Abortion services and providers in Canada in 2019: results of a national survey

Regina M. Renner; Madeleine Ennis; Damien Contandriopoulos; Edith Guilbert; Sheila Dunn; Janusz Kaczorowski; Elizabeth K. Darling; Arianne Albert; Claire Styffe; Wendy V. Norman

doi:10.9778/cmajo.20210232

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Figure 1:
Respondent flow chart, informed by the Checklist for Reporting Results of Internet E-Surveys (CHERRIES).25 *Consent statement views recorded on Research Electronic Data Capture (REDCap) platform.32 †The participation rate was 95.1%. ‡Per programming in REDCap, respondents who did not answer mandatory inclusion criteria questions correctly were automatically exited from the survey. This included a question confirming that they had not taken the survey before. §Manual removal of respondents who exited the survey before completing mandatory eligibility questions. ¶Duplicate analysis was conducted using R Statistical software, flagging matching demographics, followed by manual review of all flagged respondents. We did not collect Internet Protocol addresses or use cookies, as per our research ethics board request, to maintain respondent anonymity. **Of 465 respondents, 323 (69.5%) completed the survey, defined as completing the last survey section.
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Figure 2:
Respondents’ abortion clinical practice location and range of health care services provided at that location by type of abortion service. Note: Respondents indicated location and other types of care for each abortion service they provided.

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Table 1:

Characteristics of abortion provider respondents by specialty

Characteristic	No. (%) of respondents^*
Characteristic	Primary care providers^† n = 280	General obstetrician–gynecologists n = 145	Maternal–fetal medicine subspecialists n = 40	Total n = 465
Region^‡
British Columbia	61 (21.8)	21 (14.5)	9 (22.5)	91 (19.6)
Prairies	39 (13.9)	13 (9.0)	< 5	^§
Ontario	99 (35.4)	42 (29.0)	12 (30.0)	153 (32.9)
Quebec	41 (14.6)	54 (37.2)	12 (30.0)	107 (23.0)
Atlantic provinces	28 (10.0)	14 (9.7)	< 5	^§
Territories	12 (4.3)	< 5	0	^§
Gender
Men	36 (12.9)	22 (15.2)	12 (30.0)	70 (15.1)
Women	244 (87.1)	123 (84.8)	28 (70.0)	395 (84.9)
Other	0	0	0	0
Age, yr
< 40	123 (46.2)	60 (43.5)	< 5	^§
40–49	76 (28.6)	42 (30.4)	17 (48.6)	135 (30.8)
≥50	67 (25.2)	36 (26.1)	14 (40.0)	117 (26.7)
Type of abortion care^¶
First-trimester medical abortion	275 (98.2)	105 (72.4)	8 (20.0)	388 (83.4)
First-trimester surgical abortion	82 (29.3)	125 (86.2)	12 (30.0)	219 (47.1)
Second-trimester surgical abortion	36 (12.9)	63 (43.4)	10 (25.0)	109 (23.4)
Second- or third-trimester medical abortion	9 (3.2)	66 (45.5)	39 (97.5)	115 (24.7)
Type of abortion care combinations^¶
Exclusively first-trimester medical abortion	196 (70.0)	11 (7.6)	0	207 (44.5)
First-trimester medical abortion and surgical abortion	78 (27.9)	88 (60.7)	6 (15.0)	172 (37.0)
First- and second-trimester surgical abortion	36 (12.9)	62 (42.8)	8 (20.0)	106 (22.8)
Exclusively second- or third-trimester medical abortion	< 5	< 5	24 (60.0)	^§
Number of abortions
First-trimester medical abortion	9587 (27.8)	3669 (29.9)	173 (10.1)	13429 (27.7)
First-trimester surgical abortion	23890 (69.2)	7336 (59.8)	1119 (65.6)	32345 (66.7)
Second-trimester surgical abortion	1059 (3.1)	1039 (8.5)	83 (4.9)	2181 (4.5)
Second- or third-trimester medical abortion	< 5	218 (1.4)	332 (13.0)	^§
Total	34540	12262	1707	48509
Following national clinical abortion practice guidelines^¶
SOGC	242 (92.0)	131 (98.4)	37 (100.0)	411 (94.8)
NAF	122 (46.6)	48 (36.1)	5 (13.5)	167 (40.6)
Other	7 (2.7)	< 5	< 5	^§
Missing	16 (5.7)	12 (8.3)	< 5	^§
Experience with first-trimester medical abortion, yr
< 5	171 (64.5)	48 (52.7)	< 5	^§
5–10	40 (15.1)	19 (20.9)	< 5	^§
11–15	28 (10.6)	13 (14.3)	< 5	^§
16–20	12 (4.5)	7 (7.7)	0	19 (5.2)
> 20	14 (5.3)	< 5	< 5	^§
Years of abortion experience^**
< 5	160 (59.3)	41 (31.8)	8 (20.5)	209 (47.7)
5–10	41 (15.2)	26 (20.2)	9 (23.1)	76 (17.4)
11–15	29 (10.7)	24 (18.6)	8 (20.5)	61 (13.9)
16–20	12 (4.4)	16 (12.4)	< 5	^§
> 20	28 (10.4)	22 (17.1)	10 (25.6)	60 (13.7)
Focus^††, %, median (IQR)	15 (5–30)	10 (5–20)	5 (5–10)	10 (5–20)

