Many Barriers to Medical Abortion by Quebec Fam Physicians

VANCOUVER, British Columbia — Many women who request a medical abortion at family medicine teaching clinics don’t get one, according to a survey of academic family physicians in the province of Quebec.

Key barriers to the provision of medical abortion include lack of training and education, inadequate resources in the clinic, and physician preference, Fanny Hersson-Edery, MD, program director in the Department of Family Medicine at McGill University, Montreal, Quebec, Canada, told attendees here during a poster session at the Family Medicine Forum (FMF) 2024.

The survey was conducted in January 2023, 6 months after medical abortion restrictions were eased in Quebec, removing the requirement for ultrasound confirmation of gestational age of the fetus and of specialized mandatory training.

The survey results are particularly timely, given that the Quebec government recently announced a 3-year, $7.5-million plan to augment medical abortion services by increasing access and mounting a public information campaign.

Martine Biron, Quebec’s minister responsible for the status of women, said that expanding the use of medical abortion in Quebec will lessen the demand for procedural abortion, where wait times can be up to 5 weeks in non-urban settings.

‘Basic Care’

Researchers asked supervising physicians in nine postgraduate family medicine teaching clinics if they provide medical abortion care in the form of administering mifepristone and misoprostol, and if not, why not. A total of 86 full-time family medicine teachers (33% of those asked) completed the survey. One of the participating centers is a historically Catholic healthcare institution with a culture of not providing abortion care.

Sixty percent of respondents had patients who had required or asked about medical abortion, yet only 15.1% prescribed it, Hersson-Edery said.

Reasons for not providing medical abortion were multiple, with lack of training or experience in medical abortion taking the lead, chosen by 41 respondents (53.3%).

Additionally, more than half (59.5%) of the respondents said they had never been taught about abortion during their residency or sought additional training, only 62.8% had offered any teaching to residents about abortion, 36% had provided teaching during patient encounters, and 39.5% had taught residents to refer to resources outside of the teaching clinic.

More than a third of respondents (37.7%) said they did not prescribe medical abortion because they could refer patients elsewhere. This “significant percentage” is not surprising, Hersson-Edery noted, given that most of McGill’s teaching units are in Montreal, an urban center where abortion provider clinics are easily accessible to patients.

But referring patients elsewhere may not necessarily be the desired approach for the individual seeking a medical abortion. “The need that’s not being met is that patients are not being provided with a medical abortion at their family medicine clinic,” she said. “If you have a patient who feels very comfortable with you, she may feel less comfortable going to someone else. It is another step in getting that care.”

“If you consider that reproductive care and abortion are really part of basic care to be provided to our patients, then we have to make sure that our teachers are well trained and that as a group, they’re able to provide medical abortion care, as well as make sure that all learners are exposed and get trained and are providing it as well,” Hersson-Edery told Medscape Medical News.

A third of respondents (34.1%) said they intended to provide medical abortion in the future, 16.5% had no intention to do so, and half (49.4%) were unsure of their intention.

Awareness Is Key

The survey found nearly half (47.7%) of the respondents were not aware that many medical abortion restrictions were lifted in 2022.

But Amanda Black, MD, past president of The Society of Obstetricians and Gynaecologists of Canada and professor of obstetrics and gynecology at the University of Ottawa, Ottawa, Ontario, Canada, told Medscape Medical News that that family physicians should at least be aware of medical abortions and where to refer patients so they can obtain appropriate care and follow-up in a timely fashion.

“Given that this is an important aspect of women’s reproductive health, family medicine training programs should ensure that their trainees receive exposure to abortion care during the course of their residency program,” she said. “This may be with their primary preceptor or in another clinical setting. Once in practice, it is important that family physicians establish a network and/or family practice team that ensures requests for these procedures are handled in a timely fashion.”

Hersson-Edery and Black have disclosed no relevant financial relationships.