The Impact of Full Coverage of Mifegymiso in British Columbia
Question 1: How did the introduction of Mifegymiso impact abortion service usage and type of service sought? Did this change after each coverage policy for Mifegymiso was instated?
Hypothesis 1: The overall rate of abortion services usage has not changed. However, there is an increase in medical abortions and decrease in surgical abortions, and an increase in abortion using telemedicine, which will further increase with full coverage of Mifegymiso. The proportion of abortions before 14 completed weeks of gestation increased with the introduction of Mifegymiso and again with full coverage.
Question 2: How did the introduction of mifepristone impact abortion service access?
Hypothesis 2: Abortion access improved after mifepristone introduction and full coverage, with an expansion in the number and geographical distribution of abortion providers and shorter travel time and distance between patient residence and abortion service location after Mifegymiso introduction and full coverage.
Question 3: How do the rates of abortion-related complications and adverse events (e.g., incomplete abortions, re-aspiration, failed abortion, severe bleed, pelvic infections, severe maternal morbidity) differ between each abortion method? Have the rates changed since the introduction, listing, and full coverage of Mifegymiso was instated?
Hypothesis 3: The incidence of re-aspiration following incomplete abortion is highest amongst medical abortion recipients, with an increase in the rate with the introduction of Mifegymiso and again with full coverage. The incidence of other complications and severe adverse outcomes has remained constant.
Question 4: How has abortion-related health resource utilisation and expenditure been impacted by the reimbursement decision of Mifegymiso?
Hypothesis 4: The reimbursement of Mifegymiso did not impact overall abortion-related health services utilization or expenditures.
Question 5: Do patient characteristics (e.g. age, income, urban/rural location) differ according to abortion type sought (surgical, Mifegymiso, methotrexate)? Have these characteristics changed after Mifegymiso became available, was listed, and when full coverage was instated?
Hypothesis 5: Characteristics of individuals do differ depending on the chosen type of abortion method. These characteristics have changed over time since Mifegymiso became available and particularly after full coverage was instated.
Question 6: How has the introduction, listing, and full coverage of mifepristone medical abortion impacted abortion provider characteristics (specialty abortion providers [those performing >= 50 medical or surgical abortions in the previous year] vs. primary care providers; nurse practitioners vs. physicians; urban vs. rural service location; new to abortion care vs. experienced; male vs. female provider sex)?
Hypothesis 6: Mifegymiso introduction increased the number of providers offering abortion services, increased the proportion of abortions provided by primary care providers, those new to abortion care and those in rural service locations. These were increased further with the each subsequent coverage policy of Mifegymiso.
Question 7: How has the number and geographical distribution of pharmacies dispensing Mifegymiso changed since mifepristone introduction, listing, and full coverage?
Hypothesis 7: The number of pharmacies dispensing Mifegymiso has increased over time, including wider geographical coverage.
Question 8: How has the outcomes of unintended pregnancies changed since mifepristone introduction, listing, and full coverage? Do these differ by local health areas?
Hypothesis 8: The rate of births and stillbirths decreased slightly while abortion rates increase. These effects are more marked in rural local health areas.
Question 9: Has post-abortion utilization of contraceptive methods changed after Mifegymiso became available, was listed, and when full coverage was instated? Does post-abortion contraception utilization or method vary by abortion type?
Hypothesis 9: Utilization of post-abortion contraceptive methods have not changed after mifepristone became available, was listed, and when full coverage was instated; post-abortion contraceptive utilization and method do not vary by abortion type.
Question 10: Does post-abortion medication utilization (e.g. analgesics, anxiolytics, psychiatric medications) differ between the abortion methods? Did utilization rates change after mifepristone became available, was listed, and when full coverage was instated?
Hypothesis 10: Post-abortion medication utilization does not differ by type of abortion and the rate of utilization did not change.