Evaluation of access to medical abortion in Quebec abortion clinics in 2021 - Part I

Objective: In 2020, 11.9% of abortions in Quebec were medication abortions, compared with 32.4% in Ontario. The objective of this evaluation was to assess the quality of access to medication abortion in Quebec abortion clinics, where 91% of these abortions are performed. Methods: Quebec abortion clinics were contacted by 2 mystery client clinical profiles between October 8 and November 17, 2021. Descriptive analyses and statistical tests were performed, as well as a qualitative analysis of collected comments. Results: Medication abortion up to 63 days of gestational age or less was available in 39/47 abortion clinics, more in rural and remote areas than in urban or suburban areas (P = 0.013). The mean time from first call to first appointment was 6.2 calendar days (standard deviation [SD] 4.0), shorter in rural and remote areas (P = 0.005) and in clinics affiliated with a hospital or local community service center (P = 0.010). The mean number of visits required for medication abortion was higher than for surgical abortion (2.9 [SD] 0.9 vs. 2.3 [SD] 1.1) (P < 0.001). For one in three clinical profiles (26/78, 33%), a telemedicine visit was possible. Medication abortion entirely accessible through telemedicine was not available. Unfavorable comments about medication abortion were frequent. Conclusion: Access to medication abortion is difficult in Quebec and access through telemedicine is almost non existent. Restrictions imposed by the College des medecins du Quebec (CMQ) and constraints imposed on patients limit access. (C) 2022 The Society of Obstetricians and Gynaecologists of Canada/La Societe des obstetriciens et gynecologues du Canada. Published by Elsevier Inc. All rights reserved.