Abstract
BackgroundAn increasing proportion of Canadian induced abortions are performed in large urban areas. For unknown reasons the number of rural abortion providers in Canadian provinces, such as British Columbia (BC), has declined substantially. This study explored the experiences of BC rural and urban physicians providing abortion services.MethodsThe mixed methods BC Abortion Providers Survey employed self-administered questionnaires, distributed to all known current and some past BC abortion providers in 2011. The optional semi-structured interviews are the focus of this analysis. Interview questions probed the experiences, facilitators and challenges faced by abortion providers, and their future intentions. Interviews were transcribed and analyzed using cross-case and thematic analysis.ResultsTwenty interviews were completed and transcribed, representing 13/27 (48.1%) rural abortion providers, and 7/19 (36.8%) of urban providers in BC. Emerging themes differed between urban and rural providers. Most urban providers worked within clinics and reported a supportive environment. Rural physicians, all providing surgical abortions within hospitals, reported challenging barriers to provision including operating room scheduling, anesthetist and nursing logistical issues, high demand for services, professional isolation, and scarcity of replacement abortion providers. Many rural providers identified a need to “fly under the radar” in their small community.DiscussionThis first study of experiences among rural and urban abortion providers in Canada identifies addressable challenges faced by rural physicians. Rural providers expressed a need for increased support from hospital administration and policy. Further challenges identified include a desire for continuing professional education opportunities, and for available replacement providers.
Highlights
Induced abortion is a common procedure in Canada [1]
Since the Supreme Court of Canada R. vs. Morgentaler decision in 1988, [5] abortion service has been available in nonhospital clinics in many provinces, these are exclusively located in large urban areas [4]
While abortions in urban centers are increasingly performed in purpose-specific high volume clinics, abortions in British Columbia (BC) rural communities continue to take place predominantly within the hospital operating room
Summary
Induced abortion is a common procedure in Canada [1]. Currently 31% of Canadian women have had at least one abortion [2]. Access to abortion in Canada can be challenging, with potentially large distances between women and where abortion services are offered [3,4]. Since the Supreme Court of Canada R. vs Morgentaler decision in 1988, [5] abortion service has been available in nonhospital clinics in many provinces, these are exclusively located in large urban areas [4]. In BC it is estimated that the proportion of abortions performed in rural or community hospitals decreased by at least 60% between 1995 and 2005 [6]. An increasing proportion of Canadian induced abortions are performed in large urban areas. This study explored the experiences of BC rural and urban physicians providing abortion services
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