virtual community of practice established to support GPs, nurses and pharmacists to provide LARC and EMA in primary care. Evaluating participant engagement with AusCAPPS presents an opportunity to understand clinician needs in relation to LARC and EMA care. METHODS Data were collected from July 2021 until July 2023. Numbers of online resource views on AusCAPPS were analysed descriptively and text from participant posts underwent qualitative content analysis. RESULTS In mid-2023 AusCAPPS had 1911 members: 1133 (59%) GPs, 439 (23%) pharmacists and 272 (14%) nurses. Concise point-of-care documents were the most frequently viewed resource type. Of the 655 posts, most were created by GPs (532, 81.2%), followed by nurses (88, 13.4%) then pharmacists (16, 2.4%). GPs most commonly posted about clinical issues (263, 49% of GP posts). Nurses posted most frequently about service implementation (24, 27% of nurse posts). Pharmacists posted most about health system and regulatory issues (7, 44% of pharmacist posts). CONCLUSIONS GPs, nurses and pharmacists each have professional needs for peer support and resources to initiate or continue LARC and EMA care, with GPs in particular seeking further clinical education and upskilling. Development of resources, training and implementation support may improve LARC and EMA provision in Australian primary care.
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Affiliation(s)
- Sonia Srinivasan
- SPHERE, NHMRC Centre of Research Excellence, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sharon Maree James
- SPHERE, NHMRC Centre of Research Excellence, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joly Kwek
- SPHERE, NHMRC Centre of Research Excellence, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kirsten Black
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Science, University of Sydney, Sydney, New South Wales, Australia
| | - Angela J Taft
- Judith Lumley Centre, La Trobe University College of Science Health and Engineering, Melbourne, Victoria, Australia
| | - Deborah Bateson
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Science, University of Sydney, Sydney, New South Wales, Australia
- The Daffodil Centre, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Wendy V Norman
- Department of Family Practice, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Public Health, Environments and Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Danielle Mazza
- SPHERE, NHMRC Centre of Research Excellence, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Auger N, Brousseau É, Ayoub A, Fraser WD. Second-trimester abortion and risk of live birth. Am J Obstet Gynecol 2024; 230:679.e1-679.e9. [PMID: 37939985 DOI: 10.1016/j.ajog.2023.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Second-trimester abortion may result in a live birth, but the extent to which this outcome occurs is unknown. OBJECTIVE This study aimed to examine rates of live birth after pregnancy termination in the second trimester and identify associated risk factors. STUDY DESIGN We conducted a retrospective cohort study of 13,777 second-trimester abortions occurring in hospital settings between April 1, 1989 and March 31, 2021 in Quebec, Canada. The exposure was induced abortion between 15 and 29 weeks of gestation, including the indication for (fetal anomaly, maternal emergency, other) and use of feticidal injection (intracardiac/intrathoracic or intraamniotic). The primary outcome was live birth following abortion. We measured the rate of live birth per 100 abortions and used adjusted log-binomial regression models to estimate risk ratios and 95% confidence intervals for the association of fetal and maternal characteristics with the risk of live birth. We assessed the extent to which feticidal injection reduced the risk. RESULTS Among 13,777 abortions between 15 and 29 weeks of gestation, 1541 (11.2%) led to live birth. Fetal anomaly was a common indication for termination (48.1%), and most abortions were by labor induction (72.2%). Compared with abortion between 15 and 19 weeks, abortion between 20 and 24 weeks was associated with 4.80 times the risk of live birth (95% confidence interval, 4.20-5.48), whereas abortion between 25 and 29 weeks was associated with 1.34 times the risk (95% confidence interval, 1.00-1.79). Feticidal injection reduced the risk of live birth by 57% compared with no injection (risk ratio, 0.43; 95% confidence interval, 0.36-0.51). Intracardiac or intrathoracic injection was particularly effective at preventing live birth (risk ratio, 0.02; 95% confidence interval, 0.01-0.07). CONCLUSION Second-trimester abortion carries a risk of live birth, especially at 20 to 24 weeks of gestation, although feticidal injection may protect against this outcome.
