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 available in Canada since 2017) could provide abortion closer to home, current guidelines prevent its use unless a person stays close to emergency services for at least 2 weeks. This is because of a very rare complication, about one for every 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, and Sweden. How far from emergency services can medication abortion be safely provided? 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. To understand the timeline and events and urgency for care between the time of the MA and the transfusion and to learn who is at risk to need a transfusion, and if there are early warning signs, we will review charts, and analyze the linked administrative databases. Finally we will bring together all this evidence in handy summaries and tools that will support the national organizations and experts who create the clinical guidelines for health care professionals, and to help support people seeking abortion for their decisions. Our team convenes Indigenous leaders, patients, and government leaders with world-leading experts in abortion care from Canada, Australia, Sweden and Scotland.