The CART Access project

Advancing access to abortion for under-served populations

through tools for healthcare professionals and people seeking care

Funded by the Sexual and Reproductive Health Fund under the Health Care Policy and Strategies Program of Health Canada, Government of Canada

 

 

 

 

 

Project overview:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Year 1 National Summit meeting in Ottawa, 2024 Feb 22 & 23

The CAP-MoRE Summit

The CART Access Project – Mobilizing Results for Equity

Graphic Illustrations of Plenary Sessions:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Posters developed by each project:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Developing a shared decision aid for method of first trimester abortion:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Patient Pocket Resource kit:  How to Ask for an Abortion:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pharmacist Resources for Abortion and Contraception:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nursing School Resources for Abortion:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Midwifery Resources to improve access to abortion:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Interdisciplinary courses to improve access to Abortion:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Understanding the roles of Doulas in abortion access:

 

 

 

 

 

 

 

Understanding the barriers facing justice involved people to access abortion:

 

Youth Wellness Lab perspectives and the role of Social workers in Abortion Access:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Regional Hospitals to support mentorship for primary care abortion providers:

 

 

Evidence for approaches to support abortion health care professionals, and the need for mentorship and specific resources including a Virtual Community of Practice (vCoP)

  1. Carson A, Paynter M, Norman WV, et al. Optimizing the Nursing Role in Abortion Care: Considerations for Health Equity. Nursing Leadership. 2022;35(1):54-68. https://www.longwoods.com/product/26750
  2. Devane C, Renner RM, Munro S, et al. Implementation of mifepristone medical abortion in Canada: pilot and feasibility testing of a survey to assess facilitators and barriers. Pilot Feasibility Stud. 2019;5(1):126. https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-019-0520-8
  3. Dunn S, Munro S, Devane C, Guilbert E, Jeong D, Stroulia E, et al. A Virtual Community of Practice to Support Physician Uptake of a Novel Abortion Practice: Mixed Methods Case Study. Journal of Medical Internet Research. 2022;24(5):e34302. https://dx.doi.org/10.2196/34302
  4. Munro S, Guilbert E, Wagner M-S, et al. Perspectives Among Canadian Physicians on Factors Influencing Implementation of Mifepristone Medical Abortion: A National Qualitative Study. Annals of family medicine. 2020;18(5):413-421.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489974/pdf/0180413.pdf
  5. Munro S, Wahl K, Soon JA, et al. Pharmacist dispensing of the abortion pill in Canada: Diffusion of Innovation meets integrated knowledge translation. Implementation Science. 2021;16(1):76.https://doi.org/10.1186/s13012-021-01144-w
  6. Norman WV, Munro S, Brooks M, et al. Could implementation of mifepristone address Canada's urban-rural abortion access disparity: a mixed-methods implementation study protocol. BMJ open. 2019;9(4):e028443.https://bmjopen.bmj.com/content/9/4/e028443
  7. Rebic N, Munro S, Norman WV, Soon JA. Pharmacist checklist and resource guide for mifepristone medical abortion: User-centred development and testing. Canadian Pharmacists Journal / Revue des Pharmaciens du Canada. 2021;154(3):166-174. https://dx.doi.org/10.1177/17151635211005503
  8. Guilbert E, Wagner M-S, Munro S, et al. Slow implementation of mifepristone medical termination of pregnancy in Quebec, Canada: a qualitative investigation. The European Journal of Contraception & Reproductive Health Care. 2020;25(3):190-198. https://dx.doi.org/10.1080/13625187.2020.1743825
  9. Guilbert E WM-S, Munro S, Wilcox ES, Devane C, Dunn S, Soon J, Norman WV. La pilule abortive au Québec en 2019 – Pourquoi n’est-elle pas plus accessible? Rapport de recherche de la CART-MIFE-Study. Québec2019. https://reqef.uqam.ca/wp-content/uploads/sites/23/2019-09-06-La-pilule-abortive-au-Quebec.pdf
  10. Wagner MS, Munro S, Wilcox ES, et al. Barriers and Facilitators to the Implementation of first Trimester Medical Abortion With Mifepristone in the Province of Quebec: A Qualitative Investigation. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. 2020;42(5):576-582. https://pubmed.ncbi.nlm.nih.gov/31924442/  


Evidence for the need for and relevant design features of patient decision aids, and the need in Canada for a medical vs abortion decision aid (Kate/Sarah to complete)


Evidence for Family Planning/Reproductive and Sexual Health among Youth Experiencing Homelessness and/or With Child Welfare Histories

*Note: Many of these studies were comprised of U.S.-based samples, but challenges and issues are seemingly quite similar, comparatively to Canadian contexts.

