We sought to understand, "What are the contraception access experiences, beliefs, attitudes, knowledge and needs of youth in Canada, from the perspectives of youth and youth service providers?" We explore person-centred contraception care and highlight the importance of fostering trust, autonomy, and informed consent. We conducted one-on-one semi-structured interviews with youth (aged 15-25) and healthcare providers (HCPs) across Canada, representing a diversity of rural and urban settings, gender, age, and ethnicities. Using social constructivist grounded theory, we identified key themes related to reproductive autonomy, trust, and informed consent. We analysed data from 79 youth and 27 HCPs, identifying five themes: (1) Valuing shared decision making; (2) "Pushing" contraception: putting a stop to paternalism; (3) Seeking anti-oppressive care; (4) Contraception care is all about trust; (5) Practising control over my own body. Participants valued shared decision-making and wanted to feel that "we're in this together". Both youth and HCP participants shared stories of HCPs "pushing contraception" on youth and experiences of medical discrimination which impeded feelings of safety and autonomy. In response, youth advocated for anti-oppressive care and identified the importance of "therapeutic relationship building," emphasising that fostering safety with HCPs is "all about trust." Finally, youth reported practising advocating for their reproductive autonomy to have control over their own body. Our research highlights the importance of shared decision-making, informed consent, and anti-oppressive care in fostering supportive and safe contraception access for youth. Results have implications for jurisdictions where youth face increasing barriers to contraception access. DOI: 10.1080/26410397.2026.2678063.

BackgroundIn 2017, nurse practitioners (NPs) became the first non-physician healthcare providers authorised to independently provide medication abortion (MA) in Canada. We aimed to report on demographic and clinical characteristics of NPs providing mifepristone/misoprostol MA in Canada and to identify context-specific barriers and enablers to NP provision of mifepristone/misoprostol MA in Canada among MA providers and non-providers.MethodsFrom August 2020 to February 2021, we invited Canadian NPs to complete a national, web-based, bilingual (English/French) survey. The survey was distributed through national and provincial nursing associations and national abortion health professional organisations. We collected demographic and clinical care characteristics and present descriptive statistics and bivariate analyses to compare the experiences of NP providers and non-providers of MA.ResultsThe 181 respondents represented all Canadian provinces and territories. Sixty-five NPs (36%) had provided MA at the time of the survey and 116 (64%) had not. Nearly half (47%) of respondents worked in rural or remote communities and 81% in primary care clinics. Significant barriers impacting non-providers’ abilities to provide MA included limited proximity to a pharmacy that dispensed mifepristone/misoprostol, few experienced abortion providers in their community of practice, poor access to procedural abortion services, policy restrictions in NPs’ places of employment, and no access to clinical mentorship. Some 98% of NPs providing MA services had never encountered anti-choice protest activity.ConclusionsNPs appear prepared and able to provide MA, yet barriers remain, particularly for NPs in smaller, lower-resourced communities. Our findings inform the development of supports for NPs in this new practice to improve abortion access in Canada.

Introduction:Black nurses are under-represented in the Canadian nursing workforce. A legacy of discrimination and systemic barriers reinforce the under-representation of Black nurses in the nursing workforce throughout the health system. Objective:The objective of this study was to identify and describe organizational initiatives for the recruitment, retention and advancement of Black nurses in the healthcare system. Methods:We conducted a rapid review of peer-reviewed and grey literature regarding the recruitment, retention and advancement initiatives for Black nurses, in North America and the UK. Results:Thirty-eight sources were included in this review. Majority of the included sources focused on leadership initiatives that described a multi-pronged approach for recruitment, retention or advancement. Examples of useful initiatives included mentorship, dedicated leadership and advancement programs, as well as supportive institutional policies. In addition, several Black nurse-led organizations/initiatives were identified. Conclusion:These findings highlight the importance of multi-pronged approaches to enhance and support the Black nurse workforce. In addition, implementing and evaluating initiatives is critical to understanding how workforce representation and inclusion is strengthened.

