Patients should be provided with nonjudgmental counselling
Care should include explicit statements affirming patient choice. Clinicians with faith-based objections should provide timely, tolerant referral; judgmental or obstructive care may result in regulatory consequences.1
Clinicians should address misinformation
False information about medical risk, regret, causation of cancer, infertility, and mental illness — as well as deepfake videos of procedures — continues to flourish.2 Medication and procedural abortions are safe and do not cause long-term health problems; rates of lifetime regret are low. Clinicians should proactively query and address fears using evidence-based resources (Appendix 1, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.250372/tab-related-content).
Access to abortion care, including provision of medication in primary care settings, should be timely
People can self-refer to specialized clinics; however, assisting patients with system navigation can avoid delays that increase physical and psychological toll. Service centralization, inconsistent regional and hospital policies, geography, and provider shortages hamper access.1 Providing medication abortion directly as part of primary care breaks down access barriers. No special training is required to prescribe mifepristone and misoprostol for medication abortion, which is more than 95% effective in the first trimester; guidelines and online courses are available to support learning.3 Guidelines also support prescription by telemedicine.4 Virtual care can help improve access to safe abortion for patients for whom distance and cost of travel are barriers.1
Proactively addressing cost and availability of medication can improve access
All provinces and territories cover mifepristone and misoprostol for people included in public health insurance plans. However, many people are unaware of this coverage, and it often excludes vulnerable groups like out-of-province students and newcomers. Prescribers should inform patients of medication abortion coverage to prevent accidental overcharging and identify pharmacies with a local supply of mifepristone and misoprostol, as it is not universally stocked. Misoprostol-only regimens are slightly less effective than combined options, but remain a safe, low-cost alternative for people ineligible for mifepristone and misoprostol coverage.5
Contraception counselling should also be provided to patients seeking abortion care
Ovulation may occur as little as 8 days after termination; therefore patients should start contraception 0–5 days after abortion. Individualized options tailored to patients’ preferences (e.g., reversibility) and circumstances (e.g., cost, comorbidities) should be presented.
Supplementary Information
Footnotes
Statement of lived experience: Erin Brennand is a clinician scientist in Obstetrics & Gynecology with nearly 2 decades of experience in female reproductive health care, research, and policy development. Jadine Paw is an obstetrician-gynecologist and medical educator with more than a decade of experience caring for vulnerable populations and developing curricula on female reproductive health for learners at all levels of medical education. Natalie Scime is an epidemiologist with expertise in female reproductive health and is currently in her first year of medical school.
Competing interests: Erin Brennand reports grant funding from the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council, the Calgary Health Foundation, and the MSI Foundation, all paid to institution, outside the submitted work, as well as an honorarium from the D.A. Boyes’ Society meeting and salaried employment with Alberta Health Services. No other competing interests were declared.
This article has been peer reviewed.
References
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