The role of doulas and community birth workers in abortion and contraception care: An international scoping review.

OBJECTIVES: Equitable and safe access to abortion and contraception is essential to protecting reproductive autonomy. Despite this, barriers to access remain. Nonclinical support people, may be able to facilitate access to abortion and contraception services and care, but evidence on the scope and efficacy of doulas in abortion and contraception care is lacking. The aim of this scoping review was to synthesize what is known about the role of doulas in abortion and contraception care. STUDY DESIGN: We followed the Joanna Briggs Institute methodology for scoping reviews. A clinical librarian performed an initial search of all relevant databases. Three reviewers independently screened the titles and abstracts for assessment against the inclusion and exclusion criteria. The populations of interest included doulas, and/or untrained birth attendants and birth companions, and patients who use doula services. The concept of interest was the doula and the context was access to abortion or contraception. RESULTS: Our review identified relevant studies conducted in different countries, published between 1976 and 2023. Studies broadly focused on three key themes: doulas performing procedural abortions, doulas supporting abortion care, and doulas supporting contraception. Outcomes of interest included client outcomes, barriers to access, doula training, and attitudes. CONCLUSIONS: Doulas have the potential to improve client satisfaction and mitigate barriers to accessing abortion and contraception services. Further research is needed to identify the training needs of doulas, the potential for their integration into interdisciplinary care teams, and the role in supporting medication abortion.

A qualitative case study of pregnancy and early parenting in Canada's federal prisons for women.

OBJECTIVE: The aim of this study was to understand the experiences of pregnant people and new parents in Canadian federal prisons for women, and to better understand their ability to participate in the institutional Mother Child Program. METHODS: This qualitative case study used semi-structured interviews with people who experienced federal incarceration during pregnancy or the early parenting years. FINDINGS: Major themes in the analysis include: 1) Reasons why- and why not- to participate in the Mother Child Program; 2) Mothering from inside; 3) Health care; and 4) Strategies and survival. KEY CONCLUSIONS: Mothers describe multiple reasons for choosing not to participate or being ineligible for the Mother Child Program; separation as common and traumatic; health services as inadequate; and mental health concerns being met with punishment. Alternatives to incarceration are recommended.

Distance between institutions of incarceration and procedural abortion facilities in Canada.

OBJECTIVES: People incarcerated in facilities for women and girls face barriers to accessing abortion, including unclear legislation, operational procedures, and distance. While medication abortion could mitigate distance barriers, prison is not a hospitable environment for medication abortion. Considering this limitation, this paper aimed to identify the distance from institutions of incarceration designated for women and girls to procedural abortion facilities in Canada. STUDY DESIGN: This study builds on an inventory of the 67 institutions of incarceration designated for women and girls across 13 provinces and territories in Canada, previously created by the authors. Procedural abortion facilities were identified using publicly available directories. Distances were calculated using Google Maps. The closest procedural abortion facility was identified for each institution, as well as the gestational age limit of each facility. RESULTS: Of the 67 institutions, 23 (34%) were located 0 to 10km from a procedural abortion facility. Fourteen (21%) were located 10.1 to 20km away. Ten (15%) were located 20.1 to 100km away. Eleven were located 100.1 to 300km away (16%). The remaining 9 (13%) were located between 300.1 and 738km away. Distances ranged from 0.1 to 738km. The greatest distances were among institutions in northern Canada. CONCLUSIONS: This paper identified a large range of distances between institutions of incarceration and procedural abortion facilities in Canada. Physical distance is only one measure of accessibility of abortion services. For incarcerated people, contextual factors including carceral policies and procedures present barriers to care, with significant impact on health equity. IMPLICATIONS: Distance between carceral institutions and procedural abortion facilities reduces equitable access to reproductive health services for incarcerated populations. Pregnant people should be protected from imprisonment to ensure reproductive autonomy.

Abortion and contraception for incarcerated people: A scoping review.