BACKGROUND:The ongoing impacts of the COVID-19 pandemic on Canada's healthcare workforce and service delivery necessitate focused health system planning and delivery that prioritizes coordination, collaboration, and evidence-based strategies. A rapid evidence synthesis was commissioned by Health Canada to determine the impacts of the pandemic on the healthcare workforce and to identify promising strategies and innovations that mitigate these challenges. METHODS:Two, sequential rapid evidence syntheses were conducted between October 2022 and March 2023 using methodologies aligned with Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search extension (PRISMA-S) guidelines. The first review (October-November 2022) focused on the impacts of COVID-19 on Canadian healthcare workers and mitigation strategies, while the second (November 2022-March 2023) broadened the scope to international interventions. Findings were organized by impact level (individual, organizational, system). Quality assessment of sources was not performed. RESULTS:We included 176 and 31 sources, respectively in the analysis. Sources identifying impacts of the COVID-19 pandemic described significant mental health impacts on healthcare workers, alongside changes in demand and supply of services, physical health challenges, and shifts in scopes of practice or care models. Interventions were primarily targeted at the individual or organizational level and included mental health support, training and upskilling, enhanced organizational communication and workforce planning initiatives. System-level interventions were less common, and most interventions lacked robust evaluation or evidence-informed design. CONCLUSIONS:This review highlights a significant gap in literature regarding evaluated interventions to address healthcare workforce challenges during the pandemic. While numerous sources document the adverse impacts on healthcare workers, detailed reports on specific interventions are scarce. Most interventions focus on workforce planning, education, practice scopes, recruitment and technology integration. The research underscores the need for comprehensive recommendations addressing social and mental health support, workplace safety, organizational communication and pandemic preparedness. These recommendations are vital for developing future workforce strategies, thus enabling policymakers and healthcare leaders to effectively respond to current and future healthcare challenges. This strategic approach will enhance system resilience and improve healthcare delivery across Canada.

The coronavirus disease 2019 (COVID-19) pandemic highlighted the crucial role of robust health research systems (HRSs) in supporting effective public health responses. Understanding the responses and lessons learned from HRS during the pandemic is vital for future preparedness. This environmental scan examined high income Countries with a HRS that responded to the COVID-19 pandemic using both academic and grey literature sources to gather comprehensive insights into these areas. The analysis was structured using an organizing framework to facilitate systematic extraction and synthesis of relevant information. A total of 5336 sources were identified of which 3609 were screened following duplicate removal. A total of 117 full-text sources were reviewed leading to 65 being included. Effective interdisciplinary and cross-sector collaborations significantly enhanced the capacity to respond to the pandemic. Clear and streamlined governance structures were essential for coordinated efforts across various entities, facilitating swift decision-making and resource allocation. The robustness of pre-existing research infrastructures played a crucial role in the rapid mobilization of resources and execution of large-scale research projects. Knowledge mobilization efforts were vital in disseminating research findings promptly to inform public health responses. Continuous tracking and evaluation of health research activities enabled real-time adjustments and informed decision-making. Rapid identification and funding of research priorities, including vaccine and therapeutic development, were critical in addressing urgent public health needs. Effective resource allocation and capacity-building efforts ensured focused and accelerated research responses. Comprehensive strategic planning, involving stakeholder engagement and robust monitoring tools, was essential for aligning research efforts with health system needs. The findings underscore the necessity of flexible funding mechanisms, enhanced data-sharing practices and robust strategic planning to prepare for future health emergencies. Policy implications emphasize the need for sustained investments in health policy and systems research (HPSR) and the development of comprehensive governance frameworks. Research implications highlight the importance of community engagement and interdisciplinary partnerships. For decision-makers, the study stresses the importance of rapid response mechanisms and evidence-based policy making. Health research systems must prioritize maintaining adaptable infrastructures and strategic planning to ensure effective crisis response. Despite potential biases and the rapidly evolving context, this comprehensive analysis provides valuable lessons for strengthening HRSs to address future public health challenges.

