Wendy V. Norman

University of British Columbia | UBC · Department of Family Practice

Background Pregnant and parenting youth in Canada face multiple challenges in fulfilling their parenting responsibilities while meeting their own unique needs. The COVID-19 pandemic and its associated public health restrictions exacerbated their challenges by reducing access to support networks, limiting opportunities to promote growth and well-bei...

The COVID-19 pandemic led to significant challenges for healthcare providers working with pregnant and parenting youth. However, the impacts of the pandemic on this population and healthcare services from the perspective of healthcare providers are not well documented in Canada. We examined the narratives and experiences of healthcare providers reg...

Background In 2017, nurse practitioners (NPs) became the first non-physician healthcare providers authorised to independently provide medication abortion (MA) in Canada. We aimed to report on demographic and clinical characteristics of NPs providing mifepristone/misoprostol MA in Canada and to identify context-specific barriers and enablers to NP p...

Abortion is an essential healthcare service in many countries including Canada. The number of people who seek abortion is disproportionately higher among equity-deserving populations. Yet the knowledge needed to provide evidence-based, culturally safe, and gender-affirming abortion services remain limited among healthcare professionals. Using an in...

Aim To describe key features of a co‐designed nurse‐led model of care intended to improve access to early medication abortion and long‐acting reversible contraception in rural Australian general practice. Design Co‐design methodology informed by the Experience‐Based Co‐Design Framework. Methods Consumers, nurses, physicians and key women's health...

Background Uptake of long-acting reversible contraception (LARC) is lower in Australia compared with other high-income countries, and access to early medical abortion (EMA) is variable with only 11% of general practitioners (GPs) providing EMA. The AusCAPPS (Australian Contraception and Abortion Primary Care Practitioner Support) Network is a virtu...

BACKGROUND Access to safe abortion care is a reproductive right for all individuals across Canada. Underserved populations are over-represented among those with unintended pregnancies and particularly those seeking abortion. Yet, few resources exist to help healthcare and allied helping professionals provide culturally competent, and gender-affirmi...

Background Before the COVID‐19 pandemic, access to prenatal care was lower among some socio‐demographic groups. This pandemic caused disruptions to routine preventative care, which could have increased inequalities. Objectives To investigate if the COVID‐19 pandemic increased inequalities in access to prenatal care among those who are younger, liv...

Objective To assess the prevalence of a history of induced abortion among women who gave birth in Victoria during 2010–2019; to assess the association of socio‐demographic factors with a history of induced abortion. Study design Retrospective cohort study; analysis of cross‐sectional perinatal data in the Victorian Perinatal Data Collection (VPDC)...

Introduction Prenatal education is associated with positive health behaviours, including optimal weight gain, attendance at prenatal care, acceptance of routine screening tests, smoking cessation, decreased alcohol consumption and breast feeding. Adoption of these behaviours has been associated with reduced rates of caesarean birth, preterm birth a...

Objective: Our objective was to explore the workforce and clinical care of first and second trimester surgical abortion (FTSA, STSA) providers following the publication of updated Society of Obstetricians and Gynaecologists of Canada (SOGC) surgical abortion guidelines. Methods: We conducted a national, cross-sectional, online, self-administered...

Background: In 2015, mifepristone in combination with misoprostol, the international gold standard for medication abortion, was approved for use in Canada. By 2019, all Canadian provinces had included the medication as a publicly insured health benefit. Methods: Our content analysis of Canadian newspaper coverage describes arguments in favor of...

Background Mifepristone for medical abortion was first dispensed by community pharmacists in Canada directly to patients in January 2017. We asked about pharmacists’ experiences over their first year dispensing mifepristone in order to evaluate the frequency of the new practice and assess availability in urban/rural pharmacies. Methods From August...

Objective: We conducted a national survey to assess the experiences of stigma and harassment among physicians and nurse practitioners providing abortions and abortion service administrators in Canada. Study design: We conducted an exploratory, cross-sectional, national, anonymized, online survey between July and December 2020. Subsections of the...

BACKGROUND People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive – there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support peopl...

Background People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive—there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people...

