Current Projects

Our active research network has numerous studies underway.

Summaries of our current projects can be viewed on this page.


Summary: Although the gold standard for medical abortion care worldwide has been the use of mifepristone, a drug that terminates pregnancy, the medication was only recently approved in Canada in July 2015. The introduction of mifepristone presents an exceptional opportunity to better understand the effectiveness of health care provider training on adoption of medical abortion into practice and the impact on access to abortion, particularly for women in rural and remote areas. Our study of mifepristone implementation seeks to address the facilitators and barriers for successful initiation and ongoing provision of medical abortion service among health care professionals who have mifepristone certification, and how these relate to the distribution and availability of services throughout Canada.

We are currently raising awareness about the safety and access implications of Health Canada's request for dispensary by physicians only. Read more here 

Summary: In July 2017, provincial nursing regulators instituted regulations to permit nurses to perform medical abortion, and in November 2017, Health Canada followed suit. Allowing Nurse Practitioners (NPs) to provide abortion services has the potential to address the current inequities in abortion services in Canada, particularly for rural and remote communities. National and provincial health policy regulators, system leaders, health professionals, and education experts have identified a priority knowledge gap: data is needed urgently to understand and address the needs of NPs initiating this new service in Canada. This study proposes to identify and address the factors necessary to ensure high quality, accessible provision of medical abortion services by Nurse Practitioners throughout Canada.

This project has been awarded a three-year Canadian Institutes of Health Research (CIHR) Project Grant.

Summary: CART was awarded a CIHR Planning and Dissemination Grant in 2017 to support a planning meeting that aimed to develop a midwifery mifepristone implementation research study for Canada. In April 2018, CART, the Association of Ontario Midwives and the College of Midwives of Ontario hosted a Planning Meeting which engaged midwifery leaders from academic, regulatory, practice, health system and government settings to determine how best to design a study. From our planning meeting, it became clear that Canadian midwives are eager to ensure equitable and accessible care for prevention as well as management of unintended pregnancies.

The CART MiPMaP Study: Midwifery Prevention and Management of Unintended Pregnancy (co-led by Drs. Wendy Norman and Liz Darling) will identify and address health policy, system and service barriers, facilitators and solution's to prompting the effective implementation and uptake of midwifery provision of contraception and abortion care.

Proceedings from our April 2018 Planning Meeting: 
Planning Canada's Midwifery Abortion Implementation Study

Acknowledgements: We would like to thank the Canadian Institutes of Health Research (CIHR) for funding our Planning Meeting.

Summary: Our Canadian Sexual Health Survey gathered information regarding sexual and reproductive health, contraception use, pregnancy outcomes and accessibility of reproductive health services, enabling us to analyze how women plan and space their pregnancies. Unlike many countries, Canadian epidemiological data on sexual health to this date is very limited. Collection of this data is essential to inform health policies to improve the quality of life of Canadian women and their families. We hope that the government will be inspired to continue our project through the regular collection of nation-wide data about sexual health in the future, in order to create policies that are best representative of our Canadian population. We are currently using the data obtained from our survey to create Canada's First Cost Effectiveness Model to predict, at a provincial level, the number of pregnancies and their subsequent outcomes based on survey indicators for sexual partners and activity, contraception use and social determinants of health. Policy analyses using this model can assist the government to evaluate the potential health and financial benefits of free contraception for women, thereby supporting evidence-informed policies for optimal health system strategies.

Acknowledgements: We would like to thank the Canadian Institutes of Health Research (CIHR), the Michael Smith Foundation for Health Research and BC Women's Hospital for funding this study.






Summary: This BC Government-funded pilot program provides highly effective contraceptives free to all BC women at the time of abortion. This program was based on the recommendations that CART made to the Government, using data from two RCTs investigate post abortion contraception, linking participant data with government health administrative data to determine pregnancy outcomes. The Program preparations began mid-2016 and launched Jan 2017. CART is engaged in the evaluation of the program.

