BC MIFEPRISTONE PROVIDER STUDY RESULTS Presentations by the - PowerPoint PPT Presentation

BC MIFEPRISTONE PROVIDER STUDY RESULTS Presentations by the Contraception and Abortion Research Team C O N T R A C E P T I O N & A B O R T I O N B C : E X P E R I E N C E G U I D I N G R E S E A R C H G U I D I N G C A R E

SUPPORTING EQUITABLE ACCESS TO ABORTION CARE PROBLEMS, SOLUTIONS & NEXT STEPS Kate Wahl, MSc P H D S T U D E N T @ K A T E J W A H L

SPEAKER/PRESENTER DISCLOSURE Kate Wahl & Laura Schummers I declare I have no relationship with commercial interests. 3

ACKNOWLEDGEMENTS 4

THE CART-MIFE STUDY 5

WHAT MAKES MIFEPRISTONE DIFFICULT TO PROVIDE? Federal restrictions Apr 2017 Structural barriers – Dec 2018 Rapidly changing regulations Munro S et al. Factors influencing implementation of mifepristone. Ann. Fam. Med. In press. 2020. 6

WHAT DID CART & COLLABORATORS DO TO ADDRESS BARRIERS TO CARE? “I think there’s been a lot of design going into making that a safe space … It’s a nice centralized way of getting information” - 021_Phys Munro S et al. Factors influencing implementation of mifepristone. Ann. Fam. Med. In press. 2020. 7

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WHAT CAN WE STILL DO TO ADVANCE EQUITABLE ACCESS TO ABORTION CARE? What’s your story? 13

CART MIFEPRISTONE OUTCOMES STUDY EXAMINING THE EFFECT OF MIFEPRISTONE ON CANADIAN ABORTION ACCESS, OUTCOMES, AND COSTS Laura Schummers, ScD P O S T - D O C T O R A L F E L L O W C I H R H E A L T H S Y S T E M I M P A C T F E L L O W M I C H A E L S M I T H F O U N D A T I O N F O R H E A L T H R E S E A R C H T R A I N E E P O S T - D O C T O R A L T R A I N E E , I C E S M C M A S T E R @ D R L S C H U M M E R S

HOW DID MIFEPRISTONE CHANGE ABORTION IN BC? • abortion access • abortion complications • health system costs Is the unique Canadian medical abortion policy approach working?

POLICY ANALYSIS: How do we measure a policy effect? 30% Mifepristone Mifepristone Access introduced subsidized - Travel time; service 20% distribution Outcomes 10% Policy - Safety; effect complications 5% Costs Pre-mife Mife available Mife funded - Healthy system 0 payments 2012 2017 2018 2020

PREGNANCY SPACING DETERMINING THE OPTIMAL INTERPREGNANCY INTERVAL FOR HIGH-RISK POPULATIONS Laura Schummers, ScD P O S T - D O C T O R A L F E L L O W C I H R H E A L T H S Y S T E M I M P A C T F E L L O W M I C H A E L S M I T H F O U N D A T I O N F O R H E A L T H R E S E A R C H T R A I N E E P O S T - D O C T O R A L T R A I N E E , I C E S M C M A S T E R @ D R L S C H U M M E R S

INTERPREGNANCY INTERVAL RECOMMENDATIONS Recommendations: After a live birth: interval ≥24 months After a miscarriage or induced abortion: interval ≥6 months after live birth after miscarriage after induced abortion after perinatal loss specific high-risk populations - advanced maternal age - infertility

OPTIAL INTERPREGNANCY INTERVAL FOR WOMEN AGE ≥35? • Delivery to conception intervals shorter than 12 months : • Increased adverse fetal-infant outcomes and preterm birth risks for women <35 and ≥35 • Increased severe maternal morbidity risks only for women ≥35?

INTERPREGNANCY INTERVAL AFTER A PERINATAL LOSS? Following a perinatal loss, short interpregnancy interval: • Increased spontaneous preterm birth risk • No increased adverse fetal-infant outcome risk

INTERPREGNANCY INTERVAL FOR HIGH-RISK WOMEN? • After spontaneous preterm birth? • After ovulation stimulation therapy for infertility? • New pregnancy spacing recommendations?