BACKGROUND: Women experiencing incarceration have higher rates of unmet contraceptive needs and rates of abortion than the public. Incarceration presents multiple potential barriers to accessing abortion and contraception care, including prison security protocols, prison locations, lack of access to care providers, stigma, and low health literacy. The objective of this scoping review is to understand the extent and type of evidence in relation to contraception and abortion access for people experiencing criminalization and incarceration. METHODS: We used the Joanna Briggs Institute methodology for scoping reviews and include empirical research with people experiencing criminalization or incarceration and/or with prison staff; with respect to prescription contraception or abortion access, while in custody or after having experienced incarceration/criminalization. Databases searched include CINAHL, APA PsycInfo, Gender Studies, Medline (Ovid), Embase, Sociological Abstracts, and Social Services Abstracts. The search yielded 6096 titles of which 43 were included in the review. RESULTS: Our search yielded 43 studies published between 2001 and 2021 across six countries. The studies included qualitative, quantitative, and mixed methods designs. The main outcomes of interest included contraceptive use; attitudes towards abortion, contraception, and pregnancy; and barriers to care. Barriers identified included lack of onsite access to options, contraceptive coercion by providers, financial costs, and disruptions to medical coverage and insurance status which incarcerated. DISCUSSION: Evidence indicates that people in prison face significant barriers to maintaining continuity of contraceptive methods, abortion access, and reproductive health guidance. Some studies articulated participants felt judged when discussing contraception with prison-based health care providers. Geographic location, out-of-pocket payments, and trust in health care providers were reported as barriers to access. CONCLUSION: Incarceration presents considerable challenges to the access of contraception and abortion care. Future research should examine the interaction between institutional security policies and procedures on care seeking, the experiences of underserved and hyper-incarcerated groups, and the impact of being denied access to contraception and abortion and experiences of criminalization.

Barriers and enablers to nurse practitioner implementation of medication abortion in Canada: A qualitative study.

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 using interpretive description. We identified five overarching themes: 1) Access and use of ultrasound for gestational dating; 2) Advertising and anonymity of services; 3) Abortion as specialized or primary care; 4) Location and proximity to services; and 5) Education, mentorship, and peer support. Under certain conditions, ultrasound is not required for medication abortion, supporting nurse practitioner provision in the absence of access to this technology. Nurse practitioners felt a conflict between wanting to advertise their abortion services while also protecting their anonymity and that of their patients. Some nurse practitioners perceived medication abortion to be a low-resource, easy-to-provide service, while some not providing medication abortion continued to refer patients to specialized clinics. Some participants in rural areas felt unable to provide this service because they were too far from emergency services in the event of complications. Most nurse practitioners did not have any training in abortion care during their education and desired the support of a mentor experienced in abortion provision. Addressing factors that influence nurse practitioner provision of medication abortion will help to broaden access. Nurse practitioners are well-suited to provide medication abortion care but face multiple ongoing barriers to provision. We recommend the integration of medication abortion training into nurse practitioner education. Further, widespread communication from nursing organizations could inform nurse practitioners that medication abortion is within their scope of practice and facilitate public outreach campaigns to inform the public that this service exists and can be provided by nurse practitioners.

Nurse practitioners on 'the leading edge' of medication abortion care: A feminist qualitative approach.

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 stakeholders and nurse practitioners between January 2020 and May 2021. Data were analysed using critical feminist theory. RESULTS: Participants included 20 stakeholders, 16 nurse practitioner abortion providers, and seven nurse practitioners who did not provide abortions. We found that nurse practitioners conduct educational, communication and networking activities in the implementation of medication abortion in their communities. Nurse practitioners navigated resistance to abortion care in the health system from employers, colleagues and funders. Participants valued making abortion care more accessible to their patients and indicated that normalizing medication abortion in primary care was important to them. CONCLUSION: When trained in abortion care and supported by employers, nurse practitioners are leaders of abortion care in their communities and want to provide accessible, inclusive services to their patients. We recommend nursing curricula integrate abortion services in education, and that policymakers and health administrators partner with nurses, physicians, midwives, social workers and pharmacists, for comprehensive provincial/territorial sexual and reproductive health strategies for primary care. IMPACT: The findings from this study may inform future policy, health administration and curriculum decisions related to reproductive health, and raise awareness about the crucial role of nurse practitioners in abortion care and contributions to reproductive health equity. PATIENT OR PUBLIC CONTRIBUTION: This study focused on provider experiences. In-kind support was provided by Action Canada for Sexual Health & Rights, an organization that provides direct support and resources to the public and is committed to advocating on behalf of patients and the public seeking sexual and reproductive health services.

Community-based models of health care for women, trans and nonbinary people released from prisons: An international scoping review with implications for Canada.