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Affiliation(s)
- Nathalie Auger
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada.
| | - Émilie Brousseau
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, Canada
| | - Aimina Ayoub
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, Canada
| | - William D Fraser
- Department of Obstetrics and Gynecology, Sherbrooke University Hospital Research Centre, Sherbrooke, Canada
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Ennis M, Renner R, Olure B, Begun S, Norman WV, Munro S. Provision of care to diverse populations: results from the 2019 Canadian Abortion Provider Survey. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024:bmjsrh-2023-202175. [PMID: 38729768 DOI: 10.1136/bmjsrh-2023-202175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Affiliation(s)
- Madeleine Ennis
- Department of Obstetrics & Gynaecology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Regina Renner
- Department of Obstetrics & Gynaecology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Bimbola Olure
- Department of Obstetrics & Gynaecology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Wendy V Norman
- Department of Family Practice, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Public Health, Environments and Society, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Sarah Munro
- Department of Obstetrics & Gynaecology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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Renner R, Ennis M, Kean L, Brooks M, Dineley B, Pymar H, Norman WV, Guilbert E. First and Second-Trimester Surgical Abortion Providers and Services in 2019: Results From the Canadian Abortion Provider Survey. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102188. [PMID: 37558165 DOI: 10.1016/j.jogc.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 07/11/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE Our objective was to explore the workforce and clinical care of first and second-trimester surgical abortion (FTSA, STSA) providers following the publication of the updated Society of Obstetricians and Gynaecologists of Canada (SOGC) surgical abortion guidelines. METHODS We conducted a national, cross-sectional, online, self-administered survey of physicians who provided abortion care in 2019. This anonymized survey collected participant demographics, types of abortion services, and characteristics of FTSA and STSA clinical care. Through healthcare organizations using a modified Dillman technique, we recruited from July to December 2020. Descriptive statistics were generated by R Statistical Software. RESULTS We present the data of 222 surgical abortion provider respondents, of whom 219 provided FTSA, 109 STSA, and 106 both. Respondents practiced in every Canadian province and territory. Most were obstetrician-gynaecologists (56.8%) and family physicians (36.0%). The majority of FTSA and STSA respondents were located in urban settings, 64.8% and 79.8%, respectively, and more than 80% practiced in hospitals. More than 1 in 4 respondents reported <5 years' experience with surgical abortion care and 93.2% followed SOGC guidelines. Noted guideline deviations included that prophylactic antibiotic use was not universal, and more than half of respondents used sharp curettage in addition to suction. Fewer than 5% of STSA respondents used mifepristone for cervical preparation. CONCLUSION The surgical abortion workforce is multidisciplinary and rejuvenating. Education, training, and practice support, including SOGC guideline implementation, are required to optimize care and to ensure equitable FTSA and STSA access in both rural and urban regions. GESTATIONAL AGE NOTATION: weeks, weeks' gestation, gestational age (GA), e.g., 116 weeks.
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Affiliation(s)
- Regina Renner
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC; Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC.
| | - Madeleine Ennis
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC; Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC
| | - Lauren Kean
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC; Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC
| | - Melissa Brooks
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC; Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC
| | - Brigid Dineley
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC; Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC
| | - Helen Pymar
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC; Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC
| | - Wendy V Norman
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC; Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Edith Guilbert
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC; Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC
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Paynter M, Heggie C. Distance between institutions of incarceration and procedural abortion facilities in Canada. Contraception 2023; 124:110079. [PMID: 37245785 DOI: 10.1016/j.contraception.2023.110079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVES People incarcerated in facilities for women and girls face barriers to accessing abortion, including unclear legislation, operational procedures, and distance. While medication abortion could mitigate distance barriers, prison is not a hospitable environment for medication abortion. Considering this limitation, this paper aimed to identify the distance from institutions of incarceration designated for women and girls to procedural abortion facilities in Canada. STUDY DESIGN This study builds on an inventory of the 67 institutions of incarceration designated for women and girls across 13 provinces and territories in Canada, previously created by the authors. Procedural abortion facilities were identified using publicly available directories. Distances were calculated using Google Maps. The closest procedural abortion facility was identified for each institution, as well as the gestational age limit of each facility. RESULTS Of the 67 institutions, 23 (34%) were located 0 to 10km from a procedural abortion facility. Fourteen (21%) were located 10.1 to 20km away. Ten (15%) were located 20.1 to 100km away. Eleven were located 100.1 to 300km away (16%). The remaining 9 (13%) were located between 300.1 and 738km away. Distances ranged from 0.1 to 738km. The greatest distances were among institutions in northern Canada. CONCLUSIONS This paper identified a large range of distances between institutions of incarceration and procedural abortion facilities in Canada. Physical distance is only one measure of accessibility of abortion services. For incarcerated people, contextual factors including carceral policies and procedures present barriers to care, with significant impact on health equity. IMPLICATIONS Distance between carceral institutions and procedural abortion facilities reduces equitable access to reproductive health services for incarcerated populations. Pregnant people should be protected from imprisonment to ensure reproductive autonomy.
