Angel Foster

University of Ottawa · Faculty of Health Sciences

Since 1979, US federal appropriations bills have prohibited the use of federal funds from covering abortion care for Peace Corps volunteers. There are no exceptions; unlike other groups that receive health care through US federal funding streams, including Medicaid recipients, federal employees, and women in federal prisons, abortion care is not co...

The worldwide expansion of the Internet offers an important modality of disseminating medically accurate information about medication abortion. We chronicle the story of www.medicationabortion.com, an English-, Spanish-, Arabic- and French-language website dedicated to three early abortion regimens. We evaluated the website use patterns from 2005 t...

Despite its safety and efficacy, emergency contraception (EC) continues to spark political controversy worldwide. In this edited volume, authors explore how emergency contraception has been received, interpreted, and politicized, through the in-depth examination of the journey of EC in 16 individual countries.

In the United States, ectopic pregnancies are relatively common and associated with significant maternal morbidity and mortality. The Ethical and Religious Directives for Catholic Health Care Services (the Directives) govern the provision of care in Catholic-affiliated hospitals and prohibit the provision of abortion in almost all circumstances. Al...

Emergency contraception (EC) has the potential to reduce significantly the incidence of unintended pregnancy worldwide. In May 2003, the first Arabic-language web site dedicated to disseminating information about and increasing awareness of EC was launched. This paper examines patterns of web site use and user profiles over a 19-month period. Analy...

This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: This QES aims to address the following question: What are the lived experiences and perceptions of abortion seekers (i.e. pregnant women, transgender men, and non-binary people of any gender) traveling to obtain care? The review objectives are to: synthesize the...

Introduction The 2022 Massachusetts Shield Law protects telemedicine providers who care for abortion seekers in other states from criminal, civil, and licensure penalties. In this article we explore the characteristics of patients of The Massachusetts Medication Abortion Access Project (The MAP). Methods The MAP is an asynchronous telemedicine ser...

Although contraception and abortion are considered medically necessary services, providers in Canada are permitted to deny services and referrals on the basis of their personal beliefs or conscience. Belief-based denial, sometimes referred to as “conscientious objection,” remains a controversial issue leading to barriers to access and provision of...

Introduction Intimate partner violence (IPV) involves an individual committing acts intended to harm or intimidate a current or former romantic partner. The COVID‐19 pandemic and subsequent stay‐at‐home orders often trapped victims with perpetrators and intensified IPV. Although sexual and gender diverse people disproportionately experience IPV com...

Clinical discoveries largely depend on dedicated clinicians and scientists to identify and pursue unique and unusual clinical encounters with patients and communicate these through case reports and case series. This process has remained essentially unchanged throughout the history of modern medicine. However, these traditional methods are inefficie...

Most people experience trauma at some point in their lives. The sources of trauma can include accidents, natural disasters, physical or sexual assault, combat, torture, or the death of a loved one. Experiencing or witnessing any of these, or other terrifying events, may make one susceptible to developing post-traumatic stress disorder (PTSD), a tra...

Objectives: Both the National Abortion Federation Canada and Action Canada for Sexual Health and Rights operate national toll-free hotlines that provide information, financial support, and travel assistance to abortion seekers. We aimed to characterize callers to both hotlines before and after the onset of the COVID-19 pandemic. Methods: Hotline...

Background: Reliable and rigorously collected sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) data in humanitarian settings is often sparse and variable in quality across different humanitarian settings. To address this gap in data quality, the World Health Organization (WHO) developed a core set of indicators for m...

Objectives Clinical discoveries are heralded by observing unique and unusual clinical cases. The effort of identifying such cases rests on the shoulders of busy clinicians. We assess the feasibility and applicability of an augmented intelligence framework to accelerate the rate of clinical discovery in preeclampsia and hypertensive disorders of pre...

Background Preeclampsia is a leading cause of maternal and perinatal mortality and morbidity. The management of preeclampsia has not changed much in more than two decades, and its aetiology is still not fully understood. Case reports and case series have traditionally been used to communicate new knowledge about existing conditions. Whether this is...