AIMS AND OBJECTIVES: To illustrate the scope of different types of transitional, community-based health interventions for formerly incarcerated women, trans and nonbinary people, the eligibility criteria for these interventions, and associated health outcomes. BACKGROUND: Meeting the health needs of formerly incarcerated people in community, rather than through the criminal justice system, may prevent further experiences of criminalization. Research is needed to understand what community-based health interventions have been implemented internationally to inform the design of an intervention in Canada. DESIGN: Scoping review using the Joanna Briggs Institute scoping review methodology. METHODS: In consultation with a medical research librarian, key databases and journals were searched for English language articles, from any country, with no specified date range. Three authors independently screened titles and abstracts to identify articles for full-text review. The study adheres to PRISMA-EQUATOR guidelines. RESULTS: Thirty-six studies met the present criteria and were reviewed in full text. Method, setting, participants, sample, relevant outcomes and relevant findings were extracted from each study for synthesis. Included studies had varied methods and were published from 1999 to 2020. Thirty-one studies were based in the United States, one in Puerto Rico and two each in Canada and the United Kingdom. The most common health issue focus was human immunodeficiency virus and/or hepatitis c virus. The most common outcome was uptake of offered services, such as a transitional clinic. CONCLUSIONS: Gaps in the research pertain to a lack of attention to clinical outcomes and patient experience, and a lack of consideration of sexual and reproductive health concerns. Women were the minority population in all studies that included both men and women; transgender participants were mentioned in only four of thirty-six studies. The specific needs of women, trans and nonbinary people must be taken into consideration. RELEVANCE TO CLINICAL PRACTICE: Nurses must be conscious of the elevated health risks associated with exposure to correctional institutions and the risks associated with the period of transition. PATIENT OR PUBLIC CONTRIBUTION: A member of the research team brings lived experience expertise with respect to the criminal justice system.

The Intersection of Abortion and Criminalization: Abortion Access for People in Prisons.

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 higher among people experiencing incarceration than in the general population, and that abortion access is often problematic. Although international standards for abortion care among incarcerated populations exist, there conversely appear to be no Canadian guidelines or procedures to facilitate unintended pregnancy prevention or management. Barriers to abortion care inequitably restrict people with unintended pregnancy from attaining education and employment opportunities, cause entrenchment in violent relationships, and prevent people from choosing to parent when they are ready and able. Understanding and facilitating equitable access to abortion care for incarcerated people is critical to address structural, gender-, and race-based reproductive health inequities, and to promote reproductive justice. There is an urgent need for research in this area to direct best practices in clinical care and support policies capable to ensure equal access to abortion care for incarcerated people.

Optimizing the Nursing Role in Abortion Care: Considerations for Health Equity.

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 counselling, resources about pregnancy options and abortion follow-up care in their communities. There is a need to better understand the current status of and potential scope for optimizing nursing roles in abortion care across Canada. In this article, we describe the leadership of nurses in the provision of accessible, inclusive abortion services and discuss barriers to role optimization. We present key insights from a priority-setting meeting held in 2019 with NPs and RNs engaged in medication abortion practice in their communities. As scopes of practice continue to evolve, optimization of nursing roles in abortion care is an approach to enhancing equitable access to comprehensive abortion care and family planning.

Maternal incarceration in a provincial prison in Canada: A qualitative study.

AIMS: To explore the experiences of provincially incarcerated mothers in Nova Scotia, Canada; and to make recommendations with respect to improving the experiences of mothers facing criminalization and their children. DESIGN: This qualitative study is rooted in feminist standpoint theory, community-based research methodologies and prison abolition. METHODS: Mothers who were currently or previously incarcerated were recruited by community partners. Between Fall 2021 and Winter 2022, 14 individual interviews and one focus group were conducted, for a total of 18 study participants. Data were analysed collaboratively using thematic analysis. RESULTS: Three key themes were developed through the data analysis: Maintaining Connection, Broken Bonds and The Damage. Mothers shared experiences of trying to maintain connections with their children through numerous challenges, including emotional distress caused by the separation and significant logistical and financial barriers. Mothers felt their children unfairly bore the burden of their incarceration. They experienced a lack of or outright denial of services while incarcerated, and a lack of transitional support on release, making working towards parenting again difficult and discouraging. CONCLUSION: For participants in our study, separation from their children during incarceration caused severe emotional distress and had serious implications on their right to parent and their relationships with their children. Incarceration for even brief periods has detrimental social impacts, and release planning does not prepare people for the challenges of repairing that damage. Conditions of maternal incarceration are in violation of international human rights laws. IMPACT: Although we make some recommendations for reform (e.g. free phone calls), we focus on alternatives to incarceration for mothers experiencing criminalization. Findings will be shared with relevant institutional partners with the goal of impacting sentencing and incarceration practices.

Sexual and Reproductive Health Outcomes among Incarcerated Women in Canada: A Scoping Review.