Introduction: In response to protests for racial justice, several organizations and institutions have made public declarations denouncing anti-Black racism. One prominent sector emphasizing their commitment to addressing anti-Black racism is health care—more specifically, nursing. To address anti-Black racism, many Canadian organizations and institutions have announced initiatives to recruit, retain, and support the advancement of Black nurses. Our team is interested in charting these initiatives to inform future policy and program decisions related to the recruitment, retention, and advancement of Black nurses. Objective: The objective of this review is to identify and chart evidence of organizational and institutional initiatives related to the recruitment, retention, and advancement of Black nurses in Canada. Inclusion criteria: This rapid review will include sources focused on Black nurses in Canada. Further, this review is focused on the organizational or institutional initiatives that support or facilitate aspects of recruitment, retention, or advancement of Black nurses in the workforce in Canada. Methods: A comprehensive search, developed in collaboration with a library scientist, will be used to locate peer-reviewed and grey literature from select databases and repositories. Databases will be searched from time of inception, and language will be restricted to English and French sources. Title and abstract screening as well as full-text review will each be completed by two independent reviewers. Sources will be included if they meet the inclusion criteria for the population, concept, and context. Data will be extracted by two reviewers using an extraction tool. Data will be reviewed and consolidated before being presented narratively and visually.Protocol Registration: The protocol has been registered with Open Science Framework (OSF) on March 1st, 2023.

Introduction There is little to no evidence in Canada on the barriers that youth face when accessing contraception. We seek to identify the contraception access, experiences, beliefs, attitudes, knowledge, and needs of youth in Canada, from the perspectives of youth and youth service providers. Methods and analysis This prospective, mixed-methods, integrated knowledge mobilisation study, the Ask Us project, will involve a national sample of youth, healthcare and social service providers, and policy makers recruited via a novel relational mapping and outreach approach led by youth. Phase I will centre the voices of youth and their service providers through in-depth one-on-one interviews. We will explore the factors influencing youth access to contraception, theoretically guided by Levesque’s Access to Care framework. Phase II will focus on the cocreation and evaluation of knowledge translation products (youth stories) with youth, service providers, and policy makers. Ethics and dissemination Ethical approval was received from the University of British Columbia’s Research Ethics Board (H21-01091). Full open-access publication of the work will be sought in an international peer-reviewed journal. Findings will be disseminated to youth and service providers through social media, newsletters, and communities of practice, and to policy makers through invited evidence briefs and face-to-face presentations.

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.

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.

Context: In 2015, Health Canada approved mifepristone for medication abortion for use in Canada and by 2017, the drug was available for use by physicians and nurse practitioners (NPs). As potential abortion providers, NPs could expand access to this necessary service for a broader population. There is a need to understand the NPs experiences implementing mifepristone in practice and the unique provider-specific barriers they face, to improve implementation of mifepristone in primary care. Objectives: The objective of this study was to identify the context-specific barriers and enablers to NP provision of mifepristone in Canada. A key second objective was to improve implementation amongst NPs. Study Design: Mixed-methods implementation design. We report the qualitative component of this study. Qualitative data were analyzed using a feminist theoretical lens and organized thematically. Setting or Dataset: Primary care, women’s health, sexual and reproductive healthcare. Population studied: Nurse practitioners across Canada in primary care, women’s health, and sexual or reproductive health (n=22). Nursing stakeholders in health administration, government, advocacy, regulation (n=20). Results: NPs who provided mifepristone engaged in clinical leadership, community education and communication, and interprofessional outreach to offer this service in their practices. NPs who did not provide mifepristone felt it was either low priority in their practices, were unsupported by colleagues or employers to offer mifepristone, or faced major resource barriers (e.g. no access to emergency services in their region). Conclusions: Participants’ stories elucidate the potential value of NPs to improve and expand abortion access and pregnancy options for people in Canada. NPs also face multiple ongoing barriers to their provision of mifepristone. Allied health professionals, employers, policymakers, and administrators may use these insights to better support NPs in practice for improved reproductive 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.

