Exploring Canadians' Experiences with Belief-based Denial of Contraception and Abortion Care.

Although contraceptive and abortion care are medically necessary services, healthcare providers in Canada are permitted by professional associations to refuse to provide care or referrals for care on the basis of their personal beliefs. Regulating policies vary between provinces and often have vague phrasing, leading to confusion and controversy. Some evidence suggests that belief-based denial of legal and necessary services can lead to harmful outcomes, but rigorous research is scant. We undertook this qualitative study to explore Canadians' experiences with belief-based denial of contraception and abortion care and the consequences of this refusal in Alberta, New Brunswick, and Ontario. We conducted semi-structured, in-depth interviews with individuals who had experienced refusal of contraception or abortion care from November 2022 to March 2023. Eligible participants were sufficiently fluent in English to complete an interview and had access to a telephone or Internet. We employed a multimodal recruitment strategy including posts through community organizations and social media. We obtained oral consent prior to interviews. Interviews included questions about the participants' demographic characteristics, reproductive health histories, experiences with denial of health care, and perspectives on how abortion services could be improved. We audio-recorded and transcribed all interviews and used ATLAS.ti to manage our data. We analyzed our interviews for content and themes using deductive and inductive techniques. We organized our results around domains of inquiry and showcased key themes through narrative vignettes. The Research Ethics Board at the University of Ottawa approved this study. Our 30 participants ranged in age from 21 to 53 (mean 31.6) years; 27 used she/her pronouns, 2 used he/him pronouns, and 1 used they/them pronouns. Our participants identified as white (n=19); Black (n=2), Chinese/East Asian (n=3), South Asian (n=2), Hispanic (n=1), Indigenous (n=1), and Bi-racial (n=2). Twenty participants reported being denied contraception (including sterilization, the intra-uterine device, hormonal methods, and emergency contraceptive pills), 9 participants reported being denied abortion care, and 1 reported being denied both. Participants reported being denied tubal ligation or vasectomy because of age or parity; several participants repeatedly tried to get a tubal ligation over several years and were repeatedly denied the service. Participants reported that denial of abortion care was related to the provider's religious beliefs, the religious affiliation of the hospital/facility, and because of very low gestational age. After being denied care, participants felt angry, scared, disappointed, and frustrated. Some expressed concern over not having reproductive autonomy and described healthcare as sexist. Participants consistently voiced their opposition to policies that allow providers to refuse reproductive health services on the basis of their beliefs. The Canadian federal government has repeatedly supported the provision of a full range of respectful, timely, and accessible contraception and abortion. However, allowing healthcare providers to deny care based on their personal beliefs creates barriers to accessing necessary health services. Policymakers and clinicians should consider reforming these regulations with attention to patient-centered outcomes that are informed by patient experiences, establishing avenues for patients to report violations of practice standards, and creating enforcement mechanisms to ensure that Canadians receive the comprehensive reproductive health services they need and deserve. [ABSTRACT FROM AUTHOR]