The pregnancy options service (POS) is toll-free telephone service in the Canadian province of British Columbia (BC), established to improve rural and remote access to counseling and referral for induced abortion services.
We review the initial decade of this service to assist those facing access and referral barriers and highlight the value of a low cost model which identifies health care gaps and informs health service planning, while improving access to the full range of reproductive options and counseling, for women throughout a large geographic area.
Induced abortion is a common procedure in Canada currently experienced by a third of Canadian women [
In 1997 British Columbia Women’s Hospital and Health Centre (BC Women’s), the tertiary maternity and women’s health center for the province, implemented POS within their abortion service, in response to government recommendations to address the service distribution gap.
The POS program had three goals related to unintended and abnormal pregnancies: improve access to care by establishing a provincial counseling, information, and referral service; provide access to counseling for women; and support local health regions to identify and meet service gaps. Implementation was planned in phases.
Data on access barriers collected over ten years have informed provincial initiatives and helped develop several strategies to improve access and availability of services. The provision of support for abortion providers following targeted violent attacks on abortion providers in Canada.
A BC survey regarding access to contraception, counseling, and abortion services ( Two regional centers and two smaller communities were assisted to establish new abortion services.
POS answered over 2000 calls per year providing direct access to a capable and responsive staff person with the ability to mobilize or utilize appropriate resources and information. Figure
Total calls to the toll-free line, by year 1998–2008. The total number of calls received by the toll-free service increased gradually over the first five years then remained relatively stable at about 2500 (+/− 100) calls per year.
Figure
Number of calls per caller by health region, 1998–2008. The POS service initially provided chiefly information and referral consistent with a single call per caller, serving both health professionals and women seeking care. From 2006 to 2008 there was an increasing trend toward “case management” where the complex needs of women seeking options for a second trimester pregnancy were handled by the service utilizing a series of calls with each individual.
Women with unintended pregnancy of advanced gestation, and those with an abnormal pregnancy, are a small proportion of those seeking abortion services, but a significant proportion of those seeking service with the POS line (Figure
Proportion of callers of each gestational age by health authority, among those for whom the gestational age is known (
The POS provides health system administrators with a service provision model to identify and address barriers to access health services over wide geographic areas. The toll-free POS counseling and referral line has provided direct assistance and support for marginalized and vulnerable women. The greatest value may be to health system administrators through provision of real-time information on health service needs and gaps, thus informing continuous integrated improvements to health care planning. The benefit of continuously monitoring health service needs, while providing direct assistance to the most vulnerable in need of services irrespective of geographic barriers, may be applicable in other areas of health care where access barriers exist.
This paper reports secondary analysis of data only and does not report on any direct research on human subjects. No human subjects are identified in this report.
All three authors have worked for BC Women’s Hospital and Health Centre (BC Women’s). Wendy Norman and Barbara Hestrin are former employees. Barbara Hestrin was directly involved in the creation of the POS program. Wendy Norman is a former medical director of the POS program. Royce Dueck is currently employed by BC Women’s and at the time of writing this paper was working within the POS program. Neither the authors nor BC Women’s will gain financially from the publication of this paper. The authors declare that they have no other financial or nonfinancial competing interests in relation to this paper.
Wendy Norman and Royce Dueck planned this paper. Wendy Norman wrote and Royce Dueck edited the first draft. Barbara Hestrin contributed in the major rewrite, adding historical context and details on program planning and outcomes. All authors revised and approved the final paper.