Discourses of research impact shape the ways in which critical qualitative research and researchers are evaluated in contemporary academic environments. Mainstream conceptualizations of research impact arise from a positivist perspective that challenges the aims and approaches of critical qualitative research. In this paper, we propose a framework for conceptualizing the impact of critical qualitative research on policy, practice, and science. After critiquing literature that presents mainstream views on research impact, we summarize a recent framework for conceptualizing the impact of critical research specifically. We then add to the Machen framework by highlighting the impacts of critical qualitative research on the institutions and practices of science. We provide examples of ways in which researchers at the Centre for Critical Qualitative Health Research at the University of Toronto have made contributions to the impact of critical qualitative research on science, and conclude by addressing implications of this framework for the ways in which critical qualitative researchers can plan and evidence the impact of their work.

The Canadian Institutes of Health Research - Institute of Health Services and Policy Research's (IHSPR's) Strategic Plan 2021-2026 for accelerating health system transformation is well positioned to meet the strategic priorities being outlined by many health systems in Canada and internationally (CIHR IHSPR 2021). The IHSPR Health System Impact Fellow program has been a strong influence on the embedded research and scientist program in Nova Scotia, namely, the Network of Scholars Program, which was implemented just before the pandemic. The network includes scientists and scholars from diverse academic backgrounds and skill levels including alumni of the Health System Impact Fellow program. The Network of Scholars has over 30 scholars and approximately 100 academic partners and scientists supporting embedded activities such as rapid reviews, implementation science and rapid evaluation initiatives. These embedded activities are front facing to the needs and priorities of the health system. This commentary highlights the importance of IHSPR's outlined strategic plan and direction, which are consistent with the experience and the needs for embedded supports within the Nova Scotia health system.

Despite their low and inconsistent rates of success, assisted reproductive technologies (ARTs) are presented by fertility clinics and constructed in media and popular culture as an effective treatment for infertility. The ways in which such technologies medicalize women's health and bodies have been well documented by social scientists and feminist health researchers. However, little is known about the struggles women face in cases of "failure"; that is, when ART does not achieve its purported potential to assist women in their attempts to conceive and have the desired outcomes of conception and birth. Using a post-structural feminist interpretive framework combined with a narrative methodology, this paper critically examines the ways in which social and cultural narratives about gender and biotechnology shape women's accounts of discontinuing ART. Thirty-six interviews were conducted with twenty-two women across Canada who were at various stages of discontinuation and who utilized a variety of treatment types. Three inter-related narrative themes were developed to categorize the stories of struggle: (i) a growing desperation to be pregnant; (ii) confronting paternalistic medical expectations; and (iii) internalizing and resisting blame for treatment failures. These themes highlight both the explicit and subtle ways in which restrictive social and cultural narratives about womanhood and motherhood were perpetuated in clinical interactions, which ultimately made ending treatment more difficult. Our analysis illustrates how women navigated and resisted such narratives, through pausing or ending treatment despite provider recommendations and clinical messages. We suggest that fertility providers critically reflect on the potentially harmful language used during interactions with patients and recommend that discontinuation discussions become a recurring, normalized component of treatment protocols and patient-provider conversations so that women feel better supported to end treatment when they believe it is financially, emotionally, and physically beneficial for them to do so.

The COVID-19 pandemic has seen increased rates of intimate partner violence (IPV). This is attributed to greater stress on households and families (e.g., reduced income, limited access to childcare and schools), and isolation from friends and family. Public Health guidance on physical distancing and/or remote delivery of services are helpful for reducing the spread of infection, yet these restrictions can create further challenges and barriers for women seeking IPV services. In this review, we synthesized evidence from 4 systematic reviews and 20 individual studies to suggest how IPV services, supports, or interventions for women might be adapted within the context of the COVID-19 pandemic. Interventions generally fit into four main categories: 1) Preventing IPV through early recognition and awareness of IPV; 2) Counteracting abuse and breaking free; 3) Supporting women while living with and/or leaving an abusive partner; and 4) Supporting women after leaving an abusive partner. Many initiatives depend primarily on technology such as mobile phones and an internet connection for delivering information and interventions (e.g., mHealth, telehealth, websites, digital applications). However, it is important to consider that technological interventions are not available to all women given the financial resources necessary to secure a device and access to reliable internet. The results of this review can inform the service provision during the remainder of the COVID-19 pandemic and may be especially important for supporting women who have little access to face-to-face services (e.g., women living in rural and remote places where there are few in-person services).

