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Perspectives Among Canadian Physicians on Factors Influencing Implementation of Mifepristone Medical Abortion: A National Qualitative Study
Open accessAbstract
PURPOSE: Access to family planning health services in Canada has been historically inadequate and inequitable. A potential solution appeared when Health Canada approved mifepristone, the gold standard for medical abortion, in July 2015. We sought to investigate the factors that influence successful initiation and ongoing provision of medical abortion services among Canadian health professionals and how these factors relate to abortion policies, systems, and service access throughout Canada. METHODS: We conducted 1-on-1 semistructured interviews with a national sample of abortion-providing and nonproviding physicians and health system stakeholders in Canadian health care settings. Our data collection, thematic analysis, and interpretation were guided by Diffusion of Innovation theory. RESULTS: We conducted interviews with 90 participants including rural practitioners and those with no previous abortion experience. In the course of our study, Health Canada removed mifepristone restrictions. Our results suggest that Health Canada's initial restrictions discouraged physicians from providing mifepristone and were inconsistent with provincial licensing standards, thereby limiting patient access. Once deregulated, remaining factors were primarily related to local and regional implementation processes. Participants held strong perceptions that mifepristone was the new standard of care for medical abortion in Canada and within the scope of primary care practice. CONCLUSION: Health Canada's removal of mifepristone restrictions facilitated the implementation of abortion care in the primary care setting. Our results are unique because Canada is the first country to facilitate provision of medical abortion in primary care via evidence-based deregulation of mifepristone.
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The 2012 Canadian Abortion Provider Survey found the proportion of surgical abortions was 96.2%.
“Our 2012 Canadian Abortion Provider Survey (CAPS) found the proportion of surgical abortions was 96.2%.”
From First and Second-Trimester Surgical Abortion Providers and Services in 2019: Results From the Canadian Abortion Provider Survey (2023) · cites this paper as [3]
The Introduction (page unavailable) says that abortion services in Canada before 2017 were surgical, and the References list a report of a 2012 national survey. Our copy does not give the claimed 96.2% figure, so it supports the general point but not the specific proportion. (LLM, conf=0.78)
Experimental — accuracy not yet measuredIn the 2012 CAPS, fewer than 300 physicians responded indicating they were providers of abortion care in Canada.
“Fewer than 300 physicians responded indicating they were providers of abortion care in Canada”
From First and Second-Trimester Surgical Abortion Providers and Services in 2019: Results From the Canadian Abortion Provider Survey (2023) · cites this paper as [3]
The Introduction states that before 2017, fewer than 300 doctors provided surgical abortion services in Canada, citing a 2012 national survey. It does not say that fewer than 300 physicians responded to that survey or identified themselves as providers in their responses. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn the 2012 CAPS, abortion access was limited in rural areas.
“while abortion access was limited in rural areas”
From First and Second-Trimester Surgical Abortion Providers and Services in 2019: Results From the Canadian Abortion Provider Survey (2023) · cites this paper as [3]
The Introduction (page unavailable) says that before 2017, abortion services were concentrated in urban facilities and patients outside large cities had to travel significant distances. This supports limited rural access, but the paper does not identify that finding as a result of the 2012 CAPS; it describes CAPS elsewhere as a provider-support platform. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn the 2012 CAPS, providers mostly practiced in high-volume specialized clinics concentrated in the largest urban areas.
“they mostly practiced in high-volume specialized clinics concentrated in the largest urban areas”
From First and Second-Trimester Surgical Abortion Providers and Services in 2019: Results From the Canadian Abortion Provider Survey (2023) · cites this paper as [3]
The Introduction (page unavailable) says that before 2017, fewer than 300 doctors provided surgical abortion at roughly 100 facilities in urban cities near the Canada–US border, citing a 2012 national survey. That supports an urban concentration of services, but the paper does not say that providers mostly practiced in high-volume specialized clinics or that those clinics were in the largest urban areas. (LLM, conf=0.84)
Experimental — accuracy not yet measuredDespite the unanticipated impact of COVID-19, we recruited more providers than in our 2012 survey.
“Despite the unanticipated impact of COVID-19, we recruited more providers than in our 2012 survey.3”
From First and Second-Trimester Surgical Abortion Providers and Services in 2019: Results From the Canadian Abortion Provider Survey (2023) · cites this paper as [3]
The Recruitment and Data Collection sections describe a 2017 survey and interviews conducted in 2017–2018. A search of our copy for a 2012 survey and COVID-19 found no passage comparing provider recruitment across those surveys or assessing a pandemic impact. No page numbers were provided for these passages. (LLM, conf=0.76)
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Self-citationEnnis, M., Lavoie-Lebel, É., Renner, R., Munro, S. B., Barone, C., Ilott, E., Chisholm, J., Dineley, B., Knutzen, L., Robertson, J. E., et al. (2026) · PLoS ONE · doi:10.1371/journal.pone.0349167
Self-citationFitri, S. R., & Israhadi, E. (2024) · Journal of Multidisciplinary Sustainability Asean. · doi:10.70177/ijmsa.v1i5.1747
Duong, M.-C., Czerniak, E., Mehta, A., Chiu, R., Norman, W. V., & Abdulai, A. (2026) · BMJ Sexual & Reproductive Health · doi:10.1136/bmjsrh-2026-203275
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Beyond legality: Bureaucratic violence and obstacles to abortion care
McKay, A., & Heath, M. (2026) · Social Science & Medicine · doi:10.1016/j.socscimed.2026.119670
Metadata
- Authors
- Munro, S., Guilbert, E., Wagner, M.-S., Wilcox, E. S., Devane, C., Dunn, S., Brooks, M., Soon, J. A., Mills, M., Leduc-Robert, G., Wahl, K., Zannier, E., & Norman, W. V.
- Affiliations
- Dalhousie University (CA)
- ORCID
- Venue
- The Annals of Family Medicine
- Publisher
- Annals of Family Medicine
- Published
- 2020-09
- Volume
- 18
- Issue
- 5
- Pages
- 413-421
- ISSN
- 1544-1709 (ISSN-L)
- 1544-1717
- PMC
- PMC7489974
- OpenAlex
- W3085209431
- Cited by
- 61
- References
- 38
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 7 · 2023: 13 · 2022: 16 · 2021: 7
- FWCI
- 6.75
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Annals of Family Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Funders
- College of Family Physicians of Canada
- Michael Smith Health Research BC (16603, 18270, 16743, 18270, 16603)
- Provincial Health Services Authority
- Association des pharmaciens du Canada
- Canadian Institutes of Health Research (18270, PHE148161, CPP-329455-107837)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- mifepristone, abortion pills, physician attitudes, abortion policy, diffusion of innovation theory, family planning access, rural physicians, Canada
- MeSH terms
- Abortion, Legal, Attitude of Health Personnel, Canada, Female, Health Plan Implementation, Humans, Physicians, Pregnancy, Primary Health Care, Mifepristone, Qualitative Research
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