State Abortion Laws

and Their Relationship to Practice Authority

State-by-State Abortion Provision Map

  • Procedural and Medication
  • Neither
  • Medication Only

State Abortion Laws and Provision

State abortion laws often do not reflect the state of evidence regarding abortion safety when performed by APCs (NASEM). Previously, most abortion laws were enacted both before the expansion of APRN and PA practice and the use of medication abortion, which now accounts for over half of all abortions in the US. Over the last decade, these laws have been revised to remove physician-only and other restrictive clauses, in order to allow APRNs and PAs to provide abortion care and to support patient choice in provider. Currently, over half of all states that permit abortion include APCs in abortion practice, for both procedural and medication abortion. However, remnants of the previous restrictions remain. These laws were ostensibly passed to protect patients from unsafe providers, although there is no evidence they did so. Despite persuasive data that APCs can safely perform procedural abortions – and despite the fact that APCs routinely provide much more complex care like attending births – they have become a de facto restrictive legacy. (Jenkins et al., 2023)

 

Nevertheless, Advanced Practice Clinicians (APCs) are safely and effectively providing medication and/or aspiration abortion care—either because the state does not have a physician-only law, or has had their physician-only law repealed through legislation or because the state Attorney General, a regulatory body, or some other entity have narrowly interpreted the physician-only law. Since 2018, the APC legislative map has changed significantly as we have seen an increase in the states that have overturned their physician-only laws and recognized APCs as the qualified abortion providers that they are. In late 2018 only 6 states allowed for procedural abortion care for APCs and 12 states for medication abortion. By September of 2024, those numbers had shifted to 21 states where APCs can provide procedural care and 23 states where APCs can provide medication abortion. 

 

Even in states where abortion is restricted by law to licensed physicians, there are non-legislative strategies that clinicians can pursue to try to gain authority to incorporate abortion care into their practices through state directives, litigation, and agency policy.

 

These state-specific abortion laws must be considered within the context of nursing, midwifery, and physician assistant practice acts which also vary from state to state. Although the state regulation of practice will be discussed generally, it is beyond the scope of this Toolkit to provide detailed description of each state’s practice acts regulating advanced practice nursing roles (e.g., NPs and CNMs) and PAs. Fortunately, there are regularly updated reference documents that provide current state-by-state information practice regulation including state practice acts and legislative changes to scope of practice: AANP Fact Sheet, ACNM State Fact Sheets (members only), and AAPA State Laws and Regulations Resource (members only). Additionally, National clearing houses such as the Guttmacher Institute keep an up-to-date online record of abortion regulations.

State Laws and Regulations Governing NP, Midwifery, and PA Practice: Where to Find Information

This section examines who defines APC professional practice, explaining the roles of professional organizations, state legislatures, and licensing boards.

 

Since there is no federal law governing APC practice authority, it is necessary to go to each state licensing board to access the specific practice act and rules and regulations. Fortunately, there are websites which summarize and update these state practice laws and regulations. The CASS Project also keeps an updated list of licensure requirements for practice in each state where APCs can provide abortion care. For more state-specific information about abortion provision and legislation, click here.

Nurse Practitioners

Since 1988, The Nurse Practitioner has provided an annual APRN legislative and regulatory update, including a recap of each state’s nurse practice act and related rules and regulations about CNPs (certified nurse practitioners) with limited information on CNMs, CRNAs, and CNSs. The “Annual Legislative Update” is available in print and electronic formats with a condensed version of each state/DC/US Territory report appearing annually in January. The electronic version of “The Annual Legislative Update” is available to the public free of charge.

 

The American Association of Nurse Practitioners (AANP) also provides electronic information on state practice environments for NPs. Public access includes state information on the regulatory structure and agency, licensure requirements, a link to the Nurse Practice Act, and links to state NP organizations. AANP members have electronic access to State Policy Sheets , which provide additional information on continuing education requirements, medical staff membership, collaborative agreement ratios, and signature recognition.

Midwives

The American College of Nurse-Midwives (ACNM) provides information on state laws and regulations specific to CNMs and CMs. ACNM’s State Fact Sheets and Legislative Tracking Tool are available online to ACNM members only. Topics include the identity of the regulatory board, scope of practice, prescriptive authority, recognized midwifery credentials, Medicaid coverage, and other statutory provisions governing midwifery practice.

Physician Associates/Assistants

The American Academy of Physician Associates (AAPA) regularly revises Physician Associates: State Laws and Regulations with the most recent online edition. This resource provides summaries of more than two dozen key provisions of each state’s statute and regulations complete with legal citations. The AAPA website also provides contact information and links to each state PA regulatory agency.

If a physician-only statute in your state prohibits you from providing abortion care, you can still play an active role in providing reproductive health services to the patients in your community! 

You can:

  • Become part of a network of health professionals that advocates for improved reproductive health services, including access to early abortion care.

  • Fight back against efforts to stigmatize, burden, and harass patients who need abortions and the providers who care for them.

  • Become competent to provide the most comprehensive pregnancy options counseling available and educate patients about both medication and aspiration abortion.

  • Train to provide abortion-related care (e.g., ultrasounds, counseling) and early pregnancy loss management.

  • Train to provide abortion care in another state that does not have a physician-only law.

  • For a deeper dive into advocacy and more ways to promote APCs as abortion care providers, please see the Advocacy section of this toolkit.