  1. Henriques, E., Schmidt, C., Pascoe, R., Liss, K., & Begun, S. (2022). Counter-narratives of pregnancy stigma and resistance for youth experiencing homelessness. Qualitative Health Research, 32(10), 1447–1463. doi: 10.1177/10497323221110694 [published open-access]
  2. Begun, S., Barman-Adhikari, A., Greenblatt, A., Sahajpal, P., Campbell, D., Cooke, K., & Rice, E. (2021). Social norms of pregnancy and pregnancy attitudes among youth experiencing homelessness. Youth & Society. doi: 10.1177/0044118X211062354 [published open-access]
  3. Munro, S., Benipal, S., Williams, A., Wahl, K., Trenaman, L., & Begun, S. (2021). Access experiences and attitudes toward abortion among youth experiencing homelessness in the United States: A systematic review. PloS ONE, 16(7), p.e02522434-e0252434. doi: 10.1371/journal.pone.0252434 [published open-access]
  4. Begun, S., Combs, K. M., Schwan, K., Torrie, M., & Bender, K. (2020). “I know they would kill me”: Abortion attitudes and experiences among youth experiencing homelessness. Youth & Society, 52(8), 1457-1478. doi: 10.1177/0044118X18820661
  5. Begun, S., Barman-Adhikari, A., O’Connor, C., & Rice, E. (2020). Social support and pregnancy attitudes among youth experiencing homelessness. Children & Youth Services Review, 113. doi: 10.1016/j.childyouth.2020.104959
  6. Begun, S., Torrie, M., Combs, K. M., & Frey, C. (2019). “Getting pregnant might make me seem more normal to them”: Attitudes, experiences, and gendered nuances regarding pregnancy and parenting among youth experiencing homelessness. Journal of Gay and Lesbian Social Services, 31(4), 435-457. doi: 10.1080/10538720.2019.1633453
  7. Begun, S., Frey, C., Combs, K. M., & Torrie, M. (2019). “I guess it would be a good shock”: A qualitative examination of homeless youths’ diverse pregnancy attitudes. Children and Youth Services Review, 99, 87-96. doi: 10.1016/j.childyouth.2019.01.029
  8. Begun, S., Combs, K. M., Torrie, M., & Bender, K. A. (2019). “It seems kinda like a different language to us”: Homeless youths’ attitudes and experiences pertaining to condoms and contraceptives. Social Work in Health Care, 58(3), 237-257. doi: 10.1080/00981389.2018.1544961
  9. Combs, K. M., Brown, S., Begun, S., & Taussig, H. (2018). Pregnancy attitudes and contraceptive use among young adults with histories of foster care. Children and Youth Services Review, 94, 284-289. doi: 10.1016/j.childyouth.2018.10.017
  10. Combs, K. M., Begun, S., Rinehart, D., & Taussig, H. (2018). Pregnancy and childbearing among young adults who experienced foster care. Child Maltreatment, 23(2), 166-174. doi: 10.1177/1077559517733816
  11. Barman-Adhikari, A., Hsu, H., Begun, S., & Portillo, A. P. (2017). Condomless sex among homeless youth: The role of multidimensional social norms and gender. AIDS & Behavior, 21(3), 688-702. doi: 10.1007/s10461-016-1624-2
  12. Begun, S. (2017). A mixed methods examination of pregnancy attitudes and HIV risk behaviors among homeless youth: The role of social network norms and social support. Electronic Theses and Dissertations: ProQuest.
  13. Begun, S. (2015). The paradox of homeless youth pregnancy: A review of challenges and opportunities. Social Work in Health Care, 54(5), 444-460. doi: 10.1080/00981389.2015.1030058
  14. Thompson, S. J., Begun, S., & Bender, K. A. (2016). Pregnancy and parenting among runaway and homeless young women. In S. J. Morewitz & C. Sturdy-Colls (Eds.), Handbook of Missing Persons, An Interdisciplinary Study of Missing Persons.
  15. Eapen, D., Bergh, R., Lucas, S., Narendorf, S., Begun, S., & Santa Maria, D. (under review). Experiences of pregnancy prevention among youth experiencing homelessness. Children & Youth Services Review.
  16. Vandermorris, A., Toulany, A., McKinnon, B., Tam, M., Li, Z., Guan, J., Stukel, T., Fu., L., Wang, X., Begun, S., Harrison, M., Wigle, J., & Brown, H. (under review). The impact of the COVID-19 pandemic on sexual and reproductive health outcomes among adolescent females in Ontario, Canada. The Lancet Child & Adolescent Health.
  17. Begun, S., Lucas, V., MacEwan, R., & Eapen, D. (in progress). "My initial instinct is to listen": Promoting reproductive justice with under-housed youth.
  18. Begun, S., Lucas, V., MacEwan, R., & Eapen, D. (in progress). Frontline service worker and healthcare provider perspectives on challenges faced by youth experiencing homelessness during the COVID-19 pandemic.


