Written by: Jill Koebel (she/her).
Edited by: Miles Llewellyn (they/them).
Summary: The pandemic added fuel to the fire that is the state of the healthcare system in Canada. Researchers have been pushing for more interdisciplinary collaboration in the health and social service sectors, but logistical barriers make this challenging to implement. Dr. Stephanie Begun (she/her), a social work researcher and reproductive justice advocate, explores several phenomena at the intersection of health and social services. Her social work background prompted her to ask how social workers could support the reproductive justice movement in Canada and contribute to an equitable and accessible health system. Dr. Begun’s discussion with Sex[M]ed regarding abortion access in Canada forms the basis of this article, and her research on optimizing interdisciplinary collaboration is explored.
“Is this not a social work topic, or are we just afraid to talk about it?”
Dr. Begun’s passion for reproductive rights started early in her career – before graduate school, she worked with Planned Parenthood in Colorado. She completed her Master of Social Work, then went on to complete her PhD, examining family planning attitudes and social network influences among youth experiencing homelessness. Quickly, she noticed a connection between these intersecting social inequities: housing insecurity, reproductive health access, and social stigma. Family planning, including abortion access and education, were seldom discussed by social workers – yet these aspects made such an impact on the lives of the folks they served. She questioned why these conversations weren’t frequently happening in social work education settings, and how bringing these issues to the forefront could lead to better care outcomes for folks accessing social work services.
Some of Dr. Begun’s first projects as a independent researcher involved examining American social work students’ abortion attitudes, viewpoints and knowledge. Surprisingly, out of a large national sample, 82% of students reported they rarely discussed abortion in their social work classrooms, and 43% reported they would not know how to help a client seeking information about abortion (1). Dr. Begun emphasized the need for formal development of competencies that address abortion and sexual and reproductive health in general to bring the social work discipline in line with other professions and increase interdisciplinary collaboration. Additionally, Dr. Begun’s work found correlations between sociodemographic characteristics and abortion attitudes, suggesting social work sexual and reproductive health education should also focus on personal views, biases, and cultural competency (2).
Optimizing the roles of other allied health professionals
When asked about how we can improve abortion access in Canada, Dr. Begun emphasized the need to further engage allied health professionals – namely pharmacists, nurses, and midwives – in the provision of abortion services. Earlier this year, Dr. Begun co-authored a study that examined how to optimize the nursing role in abortion care. The research team explained that despite nurses being the largest healthcare workforce in the country and the extensive role RNs and NPs play in sexual health care and education, their expertise is not leveraged to its full potential in respect to abortion care (3). The authors suggested that since nurses are often the first healthcare professionals with whom folks from underserved communities come in contact, the presence of nurses in abortion care can increase the availability of abortions to rural patients and priority populations (3). Insight from NPs and RNs engaged in medication abortion practice suggested dismantling clinical hierarchies, advancing abortion advocacy and leadership training in nursing education, and addressing structural barriers in health services can support optimization of nurse leadership in abortion care and reproductive health equity in Canada (3).
This research is in line with findings from a 2021 study in British Columbia that explored influences on provision of medical abortion prescription by Canadian pharmacists (4). Unlike in many other countries, Canadian pharmacists are permitted to dispense mifepristone for medical abortions, but many factors influence the initiation of this practice. This study found several constructs impacted the uptake of mifepristone, including the logistics of keeping inventory on hand, dedicated time and resources to counseling, and existing organizational culture including individuals with anti-choice attitudes (4). This work, like Dr. Begun’s research in the social work sector, indicates that allied healthcare professionals can be willing and capable partners in abortion care when strong interdisciplinary collaboration is in place (4).
Evidently, interdisciplinary collaboration is essential for improved abortion access in Canada. In addition to her abortion advocacy work, Dr. Begun is leading collaborative interdisciplinary research at the Youth Wellness Lab at the Factor-Inwentash Faculty of Social Work. Here, she facilitates collaboration between academic researchers, community partners and youth advisors with the shared goal of improving services by, with and for youth.
References:
1. Begun S, Bird M, Ramseyer Winter V, Massey Combs K, McKay K. Correlates of Social Work Students’ abortion knowledge and attitudes: Implications for education and research. Social Work in Public Health. 2016;31(4):276-287. doi:10.1080/19371918.2015.1137510
2. Begun S, Kattari SK, McKay K, Ramseyer Winter V, O’Neill E. Exploring U.S. social work students’ sexual attitudes and abortion viewpoints. The Journal of Sex Research. 2016;54(6):752-763. doi:10.1080/00224499.2016.1186586
3. Carson A, Paynter M, Norman W, et al. Optimizing the nursing role in abortion care: Considerations for health equity. Canadian Journal of Nursing Leadership. 2022;35(1):54-68. doi:10.12927/cjnl.2022.26750
4. 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). doi:10.1186/s13012-021-01144-w