Objective: The aim of this study is toestimate the prevalence of unintended pregnancy and associated socio-demographic and health-related factors among a national cohort of young Australian women. Methods: Secondary analysis of three waves (2013-2015) of the Australian Longitudinal Study on Women's Health new young cohort. Women born between 198...

Background Substantial changes in abortion care regulations, available medications and national clinical practice guidelines have occurred since a 2012 national Canadian Abortion Provider Survey (CAPS). We developed and piloted the CAPS 2019 survey instrument to explore changes of the abortion provider workforce, their clinical care as well as expe...

Introduction Women living in rural and regional Australia often experience difficulties in accessing long-acting reversible contraception (LARC) and medical abortion services. Nurse-led models of care can improve access to these services but have not been evaluated in Australian general practice. The primary aim of the ORIENT trial (ImprOving Rural...

Introduction: There is little to no evidence in Canada on the barriers that youth face when accessing contraception. We seek to identify the contraception access, experiences, beliefs, attitudes, knowledge, and needs of youth in Canada, from the perspectives of youth and youth service providers. Methods and analysis: This prospective, mixed-meth...

Mifepristone medication abortion was first approved in China and France more than 30 years ago and is now used in more than 60 countries worldwide. It is a highly safe and effective method that has the potential to increase population access to abortion in early pregnancy, closer to home. In both Canada and the United States, the initial regulation...

Background In Canada, 1 in 3 women and people of gestational age undergo an abortion in their lifetime. Despite the liberal legal context, barriers continue to exist for women and people who can become pregnant to access this service. Objective This study aims to (1) conduct a pilot study to demonstrate the feasibility and acceptability of myPostC...

In this study we explored nurse practitioner-provided medication abortion in Canada and identified barriers and enablers to uptake and implementation. Between 2020–2021, we conducted 43 semi-structured interviews with 20 healthcare stakeholders and 23 nurse practitioners who both provided and did not provide medication abortion. Data were analyzed...

Objective: To evaluate practices among first-trimester surgical abortion facilities and providers in Canada in 2012 and examine the characteristics of the surgical abortion work force. Design: Self-administered paper or electronic survey adapted from a survey previously fielded in the United States. Setting: Canada. Participants: Facility ad...

BACKGROUND Canada is one of the world’s most ethnically diverse countries with over seven million individuals out of a population of 38 million being foreign-born. Immigrant adolescents (aged 10-19) make up a substantial proportion of newcomers to Canada. Religious and cultural practices can influence adolescents’ sexual attitudes and behaviours, a...

Background: Canada is one of the world's most ethnically diverse countries, with over 7 million individuals out of a population of 38 million being born in a foreign country. Immigrant adolescents (aged 10 to 19 years) make up a substantial proportion of newcomers to Canada. Religious and cultural practices can influence adolescents' sexual attitu...

Most incarcerated women are of reproductive age, and more than a third of women will have an abortion during their reproductive years. Although women are the fastest growing population in Canadian prisons, no one has studied the effect of their incarceration on access to abortion services. Studies outside of Canada indicate rates of abortion are hi...

Introduction Although primary care practitioners are the main providers of long-acting reversible contraception (LARC) and early medical abortion (EMA) in Australia, few provide these services. A professional community of practice (CoP) has the potential to improve LARC and EMA provision through evidence-based guidance, expert support and peer-to-p...

Objectives Before mifepristone became available in January 2017 in Canada, only physicians provided abortion, and most abortions were surgical and in the largest cities. Risk Evaluation and Mitigation Strategy (REMS)-like restrictions were removed in November 2017, so that mifepristone became a normal prescription. We hypothesized this would increa...

Objectives In 2017, mifepristone became available for medication abortion in Canada and nurse practitioners became eligible prescribers. Barriers to abortion — such as rural and remote location, patient knowledge and stigma — could potentially be addressed through nurse practitioner provision. This study aimed to examine barriers and enablers to im...

Objectives Analysis of newspaper coverage of medication abortion during a time of evolving regulatory framework after the approval of mifepristone in Canada in 2015. Methods We conducted a content analysis of all Canadian newspaper articles on medication abortion (January 2015–November 2019) using an a priori framework including tone (pro–, neutra...

Background Across most of Australia, the role of community pharmacists in contraceptive care has been unchanged since 2004. To understand their current scope of practice and potential for practice advancements, we examined community pharmacists’ contraceptive knowledge and their attitudes, practices and perceived barriers to and benefits of contrac...

