PAs Could Increase Access to Abortion
An article that originally appeared in the August issue of Contraception argues that increasing the number of PAs, NPs and certified nurse midwives who perform first-trimester abortions could help improve the declining availability of abortion care. The authors note that this is not just as issue of access, but rather an issue of scope of practice.
It is time to acknowledge that PAs, NPs and CNMs [collectively known as advanced practice clinicians (APCs)] are capable and qualified to provide abortion care services, but that current efforts to provide this care are thwarted by both the politics of health care and the politics of abortion. Outdated laws, restrictive regulations, lack of clinical training opportunities, professional turf battles and politically-motivated challenges impede APCs abilities to provide abortion care. APCs, physicians, reproductive health and rights advocates and attorneys must join together to promote the provision of abortion by APCs, thereby protecting both women's access to abortion care and practitioners' rights to provide essential care for their patients.
APCs have a long history of providing comprehensive reproductive health services within primary care and family planning settings. In 2004, APCs saw six times as many women for publicly-funded family planning services as did physicians. Noteworthy is that APCs have been providing abortions in some states since 1973 when abortion was nationally legalized in the United States. There is a growing body of evidence that APCs are safe, efficacious providers of abortion, via both medication and aspiration methods. Studies published in 1986, 2004 and 2006, comparing abortions performed by physicians to abortions performed by NPs and PAs found comparable rates of safety and efficacy.
Despite this evidence, many states have “physician-only” laws which prohibit the performance of abortions by anyone other than licensed physicians. Some of these laws were enacted around the time of Roe v. Wade in 1973 to protect women from unsafe, unlicensed abortion providers. They predate the recognition of APCs role in health care and the development of newer and simpler abortion technologies.
The article also includes a list of strategies to “highlight a few ways for APCs to participate in his/her professional organization and to work with others in bringing the professional voice to scope of practice conversations at the state and national level.”
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