Action Canada & Vitala Global: Client Interview Eligibility Questionnaire  
Thank you for your interest in sharing your experience with having a medication abortion using Mifegymiso. We know how personal and potentially sensitive this topic is for people, and we appreciate your openness in contributing to our research. 

The following is a short form to review your eligibility for our work. If eligible, we will be in touch in 2 weeks to schedule an interview or invite you to a co-creation workshop. 

What you expect from the interview: 
  • The interview will be conducted virtually by a member of the Vitala team through a trauma-informed approach.
  • You will be shown a demo of our app, Aya Contigo, and asked 15-20 optional questions about your experiences with seeking information, care and support for abortion
  • The interview will last 60 minutes, conducted on Zoom, in the EST time zone.
  • Following the completion of the interview, a $50 visa gift card will be emailed as an honorarium within 1-2 business days 
Our data and privacy policy:
  • The interview will be audio recorded with no video.
  • There will be no use of names during the interview to maintain privacy.
  • The name used on our back-end will be the one provided in the eligibility form, and connected to the email address we use to contact you.
  • The data from this research will be used to adapt a digital abortion accompaniment solution, currently used in Latin America and the USA, for people seeking medication and procedural abortions in Canada.
  • The data will be stored for up to 1 year with first name, email, age, province, and identities, before being cleared. 
If you have any questions or concerns, or require any specific accommodations, please do not hesitate to contact, Hima Batavia at hima@vitalaglobal.org, and we will do our best to meet your needs. 

Vitala Global is a global non-profit tech organization that provides people with evidence-based digital platforms to support their safe abortion and family planning journeys. Operating in Latin America and the USA, our digital abortion accompaniment service, Aya Contigo, has reached over 55,000 women and people. 

We are currently working in partnership with Action Canada for Sexual Health & Rights to adapt and roll out the service for Canadians. Action Canada for Sexual Health & Rights is a progressive, pro-choice charitable organization committed to advancing and upholding sexual and reproductive health and rights in Canada and globally.

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Preferred first name  *
Primary Email Address  *
This email address will be used for scheduling and to send a $50 visa gift card as a honorarium 
Current Age *
Current place of residence (city/province) *
Preferred Pronouns
Approximately when was your most recent medication abortion using Mifegysmiso?  *
MM
/
DD
/
YYYY
In which province or territory did you access medication abortion and care?  *
Do you identify with any of the following identities (Check all that apply)?  *
This question is designed to understand if and how any of your identities impact your medication abortion experience. 
Required
What ethic community do you identify with? (Check all that apply) *
Required
Are you comfortable with having our interview audio recorded for internal research purposes? *
This data will be used to inform the adaptation of the Aya Contigo app to support information, navigation and accompaniment during self-managed abortion. The data will be stored for up to 1 year and then deleted. Your first name, age, province and identities will be associated with the data. 
Are you able to meet virtually on Zoom for a 60-minute interview between April 20 and May 29, 2026? *
This would require having access to a computer or phone and a stable internet connection.
If yes, please indicate your weekday interview time preferences (Check all that apply) *
Please note: interviews will be conducted on weekdays in the Eastern Time Zone.
Required

Do you accept that a $50 gift card honorarium will be provided through email if the interview is completed in good faith, as determined by the interviewer? 

 *

Would you be interested and available to join a 2-hour in-person focus group on from 9:30am-12:00pm, in Downtown Toronto, for a $50 visa card honorarium? 

 *
If there are any accommodations, questions, or clarifying concerns you have or need, please feel free to share them below. 
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