Objective To inform UK service development to support medical abortion at home, appropriate for person and context. Design Realist review Setting/participants Peer-reviewed literature from 1 January 2000 to 9 December 2021, describing interventions or models of home abortion care. Participants included people seeking or having had an abortion. I...

Aims To explore nurse practitioners' experiences of medication abortion implementation in Canada and to identify ways to further support the implementation of medication abortion by nurse practitioners in Canada. Design A qualitative approach informed by feminist theory and integrated knowledge translation. Methods Qualitative interviews with sta...

Problem: Women in rural and regional Australia experience a number of barriers to accessing sexual and reproductive health care including lack of local services, high costs and misinformation. Setting: Nurse-led task-sharing models of care for provision of long-acting reversible contraception (LARC) and early medical abortion (EMA) are one strat...

Introduction Pharmacists were acknowledged as the most appropriate healthcare professional to dispense mifepristone for medication abortion shortly after the prescription therapy became available in January 2017 in Canada. Objective We aimed to identify the facilitators and barriers for successful initiation and ongoing dispensing of mifepristone...

Background: Since 2016, abortion care has undergone several important changes, particularly related to the provision of medical abortion using mifepristone. We aimed to document characteristics of the abortion care workforce in Canada after the update of clinical practice guidelines of mifepristone use for medical abortion. Methods: We conducted...

Introduction Telemedicine has the potential to improve abortion access disparities in Canada. We aimed to explore the provision of telemedicine for first-trimester medical abortion and related barriers in 2019. Methods We conducted a national, cross-sectional, anonymized, web-based survey of clinicians who provided abortion care in 2019 in Canada....

Background In Canada, cost prohibits access to emergency contraception (EC) which may assist to prevent unintended pregnancy. The drug, ulipristal acetate (UPA-EC), is more clinically effective and cost-effective than the prior standard levonorgestrel (LNG-EC). We analyzed provincial EC subsidization policies and examined underlying decision-making...

Purpose: Long-acting reversible contraceptives (LARC), such as intrauterine devices (IUD) and implants, are highly effective. However, the uptake of LARC in Australia has been slow and the oral contraceptive pill (OC) remains the best known and most widely used contraceptive. Our aim was to investigate women's preferences for the features of LARC....

Objectives To synthesise evidence on user experience of medical abortion at home To develop a realist programme theory to explain what interventions improve user experience for whom and in what context. To use this programme theory to develop recommendations for service providers and those having medical abortions at home Background Changes in the...

In 2015, mifepristone, the international gold standard for medical abortion, was approved for use in Canada. Our content analysis of Canadian newspaper coverage describes arguments in favor or against medical abortion and the evolving regulatory framework for mifepristone from six months before approval until the last province included the medicati...

Background Virtual communities of practice (VCoPs) have been used to support innovation and quality in clinical care. The drug mifepristone was introduced in Canada in 2017 for medical abortion. We created a VCoP to support implementation of mifepristone abortion practice across Canada. Objective The aim of this study was to describe the developme...

Background The shifting landscape of abortion care from a hospital-only to a distributed service including primary care has implications for how to identify abortion cohorts for research and surveillance. The objectives of this study were to 1) create an improved approach to define abortion cohorts using linked administrative data sets and 2) evalu...

(Abstracted from N Engl J Med 2022;386:57–67) A medical abortion regimen of mifepristone and misoprostol is safe. In the United States, mifepristone is approved for use only with onerous Risk Evaluation and Mitigation Strategy (REMS) restrictions, which include mandatory prescriber certification, observed dispensing of doses by the prescriber or me...

Registered nurses (RNs) provide abortion care in hospitals and clinics and support abortion care through sexual health education and family planning care in sexual health clinics, schools and family practice. Nurse practitioners (NPs) improve access to abortion not only as prescribers of medication abortion but also as primary care providers of cou...

Background: Evidence suggests an increase in fertility and unintended pregnancy after bariatric surgery; contraceptive counselling, traditionally defined as a discussion of contraception options, is therefore an important facet of surgical planning. Our aim was to investigate patient experiences of contraceptive counselling, the attitudes of healt...