BACKGROUND: Women are the fastest growing population in Canadian prisons. Incarceration can limit access to essential health services, increase health risks and disrupt treatment and supports. Despite legal requirements to provide care at professionally accepted standards, evidence suggests imprisonment undermines sexual and reproductive health. This scoping review asks, "What is known about the sexual and reproductive health of people incarcerated in prisons for women in Canada?" METHODS: We use the Joanna Briggs Institute methodology for systematic scoping reviews. Databases searched include MEDLINE, CINAHL, PsycINFO, Gender Studies Abstracts, Google Scholar and Proquest Dissertations and grey literature. The search yielded 1424 titles and abstracts of which 15 met the criteria for inclusion. RESULTS: Conducted from 1994-2020, in provincial facilities in Ontario, British Columbia, Alberta and Quebec as well as federal prisons, the 15 studies included qualitative, quantitative and mixed methods. The most common outcomes of interest were related to HIV. Other outcomes studied included Papanicolaou (Pap) and sexually transmitted infection (STI) testing, contraception, pregnancy, birth/neonatal outcomes, and sexual assault. CONCLUSION: Incarceration results in lack of access to basic services including contraception and prenatal care. Legal obligations to provide sexual and reproductive health services at professionally acceptable standards appear unmet. Incarceration impedes rights of incarcerated people to sexual and reproductive health.

Peer doula support training for Black and Indigenous groups in Nova Scotia, Canada: A community-based qualitative study.

OBJECTIVES: The objectives of this qualitative study were to explore participant experiences of doula training programs offered by a prisoner health advocacy organization and Indigenous and Black community groups. DESIGN: This investigation employed a qualitative design. Recruitment was conducted through email. Interviews were conducted in Winter 2020. Data were analyzed using thematic analysis. SAMPLE: A total of 12 participants were recruited to participate in this study. Six participants identify as Black and six identify as Indigenous. All participants identify as women. MEASUREMENTS: Qualitative interviews were conducted using a semi-structured interview guide to elicit a breadth of information. RESULTS: Key themes included training experiences, training improvements and ''bridging the gap''. The training validated participants' experiences of birth and began to address the exclusion of Black and Indigenous people from birth work. However, participants expressed concerns about not being adequately positioned for sustained participation in birth work. CONCLUSIONS: Participants expressed receiving great value from the training programs. These trainings, which were fully subsidized, removed a financial barrier. However, these trainings do not address the exclusion of Black and Indigenous people from perinatal work or the lack or sustainable support systems for Black and Indigenous communities. This study makes several recommendations for future interventions.

Feminist Abolitionist Nursing.

The converging crises of COVID-19 and racist state violence in 2020 shifted public discourse about marginalization, public health, and racism in unprecedented ways. Nursing responded to the pandemic with heroic commitment and new politicization. But public engagement with systemic racism is forcing a reckoning in nursing. The profession has its own history of racism and of alliance with systems of state control with which to contend. In this article, we argue nursing must adopt an ethics of abolitionism to realize its goals for health and justice. Abolitionism theorizes that policing and prison systems, originating from systems of enslavement and colonial rule, continue to function as originally intended, causing racial oppression and violence. The harms of these systems will not be resolved through their reform but through creation of entirely new approaches to community support. Nursing as a collective can contribute to abolitionist projects through advocacy, practice, and research.

Mothers' Experiences with Child Protection Services: Using Qualitative Feminist Poststructuralism.

BACKGROUND: The postpartum period is often portrayed as a blissful, calm and loving time when mothers, partners and family members bond with their newborn babies. However, this time may be experienced quite differently when mothers are monitored by Child Protection Services. Having a baby under these circumstances can be very difficult and traumatizing. While all new parents require support and information to help them through the transition to parenthood and address physical and psycho-social changes, mothers who are involved with Child Protection Services require more specialized support as they encounter higher incidences of postpartum stressors and higher rates of poverty, mental illness and substance abuse. The impact of support for mothers involved with Child Protection Services is not well-understood from the perspective of mothers. AIM: The aim of the study was to understand how new mothers in Nova Scotia prioritized their postpartum needs and where they went to obtain information and support. METHODS: Feminist poststructuralism was the methodology used to understand how the experiences of five mothers who accessed a family resource center and had been involved with Child Protection Services in Nova Scotia Canada had been personally, socially and institutionally constructed. RESULTS: Themes include: (1) We are Mothers, (2) Being Red Flagged, (3) Lack of Trust, (4) Us Against Them and (5) Searching for Supportive Relationships. CONCLUSION: Personal stories from all participants demonstrated how they experienced stigma and stereotypes from healthcare workers and were often not recognized as mothers. They also struggled to find information, supports and services to help them keep or regain their babies.

