Advanced Practice Clinicians and Abortion Care Provision
Issue Brief
Overview
Even before Roe v. Wade was overturned, people in many regions of the United States did not have local access to a physician who provided abortion care, and travel for abortion care to neighboring counties or states was common. The need for increased abortion care capacity has only continued to grow since the Supreme Court decision in Dobbs v. Jackson Women’s Health Organization. Integrating advanced practice clinicians (APCs), who are nonphysician clinical care professionals such as certified nurse–midwives, nurse practitioners, and physician assistants, into abortion care can help expand and increase access to this essential care.
Legislative mandates in many states restrict abortion care provision to only physicians or only board-certified obstetrician–gynecologists. These mandates are not based in science; improperly regulate medical practice; and impede patients’ access to quality, evidence-based health care.
APCs could become critical, lifesaving points of care networks for patients who would otherwise be forced to travel to access abortion care—or cut off from it entirely.
Need for Abortion Care and Lack of Abortion Care Resources
About 3.7 million women in the United States live in a county without abortion care access. That means 3.7 million people would have to cross county lines at least once to obtain essential reproductive health care. Per the Guttmacher Institute, residents of 15 states would have to travel even farther than just out of their county: even if their state abortion ban deemed them qualified to receive an abortion, there is no in-state clinic with abortion care services.
This lack of access to care doesn’t only affect people who live in states with abortion bans: there are people in some states that have codified protections for abortion who still find themselves lacking access to abortion care within county lines despite abortion being legal there. In states with abortion protections, it becomes easier for the evidence of factors contributing to gaps in the abortion care network to come into focus. One such factor is a dearth of health care professionals who are trained to perform abortions; another is laws that prevent nonphysicians—or even physicians who are not obstetrician–gynecologists—from providing care.
A lack of health care professionals who provide abortion care exacerbates existing health disparities, too: people of color, people living in rural areas, people who are incarcerated, and people with low income and financial resources are all disproportionately harmed when abortion care is placed out of their reach. People in these groups already face additional barriers to accessing care; these barriers become even more daunting when applied to care that can be accessed only by traveling outside of one’s town, county, or state.
Abortion care that is accessible only by those who can travel hours from their homes, afford to take time off work or away from their lives, arrange childcare if needed, and finance a trip to an available health care professional is not actually accessible. Moving toward true, equitable accessibility in abortion care means increasing the density and number of health care professionals who provide abortion care, and APCs can play a key role in achieving that goal.
APCs and Abortion Care Provision
APCs have the foundational skills necessary to be trained to provide medication and procedural abortion care. Studies have found that there is no significant difference in complication rates for medication abortions performed by APCs and those performed by physicians, and that outcomes of medication abortions performed by APCs were within the established benchmarks for effectiveness and safety of medication abortion. Evidence suggests that training to foundational competence in some abortion procedures could be achieved relatively quickly through standardized competency-based training.
Researchers and physicians alike have called for the range of health care professionals trained in abortion care provision to be expanded in order to protect, bolster, and increase access to abortion care. These measures would counteract legislative restrictions that ignore science and evidence in order to cut down access to critical reproductive health care. Organizations such as the National Abortion Federation, the American Public Health Association, the American Medical Women’s Association, and the World Health Organization all strongly support APCs being trained in and able to provide abortion care.
How APCs Can Help Expand the Abortion Access Network
APCs would provide much-needed access to abortion care, helping to close some of the gaps in geographical access to abortion care. Increasing the availability of trained clinicians who can provide abortion care will allow more patients to access quality health care in their own communities and enable patients to receive care more quickly. APCs can also offer relief to overburdened clinicians in states without abortion bans who are grappling with the influx of out-of-state patients seeking abortion care. Additionally, an increase in clinicians capable of abortion care may be able to mitigate the harmful effects of inequity in abortion care access, as certain groups—for example, marginalized people and those living in rural areas—can be disproportionately burdened by physician-only laws.
Recommendations
With physician shortages and legislative bans making care difficult to access, expanding care through APCs is critical. In order to maximize APCs’ ability to provide care, ACOG recommends the following actions for APCs, institutional leaders, and legislators.
- APCs can seek out abortion care training
- Institutional leaders can hire APCs, train them to provide abortion care within states that permit APCs to do so, and allow APCs to prescribe mifepristone
- Legislators can repeal physician-only mandates on abortion care provision and support programs that provide abortion care training to nonphysician clinicians