Evidence for Engaging Youth Experiencing Homelessness in Reproductive and Sexual Health Research

  1. Begun, S.., Weber, A., Spring, J., Arora, S., Frey, C., & Fortin, A. (2020). “This research is cool”: Engaging youth experiencing homelessness in research on reproductive and sexual health. Social Work in Public Health, 35(5), 271-281. doi: 10.1080/19371918.2020.1791296


Evidence for Opportunities and Needs for Training/CPD of Social Workers in SRH Topics

*Note: All data collected were U.S. based, though Canada and U.S. have essentially exact same Codes of Ethics, curricula/accreditation requirements re: Social Work education

  1. Begun, S., Kattari, S. K., McKay, K., Ramseyer Winter, V., & O’Neill, E. (2017). Exploring U.S. social work students’ sexual attitudes and abortion viewpoints. Journal of Sex Research, 54(6), 752-763. doi: 10.1080/00224499.2016.1186586
  2. Ramseyer Winter, V., O’Neill, E., Begun, S., Kattari, S. K., & McKay, K. (2016). MSW student perceptions of sexual health as relevant to the profession: Do social work educational experiences matter? Social Work in Health Care, 55(8), 614-634. doi: 10.1080/00981389.2016.1189476
  3. Begun, S., Bird, M., Ramseyer Winter, V., Combs, K. M., & McKay, K. (2016). Correlates of social work students’ abortion knowledge and attitudes: Implications for education and research. Social Work in Public Health, 31(4), 276-287. doi: 10.1080/19371918.2015.1137510
  4. Gómez, A. M., Downey, M., Carpenter, E., Leedham, U., Begun, S., Ely, G., & Craddock., J. (2020). Advancing reproductive justice to close the health gap: A call to action for social work. Social Work, 65(4), 358-367. doi: 10.1093/sw/swaa034
  5. Ramseyer Winter, V., Kattari, S. K., Begun, S., & McKay, K. (2016). Personal and professional values: Relationships between social workers’ reproductive health knowledge, attitudes, and ethical decision-making. Journal of Social Work Values & Ethics, 13(2), 35-46. Retrieved from: http://jswve.org
  6. Bird, M., Begun, S., & McKay, K. (2018). Religiosity and personal beliefs regarding abortion: Results from a survey of social work students in the United States. Women’s Reproductive Health, 5(2), 117-131. doi: 10.1080/23293691.2018.1463742

 

Nurse Practitioner
Prescribing of Mifepristone
Paynter M,
Carson A, Cameron E,
Martin Misener R, Munro S, Norman WV.

(site short link: https://bit.ly/CART-Access-Project)

 

 

 

 

 

 

 

 

 

 

 

 

 

Acknowledgements: These studies were made possible through CART-GRAC's partnerships with a wide range of Health Professional Organizations and partners: