title: Barriers and facilitators to family planning access in Canada.
abstract: BACKGROUND
  Contraceptives are underutilized in Canada, and nearly one in three Canadian women will have an abortion in her lifetime. To help delineate a national family planning research agenda, the authors interviewed healthcare providers and organizational stakeholders to explore their perspective on barriers to contraception across regions of Canada.
  
  
  METHODS
  Semi-structured interviews were conducted based on validated frameworks for assessing family planning access and quality. The authors purposefully selected 14 key stakeholders from government agencies, professional organizations and non-governmental organizations for in-person interviews. Fifty-eight healthcare providers and representatives of stakeholder organizations in reproductive health who self-selected through an online survey were also interviewed. Transcripts were analyzed for repeated and saturated themes.
  
  
  RESULTS
  Cost was the most important barrier to contraception. Sexual health education was reported as inconsistent, even within provinces. Regional differences were highlighted, including limited access to family physicians in rural Canada and throughout Quebec. Physician bias and outdated practices were cited as significant barriers to quality. New immigrants, youth, young adults and women in small rural, Northern and Aboriginal communities were all identified as particularly vulnerable. Informants identified multiple opportunities for health policy and system restructuring, including subsidized contraception, and enhancing public and healthcare provider education. Sexual health clinics were viewed as a highly successful model. Task-sharing and expanded scope of practice of nurses, nurse practitioners and pharmacists, alongside telephone and virtual healthcare consultations, were suggested to create multiple points of entry into the system.
  
  
  CONCLUSIONS
  Results underscore the need for a national strategic approach to family planning health policy and health services delivery in Canada.
authors.affiliation: Resident Physician, McGill University, Montreal, QC.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hulme
authors.affiliation: Clinician Researcher and Associate Professor, Department of Family and Community Medicine, University of Toronto, Toronto, ON.
authors.forename: Sheila
authors.initials: S
authors.lastname: Dunn
authors.affiliation: Senior Medical Advisor, National Institute of Public Health of Quebec, Clinical Professor, Department of Obstetrics and Gynaecology, Laval University, Québec, QC.
authors.forename: Edith
authors.initials: E
authors.lastname: Guilbert
authors.affiliation: Assistant Professor, UBC Faculty of Pharmaceutical Sciences, Director, Community Pharmacist Research Network, University of British Columbia, Vancouver, BC.
authors.forename: Judith
authors.initials: J
authors.lastname: Soon
authors.affiliation: Assistant Professor, Department of Family Practice and Midwifery, University of British Columbia, Vancouver, BC.
authors.forename: Wendy
authors.initials: W
authors.lastname: Norman
mesh_terms: D000328:Adult; D002170:Canada; D016656:Family Planning Policy; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000458:organization & administration*; D019035:Rural Health Services / Q000458:organization & administration*; D055815:Young Adult