FACTORS INFLUENCING THE DELIVERY OF ABORTION SERVICES IN ONTARIO - A DESCRIPTIVE STUDY

Context: Although Canadian women have had the right to obtain legal in duced 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 abort ion services at 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 hospital s 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, thes e factors did affect the number performed, whether there were gestatio nal limitations and the choice of procedure. About 13% of provider hos pitals indicated that staff training contributes to the existence of g estational age limits, and 24% said that it directly influences proced ure choice. Only 18% of hospitals reported that their physicians have received additional training outside of their medical school or medica l residency education to learn abortion techniques or to gain new skil ls. Forty-five percent of hospitals that provide abortions had experie nced harassment within the past two years, and 15% reported that this harassment has directly affected their staff members' willingness to p rovide abortions. Conclusion: Based upon the provision of obstetric ca re, many hospitals in Ontario that are capable of offering abortion se rvices do not Some of the reasons for this failure are related to the procedure itself while others may be related to resource issues that a ffect the delivery of other medical services as well. Variation in the availability of abortions is due to a shortage of clinicians performi ng the procedure, and training directly influences gestational limits and procedural choices.