Note: IQR = interquartile range, NAF = National Abortion Federation, SOGC = The Society of Obstetricians and Gynaecologists of Canada.
↵* Percentages were calculated based on the total number of respondents for the individual variable (based on skip-pattern logic and nonmandatory questions). The denominator for each reported percentage consists of the number of respondents who answered that question.
↵† To maintain respondent anonymity, we grouped family physicians, emergency medicine physicians and nurse practitioners into a “primary care provider” category when reporting results by specialty. Primary care providers include 246 family physicians, fewer than 5 emergency medicine physicians, and 30 nurse practitioners.
↵‡ To maintain respondent anonymity, we reported geographic results by regions (British Columbia, the Prairies, Ontario, Quebec, the Atlantic provinces and the territories), combining some provinces with low respondent numbers. Prairies include Alberta, Manitoba and Saskatchewan. Atlantic provinces includes New Brunswick, Nova Scotia, Newfoundland and Labrador, and Prince Edward Island. Territories includes the Northwest Territories, Yukon and Nunavut.
↵§ Totals not reported to maintain respondents’ anonymity.
↵¶ Respondents could select more than 1 answer option.
↵** Years of experience in abortion care was based on the highest reported value within the survey (as respondents indicated years of experience for each type of provision).
↵†† Proportion of respondent practice focused on abortion and contraception care.

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Table 2:

Characteristics of abortion providers by region

Characteristic	No. (%) of respondents^*^†
Characteristic	British Columbia n = 91	Prairies n = 56	Ontario n = 153	Quebec n = 107	Atlantic provinces n = 45	Territories n = 13
Type of abortion care^‡
First-trimester medical abortion	78 (85.7)	50 (89.3)	136 (88.9)	72 (67.3)	40 (88.9)	12 (92.3)
First-trimester surgical abortion	37 (40.7)	24 (42.9)	50 (32.7)	84 (78.5)	17 (37.8)	7 (53.8)
Second-trimester surgical abortion	10 (11.0)	16 (28.6)	26 (17.0)	42 (39.3)	9 (20.0)	6 (46.2)
Second- or third-trimester medical abortion	18 (19.8)	15 (26.8)	29 (19.0)	42 (39.3)	9 (20.0)	< 5
Exclusive first-trimester medical abortion	46 (50.5)	30 (53.6)	91 (59.5)	11 (10.3)	24 (53.3)	5 (38.5)
First-trimester medical abortion and first- trimester surgical abortion	31 (34.1)	20 (35.7)	42 (27.5)	57 (53.3)	15 (33.3)	7 (53.8)
Number of abortions
First-trimester medical abortion	4043 (40.7)	1860 (27.8)	4410 (34.9)	1918 (12.5)	1070 (30.7)	128 (28.1)
First-trimester surgical abortion	5210 (52.5)	4347 (65.0)	7674 (60.8)	12 624 (82.3)	2192 (62.9)	298 (65.4)
Second-trimester surgical abortion	575 (5.8)	459 (6.9)	339 (2.7)	614 (4.0)	165 (4.7)	29 (6.4)
Second- or third-trimester medical abortion	99 (0.1)	18 (0.3)	200 (1.6)	178 (1.2)	58 (1.6)	< 5
Total	9927	6684	12623	15334	3485	456
National clinical abortion practice guidelines^†
SOGC	84 (92.3)	52 (94.5)	136 (93.2)	105 (94.6)	49 (98.0)	9 (64.3)
NAF	46 (51.7)	26 (47.3)	58 (39.7)	33 (29.7)	24 (48.0)	10 (71.4)
Other	< 5	< 5	< 5	9 (8.1)	0	0
Missing	< 5	< 5	7 (4.6)	< 5	0	< 5