Second Opinions: Negotiating Agency in Online Mothering Forums.

STUDY BACKGROUND: Online forums and other virtual communities are an increasing source of postpartum support and information for first-time mothers. However, there is little evidence about how new mothers in Canada access and use online resources. PURPOSE: The purpose of this study was to examine how first-time mothers accessed information and support both online and off-line during the first six months postpartum and how their experiences were constructed through social and institutional discourses. METHODS: A qualitative feminist poststructuralist approach was used to analyze an online discussion board with first-time mothers in Nova Scotia. RESULTS: Mothers who used the online discussion board experienced a sense of community with other mothers where empathy and encouragement were integral to the ways in which information and support were shared. "Weak ties" (with strangers) were important and led to the following themes: (a) empathy, encouragement, and information; (b) socialization; (c) blurring the boundaries of online and off-line networks; and (d) Developing community. CONCLUSIONS: These online forums offer insight for health professionals looking to improve mothers' care postpartum and point to a need to foster spaces for new mothers to talk to each other.

Mother-Child Programs for Incarcerated Mothers and Children and Associated Health Outcomes: A Scoping Review.

BACKGROUND: Increasing incarceration of women disrupts fertility, family formation, parenting and mother-child relationships. It is common in many jurisdictions, including Canada, to mitigate the harm of separation from the primary parent through programs allowing children to co-reside with their mothers in prison. In this scoping review, we asked the following questions: (1) What are the characteristics of residential mother-child programs in carceral facilities? (2) Who is eligible to participate? (3) How do these programs make a difference to maternal and child health outcomes? METHOD: We use the Joanna Briggs Institute methodology for systematic scoping reviews. This approach includes a three-step search strategy developed with a clinical research librarian. Databases searched include MEDLINE, CINAHL, PsycINFO, Gender Studies Abstracts, Google Scholar and ProQuest Dissertations. The search yielded 1,499 titles and abstracts, of which 27 met the criteria for inclusion. RESULTS: Conducted from 1989 to 2019, across 12 countries, the studies included qualitative and quantitative methods. None was based in Canada. The most common outcomes among the studies included attachment, development, infection, neonatal outcomes, mental health, pregnancy and general experiences. DISCUSSION: Although supporting attachment, mother-child program participation is complex and challenging. High morbidity in the incarcerated population and lack of data collection before and after program participation prevent conclusions, and wide variations in contexts prevent comparisons. BENEFITS: This scoping review illustrates the complexity of maternal and child health outcomes associated with mother-child programs. Initiation or continuation of or changes to such programs must be made with careful consideration.

Experiences With Managing the Workplace Social Environment: A Qualitative Study.

OBJECTIVE: This study aims to examine 1st-line managers' (FLMs') experiences in managing the workplace social environment (WSE). BACKGROUND: FLMs are responsible for the establishment and maintenance of supportive WSE essential for effective teamwork. Poorly managed WSE and dysfunctional teams hold negative implications for patients, teams, and organizations. METHODS: This was a qualitative descriptive study, using content analysis of individual and focus group interviews with FLMs and directors. RESULTS: FLMs play a critical role in the management of the WSE; however, the task is fraught with constraints and challenges including competing demands, lack of support, and insufficient training. Findings explicate how competing demands and communication challenges impede the successful management of the WSE. CONCLUSIONS: Given the importance of a healthy WSE to patient, professional, and organizational outcomes, FLMs need support, training, and resources to assist them in managing the social environment alongside other competing priorities.

Promoting recruitment by rebranding the image of nursing.

Understanding the factors that can influence people to pursue a career in nursing is essential for healthcare service managers, human resource professionals and nurse educators, particularly given the global shortage of nurses. There is evidence that the public perception of nursing can be negatively influenced by the media and nursing recruitment advertisements, and that this can discourage some people from choosing nursing as a career. At the Dalhousie University in Canada, evidence regarding the career choices of prospective nurses was used to inform a rebranding strategy for the School of Nursing's recruitment materials. The aim of the rebranding strategy was to present the School of Nursing as a diverse institution that provided a range of career opportunities for its nursing students. This article describes the background and implementation of the rebranding project. It also details how the university's evidence-based rebranding strategy was designed to positively influence people to choose nursing as a career.