RT Journal Article SR Electronic T1 Perspectives Among Canadian Physicians on Factors Influencing Implementation of Mifepristone Medical Abortion: A National Qualitative Study JF The Annals of Family Medicine JO Ann Fam Med FD American Academy of Family Physicians SP 413 OP 421 DO 10.1370/afm.2562 VO 18 IS 5 A1 Munro, Sarah A1 Guilbert, Edith A1 Wagner, Marie-Soleil A1 Wilcox, Elizabeth S. A1 Devane, Courtney A1 Dunn, Sheila A1 Brooks, Melissa A1 Soon, Judith A. A1 Mills, Megan A1 Leduc-Robert, Genevieve A1 Wahl, Kate A1 Zannier, Erik A1 Norman, Wendy V. YR 2020 UL http://www.annfammed.org/content/18/5/413.abstract AB PURPOSE Access to family planning health services in Canada has been historically inadequate and inequitable. A potential solution appeared when Health Canada approved mifepristone, the gold standard for medical abortion, in July 2015. We sought to investigate the factors that influence successful initiation and ongoing provision of medical abortion services among Canadian health professionals and how these factors relate to abortion policies, systems, and service access throughout Canada.METHODS We conducted 1-on-1 semistructured interviews with a national sample of abortion-providing and nonproviding physicians and health system stakeholders in Canadian health care settings. Our data collection, thematic analysis, and interpretation were guided by Diffusion of Innovation theory.RESULTS We conducted interviews with 90 participants including rural practitioners and those with no previous abortion experience. In the course of our study, Health Canada removed mifepristone restrictions. Our results suggest that Health Canada’s initial restrictions discouraged physicians from providing mifepristone and were inconsistent with provincial licensing standards, thereby limiting patient access. Once deregulated, remaining factors were primarily related to local and regional implementation processes. Participants held strong perceptions that mifepristone was the new standard of care for medical abortion in Canada and within the scope of primary care practice.CONCLUSION Health Canada’s removal of mifepristone restrictions facilitated the implementation of abortion care in the primary care setting. Our results are unique because Canada is the first country to facilitate provision of medical abortion in primary care via evidence-based deregulation of mifepristone.