Abstract
Mifepristone was approved for use in medical abortion by Health Canada in 2015. Approval was accompanied by regulations that prohibited pharmacist dispensing of the medication. Reproductive health advocates in Canada recognized this regulation would limit access to medical abortion and successfully worked to have this regulation removed in 2017. The purpose of this study was to assess the leadership involved in changing these regulations so that the success may be replicated by other groups advocating for health policy change. This study involved a mixed methods instrumental design in the context of British Columbia, Canada. Our data collection included: a) interviews with seven key individuals, representing the organizations that worked in concert for change to Canadian mifepristone regulations, and b) document analysis of press articles, correspondence, briefing notes, and meeting minutes. We conducted a thematic analysis of transcripts of audio-recorded interviews. We identified strengths and weaknesses of the team dynamic using the Develop Coalitions, Achieve Results and Systems Transformation domains of the LEADS Framework. Our analysis of participant interviews indicates that autonomy, shared values, and clarity in communication were integral to the success of the group's work. Analysis using the LEADS Framework showed that individuals possessed many of the capabilities identified as being necessary for successful health policy leadership. A lack of post-project assessment was identified as a possible limitation and could be incorporated in future work to strengthen dynamics especially when a desired outcome is not achieved. Document analysis provided a clear time-line of the work completed and suggested that strong communication between team members was another key to success. The results of our analysis of the interviews and documents provide valuable insight into the workings of a successful group committed to a common goal. The existing collegial and trusting relationships between key stakeholders allowed for interdisciplinary collaboration, rapid mobilization, and identification of issues that facilitated successful Canadian global-first deregulation of mifepristone dispensing.
Highlights
In Canada, abortion was decriminalized in 1988, and it remains the only country in the world to have fully enacted decriminalization. [1,2] There are currently no Canadian criminal laws restricting abortion access
Analysis using the LEADS Framework showed that individuals possessed many of the capabilities identified as being necessary for successful health policy leadership
Document analysis provided a clear time-line of the work completed and suggested that strong communication between team members was another key to success
Summary
In Canada, abortion was decriminalized in 1988, and it remains the only country in the world to have fully enacted decriminalization. [1,2] There are currently no Canadian criminal laws restricting abortion access. [1,2] There are currently no Canadian criminal laws restricting abortion access This includes that Canada has no criminal law stipulating restrictions on gestational age and there are no criminal laws which require authorization from a medical board, or a specified number or type of physician, prior to obtaining a procedure. [11] When the Canadian restrictions were announced, advocates for abortion access raised concerns that they would limit the potential for primary care provision and access to abortion. [12,13] Physician-only dispensing of mifepristone was perceived by advocates to be an unnecessary barrier that, if removed, would dramatically impact patient access to abortion by encouraging uptake of the provision of medical abortion care among prescribers and pharmacists In BC, for instance, physician dispensing would require access to Pharmanet (a central data system tracking every prescription in the province) and special permission from the College of Physicians and Surgeons of British Columbia (CPSBC). [12,13] Physician-only dispensing of mifepristone was perceived by advocates to be an unnecessary barrier that, if removed, would dramatically impact patient access to abortion by encouraging uptake of the provision of medical abortion care among prescribers and pharmacists
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