Note: NAF = National Abortion Federation, SOGC = The Society of Obstetricians and Gynaecologists of Canada.
↵* Unless indicated otherwise. Percentages were calculated based on the total number of respondents for the individual variable (based on skip-pattern logic and nonmandatory questions). The denominator for each reported percentage consists of the number of respondents who answered that question.
↵† To maintain respondent anonymity, we report geographic results by region (British Columbia, the Prairies, Ontario, Quebec, the Atlantic provinces and the territories), combining some provinces with low respondent numbers. Prairies include Alberta, Manitoba and Saskatchewan. Atlantic provinces includes New Brunswick, Nova Scotia, Newfoundland and Labrador, and Prince Edward Island. Territories includes the Northwest Territories, Yukon and Nunavut.
↵‡ Respondents could select more than 1 answer option.

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Table 3:

Characteristics of abortion providers by rural or urban practice location

Characteristic	No. (%) of respondents^*
Characteristic	Rural n = 178	Urban n = 279
Type of abortion care^†
First-trimester medical abortion	165 (92.7)	218 (78.1)
Exclusively first-trimester medical abortion	100 (56.2)	106 (38.0)
First-trimester surgical abortion	73 (41.0)	142 (50.9)
Second-trimester surgical abortion	21 (11.8)	87 (31.2)
Second- or third-trimester medical abortion	23 (12.9)	88 (31.5)
No. (%) of abortions
First-trimester medical abortion	2334 (44.4)	11067 (25.6)
First-trimester surgical abortion	2724 (51.8)	29578 (68.5)
Second-trimester surgical abortion	167 (3.2)	2014 (4.7)
Second- or third-trimester medical abortion	34 (0.6)	508 (1.2)
Total	5259	43 167
Region^‡
British Columbia	53 (29.8)	38 (13.6)
Prairies	17 (9.6)	38 (13.6)
Ontario	36 (20.2	112 (40.1)
Quebec	38 (21.3)	68 (24.4)
Atlantic provinces	21 (11.8)	23 (8.2)
Territories	13 (7.3)	0

Note: MA = medical abortion.
↵* Unless indicated otherwise. Percentages were calculated based on the total number of respondents for the individual variable (based on skip-pattern logic and nonmandatory questions). The denominator for each reported percentage consists of the number of respondents who answered that question. We defined urban providers as those located within Statistics Canada’s defined census metropolitan areas.35 All other providers were classified as rural.
↵† Respondents could select more than 1 answer option.
↵‡ To maintain respondent anonymity, we reported geographic results by regions (British Columbia, the Prairies, Ontario, Quebec, the Atlantic provinces and the territories), combining some provinces with low respondent numbers. Prairies include Alberta, Manitoba and Saskatchewan. Atlantic provinces include New Brunswick, Nova Scotia, Newfoundland and Labrador, and Prince Edward Island. Territories includes the Northwest Territories, Yukon and Nunavut.