Medical abortion in the United States and Canada: why so different?
E. Steve Lichtenberg1, Heidi Jones2, Katharine O'Connell White3, Maureen Paul4, Edith Guilbert5, Christopher Okpaleke6, Wendy Norman7 1Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA, 2CUNY School of Public Health, Hunter College, New York, New York, USA, 3Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts, USA, 4Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA, 5Institut National de Sante Publique du Quebec, Quebec, Canada, 6University of British Columbia, Vancouver, British Columbia, Canada, 7University of British Columbia, Vancouver, British Columbia, Canada - email@example.com
Objectives: To understand differences in medical abortion provision in the United States compared to Canada. Methods: We conducted a cross-sectional survey of abortion facilities identified via publicly available resources simultaneously in the United States (n=705) and Canada (n=94) from June through December 2013, which included questions on socio-demographic characteristics and medical abortion procedures for up to 5 clinicians per facility. Results: In Canada 78 (83%) and in the US 379 (54%) of all abortion facilities participated, with respectively 60 and 348 medical abortion clinicians participating from 32 and 286 facilities providing medical abortions. In Canada all medical abortions are provided by physicians with nearly two thirds of these (59.3%) being family physicians/general practitioners compared to over three quarters of physician providers in the US (84.9%) who are specialists. In the US, 56% of providers were physicians, 26% nurse practitioners, 11% physician assistants and 6% certified nurse-midwives. In both countries, the majority of providers were female (78.7% in the US and 79.7% in Canada). Providers reported 2706 (Canada) and 135,129 (US) first trimester and respectively 322 and 1646 second trimester medical abortions. Among reported procedures in each country, medical abortion comprised 3.8 % (Canada) and 35.6 % (US) of all first trimester abortions, and 6.7% (Canada) compared to 4.3% (US) of all second trimester abortions. In the US, the majority provided medical abortions through 63 days LMP (79.1%) compared to 49 days LMP in Canada (63.3%). Providers in both countries reported practices predominantly aligned with evidence-based guidelines. Conclusion: Medical abortion is provided much less commonly in Canada where mifepristone is not an approved drug, and is more often provided by family physicians compared to the United States, where specialists or non-physicians provide most medical abortions.