Abortions are common and essential medical procedures; one in three women in Canada have an abortion in their lifetime. Access to this care helps people plan and space out their pregnancies, providing vital benefits to individuals, families and society.
Pandemic-related travel restrictions and facility closures initially jeopardized access to abortion care. However, the pandemic has also become a catalyst for more accessible ways to deliver abortion care, such as providing medical abortions, which are drug-induced rather than surgical, via telemedicine.
We are members of the Contraception and Abortion Research Team at the University of British Columbia. As a PhD student and a postdoctoral fellow, we conduct research to support knowledge about abortion, availability of safe abortion methods and equitable access to abortion services throughout Canada.
Canada has been a leader in providing legal and safe abortion care, and the current federal government has a mandate letter commitment “to ensure that all Canadians have access to the sexual and reproductive health services they need, no matter where they live.”
Expanded options and persistent disparities
Options for care were expanded in 2017, when the gold standard medication abortion drug, mifepristone, became available in Canada. Medical abortions with mifepristone can be offered by family doctors and other primary health-care providers in the first trimester.
Mifepristone has the potential to address differences in access because it is a prescription for pills that the patient takes at home, and no surgical procedure is required. However, there are still disparities in access between rural areas and urban centres in Canada.
A few provinces face particular access challenges. For example, availability of surgical abortion services is very limited in the Maritimes due to a lack of clinics. Québec has been slow to implement medical abortion care.
Abortion providers and people seeking care still experience stigma and harassment, including anti-choice protests. This has led some provinces to implement bubble zones — legally designated areas around an abortion providing facility that prohibit protest and harassment of patients and providers.
Abortion care during the pandemic
In 2020, our team and partners recognized that the pandemic could have important implications for abortion care. We asked abortion providers from across the country to share their experiences on how COVID-19 had impacted abortion practice and access. We heard from over 300 providers and abortion clinic administrators about how they adjusted their abortion care during the pandemic to continue providing this essential health-care service.
The providers we surveyed found it helpful that the Society of Obstetricians and Gynaecologists of Canada (SOGC) issued a statement on the importance of ensuring access to abortion early in the pandemic. According to the SOGC, “Induced abortion is an essential and time-sensitive medical service that must be maintained in any pandemic or during periods of social disruption.”
Providers noted that a key change in their practice was offering some or all components of abortion care via telemedicine. They used telemedicine to prescribe mifepristone and for followup, while continuing to schedule in-person visits or tests for patients as needed. In a group we surveyed, less than 20 per cent had provided medical abortion via telemedicine before the pandemic. This shifted to almost 90 per cent of providers by January 2021.
Research shows that telemedicine abortion care is safe, and enabled people to seek care despite pandemic-related restrictions and personal concerns. According to one provider we surveyed:
“Patients are more reluctant to travel out of (their region) to access abortion…. They are terrified of the virus, and do not want to self-isolate at hotel hubs for 14 days before (returning home).”
Several people who participated in our research highlighted that telemedicine increased the accessibility of care. A clinic administrator in Ontario wrote:
“We have found that many patients throughout the province have utilized our service due to an increase in accessibility that accompanies telemedicine…. We are hopeful to continue to offer this care. However, we are also aware that for patients who do not have access to a phone/internet, telemedicine is not accessible.”
Next steps: Planning for patients’ needs
Beyond considering access to the necessary technology, we need to understand the patient experiences of telemedicine abortion. Internationally, research shows that many people accessing abortion services prefer this approach to care because it is more convenient, private and comfortable.
We need to clarify how abortion services can better meet patients’ needs in Canada. In-person appointments include things like assessing patients for abuse and coercion, testing for sexually transmitted infections and providing post-abortion birth control. How these services might be integrated into telemedicine is a key question.
Other important questions include identifying what needs to be done to maintain access to in-person medical and surgical care, and assessing the sustainability of the hybrid model, which includes telemedicine and in-person options.
Pandemic restrictions may have launched Canadian abortion care into a more accessible future. Telemedicine can enable services for people who live in rural communities or who prefer to access abortions from home. The pandemic increased the opportunity for people seeking an abortion to receive the care they need close to their home in a safe and timely way.