SAFE METHODS AT THE RIGHT TIME: Results of the SMART Pilot Program A BC Women’s Hospital + Health Centre partnership with BC health authorities and abortion providers Presented by Dr. Sheila With and Suzie Maginley
ACKNOWLEDGMENTS Thank you to: • Dr. Wendy Norman and her team • Caitlin Johnston and Ronnalea Hammon • BC Women’s Hospital + Health Centre • BC Ministry of Health • All participating physicians and sites
DISCLOSURES We have no personal disclosures or conflicts of interest.
ABOUT THE PROGRAM Approximately half of all women who have an abortion in BC will have a pregnancy within 2 years if they are unable to initiate contraception at time of abortion. S afe M ethods a t the R ight T ime (“ SMART ”) is intended to reduce future unintended pregnancies by providing free and effective contraception at time of abortion.
PROGRAM ELIGIBILITY CRITERIA • Facilities must be accredited by Accreditation Canada, CPSBC or NAF • Participants must reside in BC, have provincial health insurance coverage and present for an abortion at a participating facility • Non-elective abortions (such as miscarriages or removal of retained products) are ineligible
AVAILABLE CONTRACEPTIVE OPTIONS 1. Hormone-releasing intrauterine contraceptive 2. Copper intrauterine device (non-hormonal) 3. One package of combined oral contraceptive pills 4. One injection of depot medroxyprogesterone acetate
PROGRAM REQUIREMENTS Time-limited funding must support efficient purchasing of contraceptives (the program’s largest expense) Clear eligibility criteria to avoid duplication of other government – funded contraception coverage Standardized training at facilities to uphold contract commitments and promote reliable data collection
INTERIM EVALUATION RESULTS This January, we conducted an interim evaluation of all program-eligible women from Jan 2017 to Sep 2019. In total, 22,876 women were eligible for the Program during this period and were included in our analyses.
SMART PROGRAM REACH 2017: 2019: Reached an estimated Reached an estimated one-third of women two-thirds of women having an abortion in BC having an abortion in BC
CONTRACEPTIVE UPTAKE: LARC VS. SARC uptake ARC up 26.3% and SAR LARC an 44.0% 58.4% LAR 14.0% Baseline Program LARC SARC
CONTRACEPTIVE UPTAKE: BY PROCEDURE 12.6% 15.2% 22.9% uptake, procedure type 24.1% 26.0% Contraceptive up 31.6% by pr 63.4% 58.8% 45.5% Surgical abortion Medical abortion Total LARC SARC Tier 3 Method
REDUCTION OF SUBSEQUENT PREGNANCIES 9,000 8,250 Number of subsequent pregnancies 8,000 7,000 36.9% reduction 6,000 5,202 5,000 4,000 3,000 2,000 1,000 0 Baseline With Program
OUTCOMES AND OPPORTUNITIES • Increase access to contraception — particularly highly effective, long-term methods — for women experiencing unintended pregnancy • Demonstrate positive population health and health system impacts in BC • Potential to influence policy advancement relating to contraceptive access for all women in BC
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