Summary: Women seeking an abortion often have difficult lives and face many obstacles to achieving their reproductive goals. For these and many additional reasons, they are at high risk for future unintended pregnancies. Despite the availability of intrauterine devices (IUDs), which offer very effective contraception, they are often uncommon in many marginalized populations. We hypothesize that more pregnancies will be prevented in women who undergo a second trimester abortion by inserting an IUD at the time of abortion, as opposed to scheduling a device placement later or choosing an alternate method of contraception. Our study uses contraception satisfaction questionnaire, clinical records and BC health databases to compare pregnancy rates with women using immediate and delayed IUDs after 2nd trimester abortions. We are also measuring secondary outcomes including comprehensive health economic analyses and device retention rates, complication rates and contraceptive method satisfaction.

Immediate vs delayed insertion of intrauterine contraception after second trimester abortion: a Randomized Controlled Trial Norman WV, Brant R, Bryan S, Peterson S, Chen W, Soon JA, Dicus L, Trouton K, Kaczorowski J.

Immediate vs delayed insertion of intrauterine contraception after second trimester abortion: a Randomized Controlled Trial
Norman WV, Brant R, Bryan S, Peterson S, Chen W, Soon JA, Dicus L, Trouton K, Kaczorowski J.

Acknowledgements: We would like to thank the Michael Smith Foundation for Health Research, the Canadian Institutes of Health Research (CIHR), the Child & Youth Health Research Network, and the Women's Health Research Institute for funding this study. 

Summary: In this randomized controlled trial, consenting women choose to use an IUD after an abortion for a pregnancy of less than 12 weeks of gestation were randomized to device-type  groups to receive immediate post-abortion placement of either a Flexi-T380(+) IUD, a device for  which no current evidence on expulsion or effectiveness rates is available, or the Nova-T200  IUD, the only other brand of copper IUD available in Canada at the time of study initiation. The  primary outcome measure is IUD expulsion rate at 1 year. Secondary outcomes include:  pregnancy rate, method continuation rate, complication rates (infection, perforation), and  satisfaction with contraceptive method. A non-intervention group of consenting women choosing a  range of other post-abortion contraception methods, including no contraception, was included for  comparison of secondary outcomes. Web-based contraception satisfaction questionnaires, clinical  records, and government-linked health administrative databases will be used to assess primary  and secondary outcomes.

Summary: A 2012 national survey on abortion services across Canada to understand Canadian abortion service provision. Health policy differences  between jurisdictions across Canada may affect access to abortion service, but little documentation of the potential disparities exists. A national cross-sectional self-completion survey will be used among abortion facilities in all Canadian jurisdictions identified by public sources and professional networks. We adapted a previously published instrument to be relevant for the Canadian context. English and French surveys were distributed by mail and e-mail, utilizing Dillman  reminder techniques, from July through Nov 2013. The outcome measures for this survey are: number and location of abortions, techniques, provider and facility  characteristics and experiences in 2012.

For information on the 2019 edition of this national survey, please click here.

Acknowledgements: We would like to thank the Society of Family Planning for funding this study.

Summary: We aim to develop and pilot-test a Canadian woman-centered contraception decision-making mobile application. This app will be “effectiveness-based” and will educate women about the efficacy of various contraceptive methods as well as important factors a women should consider when making decisions related to contraception.

Acknowledgements: We would like to thank the Society of Family Planning and the Women's Health Research Institute for funding this study.

Summary: This study proposes a secondary analysis of the Canadian Community Health Survey  (CCHS) data collected nationally by Statistics Canada and recently released. The World Health  Organization (WHO) has classified contraceptives into four tiers of effectiveness. Since the CCHS collects data on contraception use among those under 24 years of age, we plan to determine  correlates of contraceptive use, and particularly those for use of highly effective contraception and  for the least  effective methods of contraception, participants age 15 to 24 in Canada.

Acknowledgements: We would like to thank the Women's Health Research Institute for funding this study.

