Experiences of midwife-led abortion care through Ontario’s expanded midwifery care models: an interpretive description study

Abortion is time-sensitive, and barriers to care such as a lack of providers, long wait times, multiple appointments in different locations, and discrimination exist globally. In Canada, midwifery services are accessible across various populations, suggesting a potential to enhance access to quality abortion care, particularly for underserved individuals. The World Health Organization and the Canadian Association of Midwives support the integration of comprehensive abortion care within midwifery practice. When midwives provide abortion services, international evidence indicates positive outcomes, including effectiveness, safety, acceptability, and post-abortion contraception uptake. In 2018, the Ministry of Health in Ontario, Canada, announced funding for expanded midwifery care to address service gaps, support community needs, foster interprofessional collaboration, and offer improved continuity of care. Some expanded midwifery care models in Ontario provide comprehensive abortion care within primary care centres. This research aimed to describe the experiences of midwives, clients, and other healthcare providers who participated in midwife-led abortion across three regions in Ontario. Interpretive description methodology informed processes of purposeful sampling, data generation through surveys, interviews, documents and an interpretive approach to analysis. Eighteen people completed surveys and were interviewed. Midwife-led abortion care improves access and experiences of abortion, provides continuity for other sexual and reproductive healthcare needs, and promotes interprofessional collaboration and job satisfaction. Overall, the research suggests that expanding the role of Canadian midwives to include comprehensive abortion care could enhance accessibility, improve the quality and convenience of services, and promote professional sustainability. These qualitative findings can be conceptually utilized to inform and improve clinical practice, support midwifery policy change, and identify valued abortion care outcomes for future research.