Wendy Norman
Women in rural B.C. undergoing abortions are more likely than those in urban areas to be given general anesthesia during the procedure, and their abortion providers are more likely to experience barriers to the provision of care.
“Ninety per cent of the nearly 16,000 abortions performed in B.C. in 2010 took place in urban facilities, even though only just over half of child-bearing age women live in these areas,” says Wendy V. Norman, a family physician and Assistant Professor in the Department of Family Practice, who led the comparative study, the first of its kind in Canada. “This in itself is not surprising because over the past decade, the province has lost 60 per cent of rural abortion providers.”
“What concerns us is that all surgical abortions in rural B.C. communities are performed in a hospital operating room setting, often under general anesthesia,” says Dr. Norman, one of the lead scientists on the Canadian Contraception Access Research Team. “And half of the abortion providers reported difficulty booking time for abortion procedures due to conflict in operating room scheduling, or nurses or anesthesiologists who refuse to work with abortion cases.”
By contrast, the majority of surgical abortions in B.C.’s three urban centres are performed in outpatient facilities using local anesthesia.
“In urban areas, almost all abortions are performed in specialized clinics, with the staff hired specifically to perform these services,” Dr. Norman adds. “They feel very on board with their work, which in turn provides emotional support for the urban doctors,” Norman observes.
Raising awareness, reducing risk
Moving rural abortion services out of operating rooms and into outpatient facilities, says Dr. Norman, could lower the cost of services, help address the stigma reported by rural physicians, and reduce the risk to women associated with undergoing general anesthesia.
“One encouraging trend we noticed is that almost half of the rural cases are done medically, which is safe and affords women more privacy. This is much higher ratio than previously thought,” says Dr. Norman. “But we need to better educate women about this option as it is only available to women within the first seven weeks of pregnancy.”
“Birth control and reproductive planning is a public health issue, but it’s not being studied or discussed as widely as other issues, often to the detriment of the health of families,” says Dr. Norman. “We hope our research can empower women and their families to make their own reproductive plan and better inform future health care investments.”
Dr. Norman and her team will lead a collaborative interdisciplinary meeting in May 2014. Abortion service stakeholders from B.C. will come together with national and international experts aiming to examine the survey results and best evidence, using the knowledge gained to improved access to high quality abortion services throughout B.C.