Grant: Fellowship: POR Awards - Transition to Leadership Stream - Phase 1

One third of women in Canada will have at least one abortion in their life. Until 2017, 96% of Canadian abortions were performed using surgery in fewer than 100 facilities, located primarily in large, urban centres. Under this model, access to abortion was markedly inequitable. Some patients traveled long distances to reach service locations, and experienced significant wait times, thus undergoing abortions at later (and thus less safe) gestational ages. Drawing attention to the urgency of this issue, in 2016, the UN Human Rights Commissioner called on the Canadian government to improve equitable access to abortion in Canada. The medical abortion drug mifepristone became available in Canada in January 2017. Canadian federal and provincial governments enacted policies that are unique globally to enable mifepristone abortion provision in primary care by family doctors or nurse practitioners, including those with no prior abortion practice. Within one year of its introduction, many provincial insurers fully subsidized the $350 mifepristone cost to reduce financial barriers to access. Health policymakers urgently need to understand whether their mifepristone policies were effective in improving abortion access and reducing inequities, and whether this change in abortion practice has impacted abortion outcomes. However, the effect of mifepristone policy on abortion access and outcomes have not yet been examined. The objective of this study is to evaluate the impact of Canadian mifepristone medical abortion policy on abortion access and outcomes using comprehensive, high-quality, linked health administrative data from British Columbia and Ontario. This policy framework positioned Canada as an international leader for addressing reproductive health access inequity through innovative liberalization of abortion practice. Health policymakers eagerly await the findings of this study to inform policy changes in a wide range of international settings.