Exploring the Journeys of People Accessing Abortion Care in Ontario, Canada

Abstract

Background: Abortion has been a contentious socio-political issue throughout Canada’s history. Despite the decriminalization of abortion in 1988 and the approval of medication abortion in 2015, challenges to accessing abortion in Ontario still exist. There is a dearth of research on people’s experiences of accessing abortion, especially in an Ontario context.

Research Questions: What are the experiences of people accessing and receiving an abortion in Ontario? When reflecting on their abortion care journeys, how do people who have obtained an abortion perceive their care encounters? How can the provision of abortion care be improved in the Ontario health care system?

Methods: This research project used a qualitative research design, drawing on 16 in-depth, semi-structured narrative interviews from racially and gender diverse participants across Ontario. Participants were recruited through social media accounts of reproductive care organizations. Individuals were eligible to participate in the study if they had received a procedural and/or medication abortion in Ontario in the last 3 years (2020-2023). Interviews were conducted virtually or over the telephone and lasted 1-1.5 hours. This study also employed a novel technique of healthcare journey mapping during interviews to visually depict key healthcare encounters. Narrative-thematic analysis was used to capture themes from participants’ stories.

Findings: Five individuals’ stories and abortion care journey maps are highlighted, demonstrating multiple routes to accessing care and the differential complexity of navigating care. In the next chapter, participants’ accounts are structured into four main themes by story plot element. Most participants encountered difficulties and/or stress accessing care, which posed as the first complicating action in their journeys. The next complicating action stemmed from their interactions with abortion care professionals during diagnostics and assessment of the pregnancy. A range of interactions with care professionals were narrated, fluctuating between services being perceived as restrictive, rushed, and shame-inducing to caring, connective, and, non-judgemental. All participants received at least one abortion, categorized as the plot climax of their story. Participants often found the process of receiving an abortion emotional and/or physically painful. Lastly, the degree of “resolution” of participants’ stories was impacted by the quality of post-abortion care they received for their ongoing physical or emotional needs.

Conclusions: This study is one of the first to blend narrative inquiry with the novel technique of healthcare journey mapping to people’s experiences of abortion care, identifying the gaps in services to provide clients with non-judgemental care. By highlighting a few abortion care maps and stories, it suggests that space needs to be carved out in the healthcare system to provide individualized care sensitive to clients’ emotional, physical, and spiritual needs. It makes several recommendations as to how abortion practice and policy can be improved to be more trauma-informed, abortion-focused, and client-centered.