Midwives as agents of change: a qualitative analysis of midwives' experiences with abortion care provision in Canada

Midwives possess the skills and competencies required to provide abortion care in Canada, yet their role is constrained in health systems. They are well suited to address barriers to abortion access related to geographical and social inequities, which deprive many Canadians of essential healthcare and impede reproductive justice. To address current gaps, this study explores midwives' experiences providing abortion care in Canada. Qualitative data were collected from 25 in-depth interviews and three focus group discussions with midwives between August and December 2023. Using reflexive thematic analysis, we explored how midwives work in communities to provide or work toward providing abortion care, including health system facilitators, barriers, and their values, needs, and preferences for implementation. Findings highlight the barriers midwives face, including regulatory restrictions and a lack of flexible funding arrangements. Despite these challenges, midwives are leveraging their skills to advance reproductive justice, offering culturally safe, client-centred abortion care to underserved populations, including uninsured individuals. The study also identifies facilitators, such as applying midwifery values and philosophies to provide the midwifery model of abortion care. This research contributes to the growing body of knowledge on midwifery and abortion care, advocating for the removal of regulatory and funding barriers that limit midwives' potential to provide comprehensive sexual and reproductive healthcare. The findings have significant implications for policymakers and health system leaders in Canada and beyond, calling for the optimisation of midwives' roles to improve access to abortion care and advance reproductive rights globally.