Half of all pregnancies are unintended and half of these end in abortion. Marginalized and vulnerable populations are overrepresented among those with unintended pregnancies and particularly among those seeking abortion. Access to family planning is particularly challenging for youth; women living in northern, rural or remote locations; of Aboriginal heritage; living with substance use or mental illness; and of lower socioeconomic status.Pharmacist Survey
CART-GRAC undertook extensive National consultations throughout the fall and winter of 2011-12. Results of our conferences, meetings, surveys, and key informant interviews can be found at these links:
Additionally, please see our “Surveys Results” page for links to the English and French Survey results.Canadian Contraception Access Survey
The Transformative Community-based Primary Healthcare Initiative: Proposal for a National Family Planning Primary Healthcare Research Team
Access to high quality knowledge and services to prevent unintended pregnancies and to plan for optimal pregnancy timing is an important issue in Canada. Half of all pregnancies are unintended and nearly a third of Canadian women have an abortion during their lifetime. Vulnerable populations are overrepresented among those with unintended pregnancies and particularly among those seeking abortion. Pregnancy timing is a related issue.There is a need for broad recognition of the risks of delaying childbirth until the least fertile years and, among women with conditions or behaviours that compromise pregnancy health, such alcohol or substance use, to ensure access to optimal family planning so that they are able to achieve the healthiest pregnancies.
Led by primary healthcare clinician scientists, our Contraception Access Research Team\Groupe de recherche sur l’accessibilité à la contraception (CART/GRAC) and network incorporates priority healthcare questions identified by key health policy leaders, health system decision makers, stakeholder community group representatives and primary healthcare professionals guiding high quality research by interdisciplinary academics and researchers-in-training. We propose a programmatic Canadian Community-Based Primary Healthcare (CBPHC) family planning research agenda that will develop, compare and scale-up innovative models of care to address inequities in access to high quality family planning knowledge, services and methods. Our aim is equitable access to CBPHC leading to the prevention of unintended pregnancies, and optimal pregnancy timing. Concurrently we will build capacity for long term solutions through researcher-training, and develop an approach to measurement of meaningful national family planning indicators to track the health outcomes impact of this program of research.
To determine gaps and opportunities for improving equity in access to optimal family planning, we held conferences, surveys and key informant interviews throughout Canada among health system leaders, health service providers and those representing marginalized and vulnerable women and families. Equitable access to family planning is particularly challenging for young people; women of lower socioeconomic status; women living in northern, rural or remote locations; of Aboriginal heritage; living with substance use or mental illness; and new immigrants. Barriers to accessing contraceptives include high costs, lack of knowledge, health system barriers (e.g. inability to access primary care professional prescribing contraception) and distance to services. CART-GRAC proposes 3 linked components to achieve our goals:
- Programmatic Research Addressing Our Objectives:
- Advance the evidence base regarding the effect of innovative models of reproductive care on access to high quality knowledge and services, and on health outcomes;
- Identify the mechanisms by which social inequalities contribute to health system barriers, particularly for vulnerable populations, and use that information to inform novel training and continuing professional education approaches to enhance capacity for patient-centred programming and policy decisions;
- Expand the knowledge base regarding quality of care, and identify new knowledge translation strategies, to reduce the undesired reproductive health outcomes experienced by women, men, boys and girls, particularly those within vulnerable subgroups.
- A Capacity-Building Program: We will implement the first Canadian interdisciplinary, interprofessional clinician and academic researcher capacity-building program in Family Planning research.
- An Outcome Measures Development Process: We will collaborate with all CBPHC teams to report on a common set of outcome measures and will continue collaboration toward formation of a CBPHC Network. As well, CART-GRAC will lead a program to identify and report on process and outcome measures specific to family planning.
The innovative initiatives of CART-GRAC’s program of research and researcher capacity-building will transform access for vulnerable populations to high quality family planning knowledge and services, via equity-enhancing strategies within Canada’s evolving community-based primary healthcare system.
- Wendy V. Norman, MD, MHSc, FCFP
Assistant Professor, Dept of Family Practice;
Associate Member, School of Population & Public Health and Dept of Obstetrics & Gynecology,
Faculty of Medicine, University of British Columbia;
Michael Smith Foundation for Health Research
- Sheila Dunn, MD, MSc, FCFPAssociate Professor and Clinical Investigator, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto
- Shireen Mansouri, MD, FCFPStanton Territorial Hospital, Yellowknife, Northwest Territories and Clinical Lecturer and Preceptor, University of Calgary;
Family physician Yellowknife Health and Social Services
CART-GRAC CORE TEAM