Cross-Cultural Comparisons on Surrogacy and Egg Donation is an edited collection of interdisciplinary essays about the ethico-legal frameworks and socio-cultural debates surrounding surrogacy and egg donation in India, Germany and Israel. This collection combines empirical evidence from law, psychology, anthropology, social studies and bioethics, the goal of which is twofold: (i) disentangle the local, culturally specific ethico-legal and cultural frameworks of these three countries; and (ii) demonstrate the interconnectedness of local frameworks vis-à-vis experiential evidence of transnational assisted reproductive technology (ART) practices. The editors emphasise the need for such systematic comparisons of the macro (legislation, policy) and micro (gender, class and ethnicity issues) politics of different countries. The editors chose India, Germany and Israel as comparative examples because of their seemingly heterogeneous approaches to the governance of, and national attitudes towards, surrogacy and egg donation, as well as a few infamous cases of cross-border ART practices between these three countries. The collection begins by setting up the macro politics of ART in a global network of reproduction with transnational flows and takes a comparative approach to the practices and norms of surrogacy and egg donation across India, Germany and Israel. Part II features essays from India, a so-called “system in transition.” Here the authors provide a political-historical account of India's transition from a liberal stance towards surrogacy culminating in “Brand India” to its 2012 prohibition of gestational surrogacy services for foreign intended parents and its ongoing attempts to establish a national act. Salient to these essays are the inequities confronted by surrogate mothers in India in terms of compensation and autonomy, and the ethical responsibilities of intended parents seeking their services. Part III is the restrictive case of Germany where “it is illegal to tamper with ‘natural motherhood’” (p. 231). Here we get a glimpse into the various strategies of ART users to circumvent the German legal system, travel abroad for surrogacy services and negotiate stigmatisation back home. The collection concludes with the case of Israel: a pro-natal society with “state-supported” surrogacy and egg donation practices. The authors get at the roots of the state monitored surrogacy system in Israel and the inextricable link between Israel's political system and religious culture, enacted on the terrain of reproduction and technology. The strength of this edited collection lay in the convincing manner in which it presents empirical evidence, making connections and highlighting contradictions between policy, national values and the lived experiences of ART users within and across nations. The use of qualitative data is particularly effective in making these connections and contradictions salient for the reader while avoiding cultural relativism. For example, both Israel and India ban surrogate mothers from contributing their own genetic material (eggs) to the future child in a surrogacy arrangement. These laws are meant to protect intended parents by reducing the likelihood the surrogate mother will want to keep the child to which she is genetically connected, while also easing the moral and ethical discomfort intended parents may feel by taking a child away from its biological mother (Teschlade, Chapter 14). Despite this justification, Shalev (Chapter 15) points to the numerous cases in which the intended parents, often from foreign countries, were in fact the ones to break the surrogacy agreement and fail to take responsibility for the child, rather than the surrogate mother claiming the child as their own. This example illustrates the need for more social science data in policymaking that can illuminate the experiential outcomes of policies, which are complex and often unanticipated. I appreciate the editors’ efforts to provide a fulsome picture of surrogacy and egg donation in the glocal context. Some of the essays were less effective than others and attempted to do too much with the limited space provided. The editors admit they provide only a “cursory look” (p. 49) at the state of surrogacy and egg donation across these three countries. This collection also demonstrates the difficulty of cross-cultural comparison when the state of ART, a biotechnoscientific entity, is constantly in flux, innovating and changing the way users relate to one another in a globalised market. As a reader, I would have benefitted from a conclusion chapter in which the editors engaged with the essays presented and theorised potential ways forward. In summary, this edited text is an ambitious and convincing cross-cultural comparison of the ethical, legal, and socio-cultural frameworks of India, Germany and Israel. The editors and authors provide no easy answers to the question “what is the right way to legislate ART”? The reader is left to ruminate on the transnational implications of each form of governance. Stakeholders and policymakers would benefit from reading this collection because of its use of qualitative evidence from multiple disciplines to illustrate the local and transnational consequences of specific regulations for users of ART, which may or may not contradict their assumptions about what legislation is intended to accomplish.