History of Provision

History of Advanced Practice Clinicians (APCs) as Abortion Providers

A Timeline of APCs as Abortion Providers from Roe v. Wade to Today

In 1973, PAs first started providing procedural abortion care at the Vermont Women’s Health Center.

In 1976, Susan Cahill started providing abortion care as a PA in Montana.

Throughout the 1980s, nurse practitioners in Vermont started to provide abortion care.

In 1994, the New York Civil Liberties Union (NYCLU) obtained a Declaratory Ruling from the New York Department of Health (NYDH) stating that PAs can provide first-trimester abortions in New York under their practice act, despite the state’s physician-only law.

In 1999, Montana’s prohibition against PAs providing abortion was struck down by the Montana Supreme Court in Armstrong v. State.

In the 2000s, several states passed laws allowing APCs to provide medication abortions.

Between 2007 and 2013, Advancing New Standards in Reproductive Health conducted a 6-year study, Health Workforce Pilot Project (HWPP) #171, demonstrating that CNMs, NPs, and PAs could safely and competently provide early abortion care. HWPP #171 allowed for crucial legislation in California to be passed in 2014, AB 154, which removed barriers prohibiting CNMs, NPs, and PAs from providing abortion care.

In the past decade, several states have moved forward with striking down their physician-only laws, allowing APCs to practice to the full extent of their education and scope of practice.

APCs are Prepared in A Wide Range of Technical Skills

APCs are prepared in a wide range of procedures and skills that require a broad knowledge base and the development of specialized skills. Examples of such skills abound in specialty care (i.e. cardiovascular procedures such as central venous catheter insertion), but clinicians who focus on reproductive health and/or primary care have also acquired numerous procedural skills that are now common practice: administering local anesthesia (including paracervical), inserting intrauterine devices, performing colposcopies and biopsies, performing and interpreting ultrasound exams, conducting intrauterine inseminations, performing and repairing episiotomies, suturing lacerations, etc. They also prescribe a wide variety of medications, including hormonal contraception and, in many states, controlled substances. For many years, APCs providing reproductive health care have provided early pregnancy assessment and appropriate referrals as well as follow-up care for patients seeking pregnancy termination. Providing early abortion care is a vital part of this practice.

 

In fact, APCs  have been providing safe abortion care to patients since 1973 the same year that Roe v. Wade made abortion legal throughout the United States. APCs have long played a vital role in community care – providing comprehensive reproductive health care, particularly in clinics and other settings serving low-income populations. In 2021, APCs accounted for 64% of all clinical service providers delivering Title X-funded care. 

 

Eight years after the major social, legal, and medical milestone of legal abortion care, the first study was conducted in Vermont comparing PA and physician complication rates in first-trimester abortion. The study found no difference in overall, immediate, or delayed complication rates between physicians and PAs providing abortion care. Subsequent studies have continued to document the safety of abortion care provided by APCs. 

CONCLUSIVE EVIDENCE:

Abortion is very safe, whether it is provided by a nurse practitioner (NP, a certified nurse midwife( CNM), a physician associate (PA), or a physician

The California Health Workforce Pilot Project #171 (HWPP-171) was a California-based, multi-site, six-year study of APCs as providers of early aspiration abortion care in community-based clinics. Between 2007 and 2013, HWPP #171 collected data from almost 20,000 patients and trained nearly 50 APCs to competency in aspiration abortion care resulting in conclusive evidence that abortion is very safe, whether it is provided by an APC or a physician. Additionally, more than 2,500 patients surveyed at 25 separate facilities across the state of California rated the abortion care they received in this study as being extremely positive (9.4/10), regardless of whether the care had been provided by an APC or a physician.

 

In addition to confirming the safety of abortion by trained professionals, the California study findings also:

 

Background information and findings from the California HWPP study can also be found in four published fact sheets.

 

The National Academies of Sciences, Engineering, and Medicine published a report in March of 2018 confirming the safety and quality of abortion care in the United States. They concluded that, “both trained physicians and advanced practice clinicians (physician assistants, certified nurse-midwives, and nurse practitioners) can safely and effectively provide medication and aspiration abortions.” NASEM