Evidence map›Paper›PMID 40194816›Full record

ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2025

Changes in local access to mifepristone dispensed by community pharmacies for medication abortion in Ontario: a population-based repeated cross-sectional study.

Laura Schummers, Michael R Law, Kimberlyn McGrail, Elizabeth K Darling, Enav Z Zusman, Sheila Dunn, Janusz Kaczorowski, Anastasia Gayowsky, Peter Gozdyra, Wendy V Norman

Erratum issuedAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Canadian family physician Medecin de famille canadien
    Article
  5. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Laura SchummersCollaboration for Outcomes Research and Evaluation (Schummers), Faculty of Pharmaceutical Sciences, University of British Columbia; Centre for Health Services and Policy Research (Law, McGrail), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Darling), McMaster University; ICES McMaster (Darling, Gayowsky), Hamilton, Ont.; Department of Obstetrics & Gynaecology (Zusman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Dunn), University of Toronto; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; ICES UofT (Gozdyra), Toronto, Ont.; Dalla Lana School of Public Health (Gozdyra), University of Toronto, Toronto, Ont.; Department of Family Practice (Norman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Public Health, Environments and Society (Norman), Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK. laura.schummers@ubc.ca.
Michael R LawCollaboration for Outcomes Research and Evaluation (Schummers), Faculty of Pharmaceutical Sciences, University of British Columbia; Centre for Health Services and Policy Research (Law, McGrail), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Darling), McMaster University; ICES McMaster (Darling, Gayowsky), Hamilton, Ont.; Department of Obstetrics & Gynaecology (Zusman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Dunn), University of Toronto; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; ICES UofT (Gozdyra), Toronto, Ont.; Dalla Lana School of Public Health (Gozdyra), University of Toronto, Toronto, Ont.; Department of Family Practice (Norman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Public Health, Environments and Society (Norman), Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Kimberlyn McGrailCollaboration for Outcomes Research and Evaluation (Schummers), Faculty of Pharmaceutical Sciences, University of British Columbia; Centre for Health Services and Policy Research (Law, McGrail), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Darling), McMaster University; ICES McMaster (Darling, Gayowsky), Hamilton, Ont.; Department of Obstetrics & Gynaecology (Zusman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Dunn), University of Toronto; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; ICES UofT (Gozdyra), Toronto, Ont.; Dalla Lana School of Public Health (Gozdyra), University of Toronto, Toronto, Ont.; Department of Family Practice (Norman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Public Health, Environments and Society (Norman), Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Elizabeth K DarlingCollaboration for Outcomes Research and Evaluation (Schummers), Faculty of Pharmaceutical Sciences, University of British Columbia; Centre for Health Services and Policy Research (Law, McGrail), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Darling), McMaster University; ICES McMaster (Darling, Gayowsky), Hamilton, Ont.; Department of Obstetrics & Gynaecology (Zusman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Dunn), University of Toronto; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; ICES UofT (Gozdyra), Toronto, Ont.; Dalla Lana School of Public Health (Gozdyra), University of Toronto, Toronto, Ont.; Department of Family Practice (Norman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Public Health, Environments and Society (Norman), Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Enav Z ZusmanCollaboration for Outcomes Research and Evaluation (Schummers), Faculty of Pharmaceutical Sciences, University of British Columbia; Centre for Health Services and Policy Research (Law, McGrail), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Darling), McMaster University; ICES McMaster (Darling, Gayowsky), Hamilton, Ont.; Department of Obstetrics & Gynaecology (Zusman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Dunn), University of Toronto; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; ICES UofT (Gozdyra), Toronto, Ont.; Dalla Lana School of Public Health (Gozdyra), University of Toronto, Toronto, Ont.; Department of Family Practice (Norman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Public Health, Environments and Society (Norman), Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Sheila DunnCollaboration for Outcomes Research and Evaluation (Schummers), Faculty of Pharmaceutical Sciences, University of British Columbia; Centre for Health Services and Policy Research (Law, McGrail), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Darling), McMaster University; ICES McMaster (Darling, Gayowsky), Hamilton, Ont.; Department of Obstetrics & Gynaecology (Zusman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Dunn), University of Toronto; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; ICES UofT (Gozdyra), Toronto, Ont.; Dalla Lana School of Public Health (Gozdyra), University of Toronto, Toronto, Ont.; Department of Family Practice (Norman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Public Health, Environments and Society (Norman), Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Janusz KaczorowskiCollaboration for Outcomes Research and Evaluation (Schummers), Faculty of Pharmaceutical Sciences, University of British Columbia; Centre for Health Services and Policy Research (Law, McGrail), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Darling), McMaster University; ICES McMaster (Darling, Gayowsky), Hamilton, Ont.; Department of Obstetrics & Gynaecology (Zusman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Dunn), University of Toronto; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; ICES UofT (Gozdyra), Toronto, Ont.; Dalla Lana School of Public Health (Gozdyra), University of Toronto, Toronto, Ont.; Department of Family Practice (Norman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Public Health, Environments and Society (Norman), Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Anastasia GayowskyCollaboration for Outcomes Research and Evaluation (Schummers), Faculty of Pharmaceutical Sciences, University of British Columbia; Centre for Health Services and Policy Research (Law, McGrail), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Darling), McMaster University; ICES McMaster (Darling, Gayowsky), Hamilton, Ont.; Department of Obstetrics & Gynaecology (Zusman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Dunn), University of Toronto; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; ICES UofT (Gozdyra), Toronto, Ont.; Dalla Lana School of Public Health (Gozdyra), University of Toronto, Toronto, Ont.; Department of Family Practice (Norman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Public Health, Environments and Society (Norman), Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Peter GozdyraCollaboration for Outcomes Research and Evaluation (Schummers), Faculty of Pharmaceutical Sciences, University of British Columbia; Centre for Health Services and Policy Research (Law, McGrail), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Darling), McMaster University; ICES McMaster (Darling, Gayowsky), Hamilton, Ont.; Department of Obstetrics & Gynaecology (Zusman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Dunn), University of Toronto; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; ICES UofT (Gozdyra), Toronto, Ont.; Dalla Lana School of Public Health (Gozdyra), University of Toronto, Toronto, Ont.; Department of Family Practice (Norman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Public Health, Environments and Society (Norman), Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Wendy V NormanCollaboration for Outcomes Research and Evaluation (Schummers), Faculty of Pharmaceutical Sciences, University of British Columbia; Centre for Health Services and Policy Research (Law, McGrail), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Darling), McMaster University; ICES McMaster (Darling, Gayowsky), Hamilton, Ont.; Department of Obstetrics & Gynaecology (Zusman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Dunn), University of Toronto; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; ICES UofT (Gozdyra), Toronto, Ont.; Dalla Lana School of Public Health (Gozdyra), University of Toronto, Toronto, Ont.; Department of Family Practice (Norman), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Public Health, Environments and Society (Norman), Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlthough mifepristone for medication abortion has been available in Canada since a regulatory change in 2017, leading to its rapid uptake, the effects of this availability on regional access to abortion are unknown. We sought to examine how community pharmacy dispensation of mifepristone affected distribution of abortion services over time in Ontario, Canada.

