Abortion care in BC: Evolving practice and next steps

Abortion has been legal in Canada since 1969 and is governed as usual reproductive health care. Before the medical abortion pill mifepristone became available in British Columbia in 2017, more than 90% of abortions in the province were provided in purpose-specific high-volume clinics located in densely populated urban areas. The availability of mifepristone increased the potential for primary care providers to offer abortion care because provision of this medication is a safe, simple service that is easily managed in a routine primary care visit. Since 1997, the BC Women's Hospital and Health Centre's Pregnancy Options Service has supported BC physicians who provide abortion care by confidentially connecting patients who are seeking abortion to their closest appropriate provider. Similar services are also provided by Options for Sexual Health BC. Family physicians are the main providers of medical abortion. Primary care physicians, nurse practitioners, and gynecologists offer service in rural and urban areas, in person or by telemedicine. Providing accessible abortion care currently has three challenges: (1) more practitioners are needed to reduce travel and wait times for services, (2) to assist people seeking an abortion to find a service provider, practitioners who provide abortions should become listed with a confidential abortion service directory, and (3) enhanced training and distribution of services for second-trimester surgical abortion are needed. The time for a small handful of health care workers to provide all aspects of abortion care is over.