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People incarcerated in facilities for women and girls face barriers to accessing abortion, including unclear legislation, operational procedures, and distance. While medication abortion could mitigate distance barriers, prison is not a hospitable environment for medication abortion. Considering this limitation, this paper aimed to identify the distance from institutions of incarceration designated for women and girls to procedural abortion facilities in Canada. This study builds on an inventory of the 67 institutions of incarceration designated for women and girls across 13 provinces and territories in Canada, previously created by the authors. Procedural abortion facilities were identified using publicly available directories. Distances were calculated using Google Maps. The closest procedural abortion facility was identified for each institution, as well as the gestational age limit of each facility. Of the 67 institutions, 23 (34%) were located 0 to 10 km from a procedural abortion facility. Fourteen (21%) were located 10.1 to 20 km away. Ten (15%) were located 20.1 to 100 km away. Eleven were located 100.1 to 300 km away (16%). The remaining 9 (13%) were located between 300.1 and 738 km away. Distances ranged from 0.1 to 738 km. The greatest distances were among institutions in northern Canada. This paper identified a large range of distances between institutions of incarceration and procedural abortion facilities in Canada. Physical distance is only one measure of accessibility of abortion services. For incarcerated people, contextual factors including carceral policies and procedures present barriers to care, with significant impact on health equity. Distance between carceral institutions and procedural abortion facilities reduces equitable access to reproductive health services for incarcerated populations. Pregnant people should be protected from imprisonment to ensure reproductive autonomy. [ABSTRACT FROM AUTHOR]

This paper reports on findings from our exploratory qualitative study that aims to advance knowledge around access to and experiences with abortion services among Indigenous Peoples in Canada. We applied an Indigenous methodology to engage with 15 Indigenous Peoples across Canada utilizing a conversational interview method. Our study was informed by an Indigenous Advisory Committee consisting of front-line service providers working in the area of abortion service access and/ or support across Canada. We conducted conversations from September and November 2021. Participants identified with Métis, Cree, Dene, Inuit, Haudenosaunee, Anishinaabe, and Mi'kmaq nations, across nine provinces and territories. Participants spoke to six themes encompassing challenges and potential solutions around abortion access experiences among Indigenous Peoples in Canada. These included (1) logistical barriers, (2) poor treatment, (3) stigma, (4) impacts of colonialism on attitudes towards abortion, (5) traditional knowledge, and (6) follow-up care and support. Our study demonstrates that Indigenous Peoples experience abortion access barriers that are different than non-Indigenous Canadians, and that these barriers are closely linked to colonialism. Indigenous knowledges and practices that honor reproductive choice that pre-dates settler colonialism, must be brought forward into today to enhance the quality of abortion care. [ABSTRACT FROM AUTHOR]

Aims: To explore nurse practitioners' experiences of medication abortion implementation in Canada and to identify ways to further support the implementation of medication abortion by nurse practitioners in Canada. Design: A qualitative approach informed by feminist theory and integrated knowledge translation. Methods: Qualitative interviews with stakeholders and nurse practitioners between January 2020 and May 2021. Data were analysed using critical feminist theory. Results: Participants included 20 stakeholders, 16 nurse practitioner abortion providers, and seven nurse practitioners who did not provide abortions. We found that nurse practitioners conduct educational, communication and networking activities in the implementation of medication abortion in their communities. Nurse practitioners navigated resistance to abortion care in the health system from employers, colleagues and funders. Participants valued making abortion care more accessible to their patients and indicated that normalizing medication abortion in primary care was important to them. Conclusion: When trained in abortion care and supported by employers, nurse practitioners are leaders of abortion care in their communities and want to provide accessible, inclusive services to their patients. We recommend nursing curricula integrate abortion services in education, and that policymakers and health administrators partner with nurses, physicians, midwives, social workers and pharmacists, for comprehensive provincial/territorial sexual and reproductive health strategies for primary care. Impact The findings from this study may inform future policy, health administration and curriculum decisions related to reproductive health, and raise awareness about the crucial role of nurse practitioners in abortion care and contributions to reproductive health equity. Patient or Public Contribution: This study focused on provider experiences. In‐kind support was provided by Action Canada for Sexual Health & Rights, an organization that provides direct support and resources to the public and is committed to advocating on behalf of patients and the public seeking sexual and reproductive health services. [ABSTRACT FROM AUTHOR]

In this study we explored nurse practitioner-provided medication abortion in Canada and identified barriers and enablers to uptake and implementation. Between 2020–2021, we conducted 43 semi-structured interviews with 20 healthcare stakeholders and 23 nurse practitioners who both provided and did not provide medication abortion. Data were analyzed using interpretive description. We identified five overarching themes: 1) Access and use of ultrasound for gestational dating; 2) Advertising and anonymity of services; 3) Abortion as specialized or primary care; 4) Location and proximity to services; and 5) Education, mentorship, and peer support. Under certain conditions, ultrasound is not required for medication abortion, supporting nurse practitioner provision in the absence of access to this technology. Nurse practitioners felt a conflict between wanting to advertise their abortion services while also protecting their anonymity and that of their patients. Some nurse practitioners perceived medication abortion to be a low-resource, easy-to-provide service, while some not providing medication abortion continued to refer patients to specialized clinics. Some participants in rural areas felt unable to provide this service because they were too far from emergency services in the event of complications. Most nurse practitioners did not have any training in abortion care during their education and desired the support of a mentor experienced in abortion provision. Addressing factors that influence nurse practitioner provision of medication abortion will help to broaden access. Nurse practitioners are well-suited to provide medication abortion care but face multiple ongoing barriers to provision. We recommend the integration of medication abortion training into nurse practitioner education. Further, widespread communication from nursing organizations could inform nurse practitioners that medication abortion is within their scope of practice and facilitate public outreach campaigns to inform the public that this service exists and can be provided by nurse practitioners. [ABSTRACT FROM AUTHOR]

Mifepristone medication abortion was first approved in China and France more than 30 years ago and is now used in more than 60 countries worldwide. It is a highly safe and effective method that has the potential to increase population access to abortion in early pregnancy, closer to home. In both Canada and the United States, the initial regulations for distribution, prescribing, and dispensing of mifepristone were highly restricted. However, in Canada, where mifepristone was made available in 2017, most restrictions on the medication were removed in the first year of its availability. The Canadian regulation of mifepristone as a normal prescription makes access possible in community primary care through a physician or nurse practitioner prescription, which any pharmacist can dispense. In this approach, people decide when and where to take their medication. We explore how policy-maker-engaged research advanced reproductive health policy and facilitated this rapid change in Canada. We discuss the implications of these policy advances for self-management of abortion and demonstrate how in Canada patients "self-manage" components of the abortion process within a supportive health care system. [ABSTRACT FROM AUTHOR]