Cano Jennifer K, Foster Angel M
Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institute of Population Health, University of Ottawa, Ottawa, ON, Canada.
Contraception. 2016 Nov;94(5):489-495. doi: 10.1016/j.contraception.2016.06.015. Epub 2016 Jun 29.
Abortion has been legal without restriction in Canada since 1988 and is recognized as a medically necessary service. However, research indicates that women still face numerous barriers to accessing care, challenges that are amplified for women living in rural, remote and northern regions in Canada.
This qualitative study aimed to document women's experiences seeking and obtaining abortion services while residing in Yukon Territory, identify financial and personal costs and explore avenues through which services could be improved.
We conducted 16 in-depth semi-structured phone interviews with women who accessed abortion services on/after January 1, 2005, while residing in the Yukon. We employed an iterative multiphase analytic approach centering on content and themes, using both inductive and deductive techniques.
With the Yukon's sole facility offering first trimester abortions twice a month, women experienced difficulty navigating a fragmented process and long wait times. Women found the process of attending multiple pre-procedure appointments at multiple locations with multiple health care providers, all while enduring pregnancy symptoms and handling other life commitments, physically, financially and emotionally taxing.
Efforts to streamline the process of obtaining an abortion and providing women with more information at the first point of contact would improve service access and quality. Mifepristone has the potential to improve access for rural and remote populations, reduce wait times and alleviate privacy concerns, but only if the medication abortion regimen is affordable and available at a range of service delivery points and provision requirements are aligned with the global evidence.
By documenting women's experiences, the identified barriers and outlined suggestions for improvement offer realistic avenues through which current abortion services in Yukon Territory can be modified in order to increase access. This study highlights future reproductive health care initiatives that warrant prioritization in Canada's North.
自1988年以来，堕胎在加拿大一直不受限制地合法，并且被视为一项医疗必需服务。然而，研究表明，女性在获得护理方面仍面临诸多障碍，对于生活在加拿大农村、偏远和北部地区的女性而言，这些挑战更为严峻。
这项定性研究旨在记录育空地区女性寻求和获得堕胎服务的经历，确定经济和个人成本，并探索可以改善服务的途径。
我们对2005年1月1日及以后居住在育空地区并获得堕胎服务的女性进行了16次深入的半结构化电话访谈。我们采用了一种以内容和主题为中心的迭代多阶段分析方法，运用归纳和演绎技术。
由于育空地区唯一提供孕早期堕胎服务的机构每月进行两次手术，女性在应对分散的流程和漫长的等待时间方面遇到困难。女性发现在多个地点与多个医疗服务提供者进行多次术前预约的过程，同时还要忍受怀孕症状并处理其他生活事务，这在身体、经济和情感上都造成了负担。
简化堕胎程序并在首次接触时为女性提供更多信息的努力将改善服务的可及性和质量。米非司酮有潜力改善农村和偏远地区人群的可及性，减少等待时间并减轻隐私担忧，但前提是药物流产方案价格合理且在一系列服务提供点均可获得，并且提供要求与全球证据一致。
通过记录女性的经历，所确定的障碍和概述的改进建议为改善育空地区目前的堕胎服务提供了切实可行的途径，以便增加可及性。这项研究突出了未来在加拿大北部应优先考虑的生殖健康保健举措。