Summary: There are numerous barriers and facilitators that affect women’s contraception  choices. We are particularly interested in exploring contraception method choices and access  among women on methadone or suboxone maintenance therapy for substance dependence. This unique patient group highlights the overlap of reproductive health and addictions medicine.  Unfortunately, there is currently little Canadian data on this topic. This project utilizes the  Canadian Sexual Health Survey (CSHS) as a tool to assess the barriers to care and knowledge that women experience.

Acknowledgements: We would like to acknowledge the College of Family Physicians of Canada  for funding this study through a grant from their Research and Education Foundation; the Children and Family Research Institute for provision of the RedCAP platform; and the UBC Faculty of Medicine for providing us with the opportunity to engage in clinical research.


Summary: Women in high resource nations are increasingly delaying childbearing until their thirties. Delayed childbearing poses challenges for the spacing of a woman’s pregnancies. Inter-pregnancy intervals greater than 12 months are associated with risk for adverse pregnancy outcome, yet increased maternal age at delivery is linked with higher risk. The optimal inter-pregnancy interval for older mothers is uncertain. This systematic review will aim to assess the relation between inter-pregnancy interval and perinatal and maternal health outcomes in women who delay childbearing to age 30 and older.

Our review seeks to answer three questions:

  • What is the relationship between inter-pregnancy interval and adverse perinatal health outcomes in women who delayed childbearing to 30 years or older?
  • What is the relationship between inter-pregnancy interval and adverse maternal health outcomes in women who delayed childbearing to 30 years or older?
  • What is the relationship between inter-pregnancy interval and pregnancy complications in women who delayed childbearing to 30 years or older?

Acknowledgements: We would like to thank the Canadian Institutes of Health Research (CIHR) for funding this study through the CIHR-PHAC Chair in Family Planning Applied Public Health Research.

Summary: The goal of this research project is to perform a systematic review of the effectiveness  of asking all reproductive-age women in primary care settings what their plans for pregnancy are.  The evidence will be used to guide policy-making and future research to reduce unintended pregnancy and its many consequences. We will answer the following research question: “What are  the effects of the incorporation of fertility intention questions in patients of reproductive age in  primary care settings globally for pregnancy-related outcomes?”

Summary: We will determine timing discrepancies for hormonal contraceptive application  approval between Health Canada (HC), the Food and Drug Administration (FDA) in the United  States, and European Medicines Agency (EMA) and Medicines and Healthcare Products  Regulatory Agency (MHRA) in the United Kingdom. The initial application dates and final  approval dates for hormonal contraceptives approved between 2000 and January 2015 were  obtained from HC, the FDA , EMA, and MHRA. In addition, hormonal contraceptives approved  after 2000 by HC but before 2000 by the FDA, EMA, and MHRA were included. Generic  versions of drugs were not included.

Summary: We will compare hysteroscopic tubal occlusion, one of the most commonly used permanent contraception methods; levonorgestrel releasing intrauterine contraceptive (LNG-IUC), a more effective method for prevention of pregnancy than tubal ligation but one that is often overlooked; and opportunistic salpingectomy, the removal of fallopian tubes. The latter has rapidly gained popularity in BC, cited for its theoretical prevention of ovarian cancer. It is important for women to be counselled on all available contraception options, however to date there exists no study that systematically brings together methods of permanent contraception. We hope to inform current policy guidelines by comparing the effectiveness, adverse effects, tolerability, non-contraceptive benefits and accessibility of these three contraceptive techniques.

Summary: During provincial surveys in 2011/12 on access to contraception in B.C carried out by our team, several Contraception Management (CM) certified nurses volunteered information on specific barriers and difficulties they had encountered in effectively delivering care. Many of those mentioned may be addressable at the system, regional or local level. To date, no comprehensive  evidence exists on the effectiveness, facilitators and barriers for the CM certification practice. In  order to assess if there are addressable issues to improve the effectiveness of the CM certification program, we propose an evaluation of the certificants’ experience in provision of this service. We hypothesize that addressable health system barriers may be preventing optimal effectiveness of  the Nurse Contraception Management practice in British Columbia.

Acknowledgements: We would like to thank the College of Family Physicians of Canada for funding this study.