Since the decriminalization of abortion in Canada in 1988, there have been no legal restrictions on when in pregnancy an abortion can take place. However, abortion care is only consistently available in Canada up to 23 weeks and 6 days; women, transgender men, and gender non-binary individuals who need abortion care after 24 weeks typically obtain...

Objective: Travel restrictions, physical distancing and quarantine requirements, lockdowns, and stay-at-home orders due to COVID-19 have impacted abortion services across Canada. We aimed to explore the decision-making and care experiences of those who obtained abortion services during the COVID-19 pandemic and understand recent abortion patients'...

Objective: To evaluate the outcomes of a community-based distribution program in which lay providers offer women in Sindh, Pakistan misoprostol for early abortion. Methods: We reviewed monitoring logbooks to examine pregnancy outcomes and analyzed logbook data using descriptive statistics. Results: In late 2019, 120 women obtained abortion car...

Post-sedation escort policies are not evidence-based but traditional consensus recommendations made by professional societies. As people travel further for abortion care, escort policies are increasingly difficult to navigate and force people to delay care, compromise privacy, or undergo procedures without sedation. At worst, clinics may turn away...

Objectives Following the 2017 introduction of mifepristone in Canada and both ensuing regulatory changes and increased demand for medication abortion care, Planned Parenthood Ottawa created the Medical Abortion Access Project (MAAP). This study aimed to document outcomes, identify facilitators and barriers, and distill learnings from an initiative...

Background: Reliable and rigorously collected sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) data in humanitarian settings is often sparse and variable in quality across different humanitarian settings. To address this gap in data quality, the World Health Organization (WHO) developed a core set of indicators for mo...

Introduction In 2019, over 70 million people were forcibly displaced worldwide. Women and girls comprise nearly half of this population and are at heightened risk of negative sexual and reproductive health outcomes. With the collapse of health systems, reduced resources and increased vulnerabilities from displacement, there is a need to strengthen...

Objective: To explore violence and disruption events reported by Canadian facilities providing abortion care in 2017, when only three provinces had passed safe access zone legislation. Methods: We reviewed self-reported data from 16 of 38 Canadian members of the National Abortion Federation. Results: Twelve facilities in seven provinces report...

s These scientific abstracts are scheduled for presentation at the 2021 Society of Family Planning Annual Meeting. This year, 225 abstracts were submitted for consideration, of which 12 were selected for oral presentation and 84 were selected for poster presentation. The scientific abstract review was completed by the scientific reviewers and selec...

The COVID-19 pandemic disrupted health care delivery in all aspects of medicine, including abortion care. For six months, the mifepristone Risk Evaluation and Mitigation strategy (REMS) was temporarily blocked, allowing for remote provision of medication abortion. Remote medication abortion may become a dominant model of care in the future, either...

IntroductionUganda hosts over 1.4 million refugees and is regarded as one of the world’s most hospitable places for displaced populations. However, reports suggest that comprehensive sexual and reproductive health (SRH) services remain inadequate. We aimed to explore the SRH experiences of Congolese refugees living in Uganda and ways that services...

In 2017, mifepristone and misoprostol became available for early pregnancy termination as the combination pack Mifegymiso® in Ottawa, Ontario, Canada. We conducted 40 semi-structured telephone interviews with Ottawa residents who had abortions before mifepristone’s introduction (n = 20) and after mifepristone–misoprostol became available (n = 20) t...

Objective Patient-centered care (PCC) could reduce gender inequities in quality of care. Little is known about how to implement patient-centered care for women (PCCW). We aimed to generate consensus recommendations for achieving PCCW. Methods We used a 2-round Delphi technique. Panelists included 21 women of varied age, ethnicity, education, and u...

Objectives Although a body of research has focused on violence, disruption, and harassment targeting abortion clinics and clinic staff, little research has explored Canadian abortion patients’ experiences with protesters. Through this national qualitative study we aimed to address this gap. Methods Between 2012 and 2016, we conducted in-depth inte...

Introduction For more than a decade, the National Abortion Federation (NAF) has operated a Hotline to improve access to abortion care in the US. Each year NAF Hotliners work with thousands of low-income women living in states in which abortion is not covered by state-level Medicaid to obtain subsidized abortion care. Through in-depth interviews wit...

