Barriers to Rural Induced Abortion Services in Canada Findings of the British Columbia Abortion Providers Survey (BCAPS).docVIP

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Barriers to Rural Induced Abortion Services in Canada Findings of the British Columbia Abortion Providers Survey (BCAPS).doc

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Barriers to Rural Induced Abortion Services in Canada Findings of the British Columbia Abortion Providers Survey (BCAPS)

BarrierstoRuralInducedAbortionServicesinCanada: FindingsoftheBritishColumbiaAbortionProviders Survey(BCAPS) WendyV.Norman1,2*,JudithA.Soon1,2,3,NanammaMaughn2,JenniferDressler2 1DepartmentofFamilyPractice,FacultyofMedicine,UniversityofBritishColumbia,Vancouver,Canada,2Women’sHealthResearchInstitute,BritishColumbiaWomen’s Hospital,ProvincialHealthServicesAuthority,Vancouver,Canada,3FacultyofPharmaceuticalSciences,UniversityofBritishColumbia,Vancouver,Canada Abstract Background: Rural induced abortion service has declined in Canada. Factors influencing abortion provision by rural physicians are unknown. This study assessed distribution, practice, and experiences among rural compared to urban abortionprovidersintheCanadianprovinceofBritishColumbia(BC). Methods:WeusedmixedmethodstoassessphysiciansontheBCregistryofabortionproviders.In2011wedistributeda previously-publishedquestionnaireandconductedsemi-structuredinterviews. Results:Surveyswerereturnedby39/46(85%)ofBCabortionproviders.Halfwerefamilyphysicians,withinbothruraland urban cohorts. One-quarter (17/67) of rural hospitals offer abortion service. Medical abortions comprised 14.7% of total reportedabortions. Thethreelargesturbanareasreported90%ofallabortions, althoughonly57%ofreproductiveage womenresideintheassociatedhealthauthorityregions.Eachruralphysicianprovidedonaverage76(SD52)abortions annually, including 35 (SD 30) medical abortions. Rural physicians provided surgical abortions in operating rooms, often usinggeneralanaesthesia,whileurbanphysiciansprovidedthesameservicesprimarilyinambulatorysettingsusinglocal anaesthesia. Rural providers reported health system barriers, particularly relating to operating room logistics. Urban providersreportedoccasionalanonymousharassmentandviolence. Conclusions:Medicalabortionsrepresented15%ofallBCabortions,alargerproportionthanpreviouslyreported(under 4%) for Canada. Rural physicians describe addressable barriers to service provision that may explain the declining acces