AOM Board and IMAC endorse new statements on abortion care and reproductive choice

The AOM is a pro-choice organization that supports reproductive justice, including recognizing equitable access to safe and legal abortion care as a human right. At the 2024 Annual Members’ Meeting, AOM membership overwhelmingly passed a member proposal (member login required) directing the AOM to advocate for autonomous, midwife-led, comprehensive abortion care through appropriate funding, remuneration and regulation.

A new position statement on midwife provision of abortion care and reproductive justice has been approved by the AOM Board of Directors. The position statement replaces the AOM’s former position statement on reproductive justice.

A distinct consultation process with the Indigenous Midwifery Advisory Circle (IMAC) was led by the AOM’s Indigenous Midwifery team. IMAC supports the AOM position statement but felt strongly about developing a separate statement that reflects perspectives of Indigenous midwives and Indigenous people, including First Nations, Inuit and Métis. The complementary IMAC statement makes room for cultural factors that govern the practice of Indigenous midwives, as well as societal norms that may shape a community’s views on abortion.

The AOM’s work to support midwife provision of abortion

The AOM unequivocally supports midwife provision of abortion. The AOM’s activities to support midwife-led abortion care have included:

• advocating for funding for midwife provision of abortion as part of Expanded Midwifery Care Models
• holding membership on the Steering Committee of the Canadian Association of Midwives’ (CAM’s) Contraception and Abortion Research Team (CART), contributing to the National Strategy for Midwife-Led Abortion Care in Canada
• conducting research, including interviews and focus groups with midwives providing abortion care and other sexual and reproductive health services
• hosting educational opportunities to deepen midwifery skills, including an early pregnancy loss (EPL) and abortion management workshop
• advocating to the Ministry of Health for expansion of scope, including midwives’ role in provision of abortion care

Ontario midwives’ role in the provision of medical abortion

The College of Midwives of Ontario (CMO) and the AOM interpret abortion care as normal variation in pregnancy and support midwives acting to their fullest scope of practice. However, midwifery’s highly regulated scope of practice, compensation models, and limitations on prescription authority currently pose barriers to the integration of midwife-led abortion care in Ontario.

Despite these barriers, midwives across Ontario are increasingly involved in the provision of contraceptive and abortion care. Many Ontario midwives have expressed the desire to engage more deeply in this work and reduce the disparity in access to care.

The most recent Drug Regulation in Ontario, amended in May 2024, permits midwives to prescribe Mifegymiso for the management of spontaneous early pregnancy loss. Midwives may continue to use this medication on the order of a physician or a nurse-practitioner for the purpose of planned termination of pregnancy.

The AOM continues to support the framework advocated for by the CMO to adopt broad and adaptive drug regulation, based on the knowledge, skills and judgement of the midwife providing care. Allowing midwives to prescribe to scope and for any indication, as opposed to a restrictive list of medications and indications, would address the challenges of being reliant on medical directives to provide appropriate care, and allow for flexibility as best practices evolve or constraints arise on the medication supply chain.

Future Advocacy

The development of the AOM’s position statement on midwife-provided abortion care and reproductive justice and IMAC’s statement on reproductive choice and reproductive justice support future midwife-led abortion advocacy, including alignment and collaboration with supportive stakeholders. The new statements continue to align the AOM with stakeholders and supporters in this work, including but not limited to: Canadian Association of Midwives (CAM), Canadian Abortion Hospital Network (CAHN), College of Midwives of Ontario (CMO), Ontario Midwifery Education Programs (MEPs), the Ministry of Health (MOH), the Ontario Medical Association (OMA), the Ontario Pharmacists Association (OPA), the Pregnancy And Infant Loss Network (PAIL), midwifery clients and the general public.

The AOM will continue its advocacy efforts, guided by the new position statement, for well supported, funded, autonomous and comprehensive midwife-led abortion care, rooted in a commitment to reproductive justice.