Objective : To explore the Canadian first-trimester medication abortion (MA) workforce and their clinical care following the introduction of mifepristone in 2017, updated national clinical practice guidelines and government approval of nurse practitioners (NPs) as first-trimester MA providers. Study Design : We conducted a national, self-administe...

Background Substantial changes in abortion care regulations, available medications and national clinical practice guidelines have occurred since a 2012 national Canadian Abortion Provider Survey (CAPS). We developed and piloted the CAPs 2019 to explore changes of the abortion provider workforce, their clinical care as well as experiences with stigm...

Background In the United States, mifepristone is available for medical abortion (for use with misoprostol) only with Risk Evaluation and Mitigation Strategy (REMS) restrictions, despite an absence of evidence to support such restrictions. Mifepristone has been available in Canada with a normal prescription since November 2017. Methods Using popula...

Given sub-optimal HIV care outcomes for people living with HIV (PLWH) post-release from incarceration, we systematically searched peer-reviewed literature (2010–2021) describing controlled trial interventions aimed at improving Antiretroviral Therapy (ART) adherence and care linkage following release from correctional facilities for PLWH. Of 392 st...

Background Early pregnancy loss (unintended pregnancy loss before 20 completed weeks of gestation) is a common adverse pregnancy outcome, with previous evidence reporting incidence ranging from 10 to 30% of detected pregnancies. The objective of this systematic review and meta-analysis is to determine the incidence and range of early pregnancy loss...

BACKGROUND Virtual communities of practice (VCoPs) have been used to support innovation and quality in clinical care. The drug mifepristone was introduced into Canada in 2017 for medical abortion. We created a VCoP to support implementation of this medical abortion practice across Canada. OBJECTIVE To describe the development and utilization of th...

Background The COVID-19 pandemic and pandemic response created novel challenges for abortion services. Canada was uniquely positioned to transition to telemedicine because internationally common restrictions on abortion medication were removed before the pandemic. Objective We sought to characterize the experiences of abortion health care professi...

Background Since Canadian drug regulatory approval of mifepristone for medical abortion in 2015 and its market availability in January 2017, the role of pharmacists in abortion provision has changed rapidly. We sought to identify the factors that influenced the initiation and provision of medical abortion from the perspectives of Canadian pharmacis...

Plain Language Summary There are multiple options available to help people end their fertility: each option with accompanying benefits and risks. A comprehensive comparison of the benefits and risks of available options is important to support informed decision-making. We aimed to understand the comparability of laparoscopic tubal ligation, hystero...

Objectives Canadian policy allowing mifepristone medication abortion without regulations limiting practice is globally unique. The objective of this study was to examine the impact of Canadian deregulated medication abortion policy on abortion utilization and complications. Methods We used linked administrative data (billing, hospital, ambulatory...

Objectives Following the 2017 introduction of mifepristone medical abortion in Canada, we developed a patient decision aid (PDA) to support informed, values-based choice between medical and surgical care for first trimester abortion. Methods We used the International PDA Standards Collaboration process to develop a prototype based on Canadian clin...

Population health surveys are rarely comprehensive in addressing sexual health, and population-representative surveys often lack standardized measures for collecting comparable data across countries. We present a sexual health survey instrument and implementation considerations for population-level sexual health research. The brief, comprehensive s...

Background: Multiple options for permanent or long-acting contraception are available, each with adverse effects and non-contraceptive benefits. A comprehensive comparison of methods to support decision-making for people seeking to end their fertility and their healthcare providers is needed. We aimed to understand what is known from high quality s...

Abstract Background: Estimation of causal effects of short interpregnancy interval on pregnancy outcomes may be confounded by time-varying factors. These confounders should be ascertained at or before delivery of the first (“index”) pregnancy, but are often only measured at the subsequent pregnancy. Objectives: To quantify bias induced by adjusting...

Population health surveys are rarely comprehensive in addressing sexual health, and population-representative surveys often lack standardized measures for collecting comparable data across countries. We present a sexual health survey instrument and implementation considerations for population-level sexual health research. The brief, comprehensive s...

The article "Why public health matters today and tomorrow: the role of applied public health research," written by Lindsay McLaren et al., was originally published Online First without Open Access.