Trends in medication abortion provision before and after the introduction of mifepristone: A study of the National Abortion Federation's Canadian member services

Autor: Jill Doctoroff, Angel M. Foster, Alice Mark, Abdiasis Yalahow
Rok vydání: 2020
Předmět:
Zdroj: Contraception. 102(2)
ISSN: 1879-0518
Popis: Introduction In July 2015, Health Canada approved the mifepristone/misoprostol regimen under the brand name Mifegymiso® for early abortion in Canada. The initial decision included several non-evidence-based restrictions, including limiting use to seven weeks gestation. The combi-pack became available in January 2017 but was not covered by provincial, territorial, or federal health insurance schemes. However, by the end of 2017, Health Canada revised the product monograph to align with global standards and several provinces offered universal cost coverage of Mifegymiso®. We aimed to document trends in medication abortion provision before and after the introduction of Mifegymiso® in Canada. Method We analyzed abortion services data from National Abortion Federation (NAF) Canada members over a three-year period (2016-2018, inclusive). We used descriptive statistics to determine the overall proportion of medication abortions in each calendar year, as well as temporal trends in the geographic location of medication abortion providers. Results In 2016, 19 NAF Canada members provided 33,857 abortions, of which 7.3% (2,844) were medication abortions with methotrexate/misoprostol. Almost all medication abortions occurred at 6 weeks gestation or less (96.9%) and most medication abortion providers were in British Columbia. In 2017, 20 NAF Canada members provided 35,389 abortions, of which 14.3% (5,029) were medication abortions. Almost all these were with mifepristone/misoprostol and occurred at 6 weeks gestation or less (86.4%); medication abortion services were concentrated in Alberta, British Columbia, and Ontario. In 2018, 23 NAF Canada members provided 33,320 abortions, of which 26.6% (8,534) were medication abortions. About 60% of these took place at 6 weeks gestation or less and 39.7% occurred between seven- and 10-weeks’ gestation. NAF Canada members throughout the country provided Mifegymiso® in 2018. Conclusions Medication abortion with Mifegymiso® has been rapidly incorporated into abortion services in Canada. The introduction of mifepristone, regulatory changes impacting clinical practice, and expansion of universal cost coverage align with increased medication abortion provision. Our findings showcase the importance of both regulatory and insurance policies in expanding medication abortion services.
Databáze: OpenAIRE
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