Context: Although Canadian women have had the right to obtain legal induced abortions for the past decade, access to the procedure is still limited and controversial in many areas.
Methods: Chiefs of obstetrics and gynecology, chiefs of staff, directors of nursing and other health professionals at 163 general hospitals in Ontario, Canada, were asked to provide information on issues concerning the availability of abortion services of their facility. The hospital participation rate was 97% and the individual response rate was 75%.
Results: Nearly one-half (48%) of hospitals perform abortions. Approximately 36% of these hospitals do so up to a maximum gestational age of 12 weeks, 23% to a maximum of 13-16 weeks, 37% to a maximum of 17-20 weeks and 4% at greater than 20 weeks. Hospital factors, including resources and policies, did not significantly influence whether abortions are provided. However, these factors did affect the number performed, whether there were gestational limitations and the choice of procedure. About 13% of provider hospitals indicated that staff training contributes to the existence of gestational age limits, and 24% said that it directly influences procedure choice. Only 18% of hospitals reported that their physicians have received additional training outside of their medical school or medical residency education to learn abortion techniques or to gain new skills. Forty-five percent of hospitals that provide abortions had experienced harassment within the past two years, and 15% reported that this harassment has directly affected their staff members' willingness to provide abortions.
Conclusion: Based upon the provision of obstetric care, many hospitals in Ontario that are capable of offering abortion services do not. Some of the reasons for this failure are related to the procedure itself, while others may be related to resource issues that affect the delivery of other medical services as well. Variation in the availability of abortions is due to a shortage of clinicians performing the procedure, and training directly influences gestational limits and procedural choices.
PIP: Although induced abortion was awarded the same status as any other medical procedure in 1991 in Canada, women's access to the procedure remains limited. To identify factors influencing the delivery of abortion services, a questionnaire was mailed to chiefs of obstetrics and gynecology, chiefs of staff, directors of nursing, and other health professionals at 163 general hospitals in Ontario, Canada, in 1994. The hospital participation rate was 97% and the individual response rate was 75%. Of the 158 responding hospitals, 76 (48%) perform abortions--36% up to 12 weeks' gestation, 23% to a maximum of 13-16 weeks, 37% up to 17-20 weeks, and 4% beyond 20 weeks. Staff preferences and training were significant determinants of both these age limits and the choice of procedures offered. 47% of provider hospitals had written guidelines or policies regulating abortion. 67% provided alternative work assignments for nurses unwilling to participate in pregnancy terminations. Only 18% of hospitals reported that their staff physicians have received training beyond that obtained in medical school or medical residencies to learn abortion techniques or gain new skills. 45% of hospitals that provide abortion had experienced harassment--primarily picketing--in the 2 years preceding the survey and, in 15% of hospitals, this harassment had reportedly affected the willingness of staff members to provide abortions. If provision of obstetric care is a marker for a hospital's capacity to provide abortion services, 59 general hospitals (72% of nonproviders) do not provide abortion despite the capacity to do so. The restructuring process currently underway in Canadian hospitals should include steps to ensure more widespread access to abortion services and more opportunities for physicians to become trained in this area.