"It gives you autonomy over your own choices": A qualitative study of Canadian abortion patients' experiences with mifepristone and misoprostol.

OBJECTIVES

The gold standard of medication abortion, mifepristone and misoprostol, became available in Canada in 2017 as a combination pack under the trade name Mifegymiso®. We aimed to document people's experiences deciding to use and accessing medication abortion and generate insights for how information and services could be improved.

METHODS

We conducted semi-structured, in-depth interviews with 64 people who had used the mifepristone/misoprostol regimen to induce an abortion in seven different Canadian provinces. We used ATLAS.ti to manage our data, which we analyzed for content and themes using inductive and deductive techniques.

RESULTS

The overwhelming majority of participants reflected positively on their experience with mifepristone/misoprostol for early abortion. Most people reported that medication abortion offered increased autonomy, privacy, and convenience compared with instrumentation procedures and especially liked being able to have the abortion in a comfortable and familiar environment. The small number of participants who reflected more negatively on their experiences generally did not feel well informed about what to expect. Several participants reported that the media served as a key information source for finding and accessing services.

CONCLUSIONS

Although our sample of Canadian abortion patients appear to be highly satisfied with the mifepristone and misoprostol regimen, there are several avenues by which medication abortion care could be improved. Providing more detailed information about pain management and the products of conception and lifting up the voices and stories of those who have used mifepristone and misoprostol could help patients manage expectations and would likely be welcomed.

IMPLICATIONS

Changes to the Mifegymiso® product monograph since its introduction seem to have addressed a number of barriers described by early users of mifepristone and misoprostol. Continued engagement with clinicians to ensure that the process is not overly medicalized appears warranted.