title: First-trimester medical abortion practices in Canada: National survey.
abstract: OBJECTIVE
  To understand the current availability and practice of first-trimester medical abortion (MA) in Canada.
  
  
  METHODS
  Using public sources and professional networks, abortion facilities across Canada were identified for a cross-sectional survey on medical and surgical abortion. English and French surveys were distributed by surface or electronic mail between July and November 2013.
  
  
  METHODS
  Canada.
  
  
  METHODS
  A total of 94 abortion facilities were identified.
  
  
  METHODS
  Descriptive statistics on MA practice and facility and provider characteristics, as well as comparisons of MA practice by facility and provider characteristics using χ2andttests.
  
  
  RESULTS
  A total of 78 of 94 (83.0%) facilities responded. Medical abortion represented 3.8% of first-trimester abortions reported (2706 of 70 860) in 2012. Among the facilities offering MA, 45.0% performed fewer than 500 first-trimester abortions a year, while 35.0% performed more than 1000. More MAs were performed in private offices or ambulatory health centres than in hospitals. Sixty-two physicians from 28 of 78 facilities reported providing first-trimester MA; 87.1% also provided surgical abortion. More than three-quarters of MA physicians were female and 56.5% were family physicians. A preponderance (85.2%) of providers offered methotrexate with misoprostol. Nearly all physicians (90.3%) required patients to have an ultrasound before MA, and 72.6% assessed the completion of the abortion with ultrasonography. Most physicians (74.2%) offered MA through 49 days after the onset of the last menstrual period, and 21.0% offered MA through 50 to 56 days; 37.1% reported providing MA to patients who lived more than 2 hours away. Four physicians from 1 site provided MA via telemedicine.
  
  
  CONCLUSIONS
  In Canada, MA provision using methotrexate and misoprostol is consistent with best-practice guidelines, but MA is rare and its availability is unevenly distributed.
authors.affiliation: Senior Medical Advisor in the Institut national de santé publique du Québec in Quebec city. edith.guilbert@inspq.qc.ca.
authors.forename: Edith R
authors.initials: ER
authors.lastname: Guilbert
authors.affiliation: Resident in the School of Population and Public Health at the University of British Columbia.
authors.forename: Althea S
authors.initials: AS
authors.lastname: Hayden
authors.affiliation: Assistant Professor in the School of Public Health in Hunter College at the City University of New York in New York, NY.
authors.forename: Heidi E
authors.initials: HE
authors.lastname: Jones
authors.affiliation: Associate Professor at the Baystate Medical Center at Tufts University School of Medicine in Springfield, Mass.
authors.forename: Katharine O'Connell
authors.initials: KO
authors.lastname: White
authors.affiliation: Professor of Clinical Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine in Chicago, Ill.
authors.forename: E
authors.initials: E
authors.lastname: Steven Lichtenberg
authors.affiliation: Professor in the Beth Israel Deaconess Medical Center at Harvard Medical School in Boston, Mass.
authors.forename: Maureen
authors.initials: M
authors.lastname: Paul
authors.affiliation: Assistant Professor and Canadian Institutes of Health Research Chair of Family Planning Public Health Research in the Department of Family Practice at the University of British Columbia in Vancouver.
authors.forename: Wendy V
authors.initials: WV
authors.lastname: Norman
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data*; D000554:Ambulatory Care Facilities; D002170:Canada; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D010821:Physicians, Family; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D000072263:Private Facilities; D011795:Surveys and Questionnaires; D014463:Ultrasonography