Introduction In July 2015, Health Canada approved the mifepristone/misoprostol regimen under the brand name Mifegymiso® for early abortion in Canada. The initial decision included several non-evidence-based restrictions, including limiting use to seven weeks gestation. The combi-pack became available in January 2017 but was not covered by provincia...

Although levonorgestrel-only emergency contraceptive pills (LNg-ECPs) have been available over the counter in Canada for more than a decade, barriers to access persist. We aimed to obtain information about the availability and cost of LNg-ECPs in New Brunswick. Using a mystery-client study design, we called all 207 non-specialty pharmacies in the p...

Objectives The gold standard of medication abortion, mifepristone and misoprostol, became available in Canada in 2017 as a combination pack under the trade name Mifegymiso®. We aimed to document people’s experiences deciding to use and accessing medication abortion and generate insights for how information and services could be improved. Methods W...

Objective We analyzed trends in medication abortion provision before and after the 2017 introduction of mifepristone in Canada. Methods We reviewed 2016-2018 abortion services data from Canadian members of the National Abortion Federation (NAF) to determine the overall proportion of medication abortions in each calendar year as well as temporal an...

Background: Considerable research shows that women experience gendered disparities in healthcare access and quality. Patient-centred care (PCC) could reduce inequities by addressing the patient's clinical and personal needs. Healthcare policies can influence service delivery to optimise patient outcomes. This study assessed whether and how governm...

The number of people who wish to stop an abortion once it has started is low. There is little evidence-based guidance for clinicians about how to help those few patients who may want to stop an abortion procedure once it has started. This National Abortion Federation Clinical Policies Committee guidance discusses certainty around abortion decision...

Objectives: Across Australia, multiple strategies have emerged to decentralize abortion care and increase access to mifepristone, including incorporating medication abortion into primary care and offering mifepristone via telemedicine. We aimed to explore the experiences of patients accessing medication abortion care across these different health...

Introduction: Nine different sets of laws govern abortion in Australia, and the criteria for an abortion to be considered lawful varies considerably by jurisdiction. We explored how the criminal status of abortion affected patients’ experiences in accessing care in a country where abortion services are widely available. Methods: We conducted quali...

Uganda hosts 1.4 million refugees and conflict-affected people. Widely regarded as the best place in Africa to be a refugee, Uganda’s policies encourage self-sufficiency and local integration. However, abortion is legally restricted and recent studies suggest that displaced women and girls have persistent unmet sexual and reproductive health needs....

Background: Women experience disparities in health care delivery and outcomes. Patient-centred care for women (PCCW) is needed. This study examined how PCC has been conceptualized and operationalized in women's health research. Methods: We conducted a theoretical rapid review of PCCW in MEDLINE, EMBASE, CINAHL and SCOPUS from 2008 to 2018 for st...

Objectives: Jordan has a robust contraceptive method mix in both the public and private sectors and oral contraceptive pills and the copper-T intrauterine device are widely available. However, Jordan remains one of only a few countries in the world without a registered dedicated product for emergency contraception (EC). We aimed to explore retail...

Objectives: We aimed to document the availability and explore the accessibility of emergency contraceptive pills for Congolese refugees living in both camp and urban settings in Uganda. Methods: In 2017, we conducted a multi-methods assessment in both the Nakivale Refugee Settlement and Uganda's capital of Kampala. Our study included a review of...

Objectives: Pharmacists play a key role in contraceptive service delivery in Albania. This qualitative study explores the availability and accessibility of different contraceptive methods in Tirana, Albania, as well as the knowledge, opinions, and provision practices of retail pharmacists in the county. Methods: In 2016, we conducted 16 in-perso...

Background Maternal and neonatal survival are key components of population health and may be particularly vulnerable in humanitarian contexts of civil unrest and displacement. Understanding what factors contribute to poor health outcomes throughout the reproductive life cycle and across the continuum of care is crucial for improving health programm...

