Women in rural areas have less access to abortion services than their urban counterparts, says UBC’s Dr. Wendy Norman.
Half of all pregnancies in Canada are unintended at the time of conception, and about half of those unintended pregnancies end in abortion.
But unless a woman lives in a major urban centre, she’s more likely to undergo general anesthesia for the procedure and her abortion provider is more likely to experience barriers to the provision of care, according a recent study examining rural access to abortions in British Columbia, the first of its kind in Canada.
Rural vs urban
“Ninety per cent of the nearly 16,000 abortions performed in B.C. in 2010 took place in urban facilities, even though only just over half of child-bearing age women live in these areas,” says Dr. Wendy V. Norman, a family physician and assistant professor in the Department of Family Practice, who led the study. “This in itself is not surprising because over the past decade, the province has lost 60 per cent of rural abortion providers.”
Birth control and reproductive planning is a public health issue, but it’s not being studied or discussed as widely as other issues, often to the detriment of the health of families.
“What concerns us is that all surgical abortions in rural B.C. communities are performed in a hospital operating room setting, often under general anesthesia,” says Norman, one of the lead scientists on the Canadian Contraception Access Research Team (@cartgrac). “And half of the abortion providers reported difficulty booking time for abortion procedures due to conflict in operating room scheduling, or nurses or anesthesiologists who refuse to work with abortion cases.”
Dr. Wendy V. Norman found rural abortion providers experience barriers such as stigma and harassment.
By contrast, the majority of surgical abortions in B.C.’s three urban centres are performed in outpatient facilities using local anesthesia.
“In urban areas, almost all abortions are performed in specialized clinics, with the staff hired specifically to perform these services,” Norman adds. “They feel very on board with their work, which in turn provides emotional support for the urban doctors,” Norman observes.
Raising awareness, reducing risk
Moving rural abortion services out of operating rooms and into outpatient facilities, says Norman, could lower the cost of services, help address the stigma reported by rural physicians, and reduce the risk to women associated with undergoing general anesthesia.
“One encouraging trend we noticed is that almost half of the rural cases are done medically, which is safe and affords women more privacy. This is much higher ratio than previously thought,” says Norman. “But we need to better educate women about this option as it is only available to women within the first seven weeks of pregnancy.”
“Birth control and reproductive planning is a public health issue, but it’s not being studied or discussed as widely as other issues, often to the detriment of the health of families,” says Norman. “We hope our research can empower women and their families to make their own reproductive plan and better inform future health care investments.”
Norman (@wvnorman) and her team will lead a collaborative interdisciplinary meeting in May 2014. Abortion service stakeholders from B.C. will come together with national and international experts aiming to examine the survey results and best evidence, using the knowledge gained to improved access to high quality abortion services throughout B.C.