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Affiliation(s)
- Martha Paynter
- Faculty of Nursing, University of New Brunswick, Fredericton, NB, Canada.
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Ennis M, Renner RM, Olure B, Norman WV, Begun S, Martin L, Harris LH, Kean L, Seewald M, Munro S. Experience of stigma and harassment among respondents to the 2019 Canadian abortion provider survey. Contraception 2023; 124:110083. [PMID: 37263373 DOI: 10.1016/j.contraception.2023.110083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE We conducted a national survey to assess the experiences of stigma and harassment among physicians and nurse practitioners providing abortions and abortion service administrators in Canada. STUDY DESIGN We conducted an exploratory, cross-sectional, national, anonymized, online survey between July and December 2020. Subsections of the survey explored stigma and harassment experienced by respondents, including the 35-item Revised Abortion Providers Stigma Scale and open-ended responses. We analyzed the quantitative data to generate descriptive statistics and employed a reflexive thematic analysis to interpret open-ended responses. RESULTS Three hundred fifty-four participants started the stigma and harassment section of the survey. Among low-volume clinicians (<30 abortions/year, 60%, n = 180) 8% reported harassment; 21% among higher volume clinicians (≥30 abortions/year, 40%, n = 119) and 47% among administrators (n = 39), most commonly picketing. The mean stigma score was 67.8 (standard deviation 17.2; maximum score 175). Our qualitative analysis identified five themes characterizing perceptions of stigma and harassment: concerns related to harassment from picketing, protestors, and the public; wanting protestor "bubble zones"; aiming to be anonymous to avoid being a target; not providing an abortion service; but also witnessing a safe and positive practice environment. CONCLUSIONS Being a low-volume clinician compared to higher volume clinician and administrator appears to be associated with less harassment. Clinicians providing abortion care in Canada reported mid-range abortion-related stigma scores, and expressed strong concerns that stigma interfered with their abortion provision. Our results indicate that further de-stigmatization and protection of abortion providers in Canada is needed through policy and practice interventions including bubble zones. IMPLICATIONS While Canadian abortion care clinicians and administrators reported relatively low incidence of harassment, our results indicate that they are concerned about stigma and harassment. However, as this was an exploratory survey, these data may not be representative of all Canadian abortion providers. Our data identify a need to support abortion clinicians and to bolster protections for dedicated abortion services.
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Affiliation(s)
- Madeleine Ennis
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Contraception and Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Regina M Renner
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Contraception and Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada.
| | - Bimbola Olure
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Contraception and Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital Vancouver, Vancouver, BC, Canada
| | - Wendy V Norman
- Contraception and Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada; Department of Family Practice, University of British Columbia, Vancouver, BC, Canada; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Lisa Martin
- Department of Health and Human Services, University of Michigan-Dearborn, Dearborn, MI, United States
| | - Lisa H Harris
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States
| | - Lauren Kean
- Contraception and Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Meghan Seewald
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Contraception and Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital Vancouver, Vancouver, BC, Canada
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La SOGC plaide en faveur de l'accès aux soins d'avortement de haute qualité. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:948-950. [PMID: 36109103 DOI: 10.1016/j.jogc.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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