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Purpose Efforts are needed to reduce gendered inequities and improve health and well-being for women. Patient-centred care (PCC), an approach that informs and engages patients in their own health, is positively associated with improved care delivery, experiences and outcomes. This study aimed to describe how PCC for women (PCCW) has been conceptual...

Background Determinants of newborn health and survival exist across the reproductive life cycle, with many sociocultural and contextual factors influencing outcomes beyond the availability of, and access to, quality health services. In order to better understand key needs and opportunities to improve newborn health in refugee camp settings, we cond...

English- and Arabic-language cyberfatwas on emergency contraception (EC) illuminate current debates around sexuality in the global Muslim community. In websites with fatwas about EC, there are significant differences in the way that English- and Arabic-language fatwa websites discuss this reproductive health technology. During the study period of 2...

Focus group discussions were conducted with medical students in Kathmandu, Nepal to gain insight into their knowledge, attitudes and intentions on induced abortion a decade after legalization.

Canadian mothers’ abortion experiences: Results from a large-scale qualitative study

Final report of a two-year project conducted in Albania. The report was presented to stakeholders in Tirana, Albania on the occasion of 2018 World Population Day.

Background: Although the contraceptive vaginal ring (CVR) has been available in Canada since 2001, overall use and availability remain low compared with other combined hormonal contraceptive methods. We aimed to explore women's experiences with the CVR in Ontario as well as factors that influenced their decisions to choose the method and continue/...

Background: Roughly one-third of all abortions in Canada are subsequent abortions. However, few published reports showcase women's voices or explore women's experiences on this topic. Our study aimed to understand better the ways that women who have had multiple abortions talk about and view those experiences. Methods: Between 2012 and 2016, we...

Objectives: Postpartum contraception plays a significant role in reducing subsequent pregnancy. However, young mothers in Ottawa, the capital of Canada, face various barriers when trying to access contraception after delivery. Through this project we aimed to explore these barriers and understand the decision-making processes of young mothers surr...

Since the 1990s, the Inter-agency field manual on reproductive health in humanitarian settings (IAFM) has provided authoritative guidance on reproductive health service provision during different phases of complex humanitarian emergencies. In 2018, the Inter-Agency Working Group on Reproductive Health in Crises will release a new edition of this gl...

For displaced and migrant women in northern Thailand, access to health care is often limited, unwanted pregnancy is common, and unsafe abortion is a major contributor to maternal death and disability. Based on a pilot project and situational analysis research, in 2015 a multinational team introduced the Safe Abortion Referral Programme (SARP) in Ch...

Following two decades of civil war, Somalia recently entered the post-conflict rebuilding phase that has resulted in the rapid proliferation of higher education institutions. Given the high maternal mortality ratio, the federal government has identified the reproductive health education of health service professionals as a priority. Yet little is k...

Young mothers constitute a vulnerable population in Canada. Teens with children are at significant risk of subsequent pregnancy, a dynamic that can exacerbate health, emotional, and socio-economic challenges. We aimed to understand better the dynamics shaping “rapid repeat pregnancy” among young mothers in Ottawa, explore young mothers’ subsequent...

Background: Abortion has been available without criminal restriction in Canada since 1988, and approximately 33 000 terminations take place in Ontario each year. Objectives: This study aimed to explore women’s expressed desire for post-abortion support services, document the priorities expressed by women in seeking post-abortion support, and identi...

Contraceptives were legalized in Albania in 1992 and abortion was decriminalized in 1991 and legalized without restriction as to reason in the first trimester in 1995. Several modern methods of contraception have been available for free in over 422 public sector health centres across the country since legalization of contraceptives. At only 8% the...

This article aims to identify how the health system in Tak province, Thailand has responded to migrants’ barriers to tuberculosis (TB) treatment. Our qualitatively driven multi-methods project utilized focus group discussions, key informant interviews, and a survey of community health volunteers to collect data in 2014 from multiple perspectives. M...

Introduction: The lack of economic development and longstanding conflict in Burma have led to mass population displacement. Unintended pregnancy and unsafe abortion are common and contribute to maternal death and disability. In 2011, stakeholders operating along the Thailand-Burma border established a community-based distribution program of misopr...