methodsWe used linked health administrative data to identify a cohort of all medication and procedural abortions provided in Ontario from 2017 to 2022, defined by outpatient mifepristone dispensations and abortion billing, diagnostic, and procedure codes. We evaluated changes over time in the annual proportion of community pharmacies that dispensed mifepristone and the availability and distribution of medication and procedural abortion services across geographic regions, defined by postal code forward sortation areas.

resultsIn 2017, 2% of Ontario pharmacies filled 1 or more prescriptions for mifepristone, which increased to 20% in 2022. In 2017, few regions contained a mifepristone-dispensing pharmacy (19%) or procedural abortion service (18%). By 2022, most regions had local access to a mifepristone-dispensing pharmacy (77%), with geographically distributed abortion services across Ontario. Although only 37% of abortion service users lived in a region with either a mifepristone-dispensing pharmacy or procedural provider in 2017, this increased to 91% by 2022.

interpretationAccess to medication abortion across Ontario increased substantially within 5 years of mifepristone's availability as a normally prescribed and dispensed medication. This regulatory approach appears successful for achieving widespread access to local abortion services.

Indexed as

Abortifacient Agents, SteroidalAbortion, InducedCommunity Pharmacy ServicesHealth Services AccessibilityMifepristonePharmaciesAdultCross-Sectional StudiesFemaleHumansOntarioPregnancyAbortifacient Agents, SteroidalMifepristone

Identifiers

PMID40194816
PMCPMC11991852

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.