Project 467619

In Canada, longstanding inadequate and inequitable access to reproductive health services has limited the ability for women to optimally time and space pregnancies - a key reproductive population health indicator. For many Canadian populations, particularly rural and remote, adolescent, and structurally disadvantaged groups, inadequate access to family planning services (contraception, abortion) prevents the ability to time and space pregnancies and births. In these groups, mistimed or unwanted pregnancies continue to be frequent, leading to poor reproductive outcomes and limiting gender equity. In the past 5 years, substantial changes to Canadian health policy and practice were implemented to address inadequate and inequitable access to reproductive health services. The impacts of these policy and practice changes on reproductive population health and equitable family planning service access are unknown. My research will harness the power of Canada's rich population-based health data to rigorously examine policy and practice impacts on reproductive population health. I will work with patients, clinicians, and policymakers to identify priority research areas and inform policy and practice improvements based on research findings. SPECIFIC AIMS: 1.Determine impacts of abortion pill availability as a normal prescription on patient access to abortion in BC and Ontario. 2.Determine impacts of contraceptive implant introduction and no-cost contraception subsidy on contraception use, pregnancy rates, and pregnancy outcomes. 3.Develop and validate methods to identify early pregnancy loss using administrative health data.