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  • Author
    Michelle Didero
  • Co-author

    Dr. Wendy V. Norman

  • Title

    Who provides mifepristone for medical abortion?: An analysis after mifepristone’s approval in Canada

  • Abstract

    BACKGROUND: Mifepristone-misoprostol is the only government-approved medical abortion regimen in Canada. Though mifepristone was made commercially available in 2017, its uptake in Canada was slow due to prescribing and dispensing restrictions. The aim of this project is to understand baseline physician characteristics associated with new or continued mifepristone provision, as little is known about factors that may improve mifepristone access. METHODS: A 61-item online Mifepristone
    Implementation Survey was distributed at baseline and 12-months among providers in Canada. The survey included 12 theory-based questions about likeliness to adopt a new behavior, referred to as the Legare scale. Univariate analysis was done using chi-square tests and logistic regression. RESULTS: Of 554 respondents, ages 22-79, 452 (81.6%) self-identified as female, 99 (17.9%) as male, and 3 (0.5%) as other. All Canadian provinces were represented. Of the survey participants, 285 (53.5%) had medical and/or surgical abortion experience and 248 (46.5%) did not. Previous medical and/or surgical abortion experience was strongly tied to mifepristone provision by 12 months (p<0.001). The odds of prescribing mifepristone by 12 months was significantly increased for respondents who reported baseline confidence in ability, baseline plan, baseline ability, and baseline belief about degree of difficulty to provide medical abortion. An overall average score of at least 6 across all 12 Legare factors across was associated with 4.15 times the odds of providing mifepristone by 12-month follow up (p<0.001). CONCLUSION: Physician traits associated with abortion provision included: previous experience, confidence, plan, and perception of medical abortion difficulty. Future studies should investigate ways to strengthen these traits across providers to improve abortion access.

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