Grant: Project Grant

Abortion care is not equally accessible in Canada, particularly for people living in rural and remote areas. Abortion clinics are usually located in the largest cities. Although medication abortion ("MA", using the abortion pill approved in Canada 2017) could provide abortion closer to home, current guidelines prevent its use unless a person stays close to emergency services for at least the 2 weeks. This is because of a very rare complication, about one in 1000 MA, where the person may need a blood transfusion. Clinicians wishing to provide MA for residents of remote locations do not have the evidence or guidelines to know how to predict, or avoid, that complication or to know the safe time for a patient to return home from the city. To create evidence-based guidelines we will bring together data from health administrative databases, case records and interviews among remote residents and their health care providers from Canada, Australia, Scotland, Sweden and the United States. Research Question: What is the evidence needed to support safe provision of first-trimester medication abortion for residents of remote communities? Methods: We will interview people living in remote communities about their experiences and important contextual considerations. We will also interview healthcare professionals providing abortion services for people in remote communities. Finally, to understand the timeline and events and urgency for care between the time of the MA and of the transfusion, we will review patient charts, and conduct analyses of the linked administrative databases in Ontario, BC and Sweden. Finally we will bring together all this evidence to support clinical guidelines and shared-decision making tools for people seeking abortion and their care providers. Our team convenes Indigenous leaders, patients, and government leaders with world-leading experts in abortion care from Canada, Australia, Sweden, UK and US.