The APC Abortion Provider Toolkit

This edition of the APC Toolkit is an updated, expanded, and dynamic version of a publication that has been a vital resource for clinicians, researchers, advocates, and educators for the past two decades. While this edition aims to both build upon and further develop the invaluable content included in the previous two editions, we want to acknowledge and celebrate the people who created and contributed to previous iterations.

Over the past few decades, a complicated patchwork of barriers to abortion has been spreading across the country, which has most profoundly impacted those who live in rural areas, have limited financial resources and/or access to transportation, are people of color, or otherwise face discriminatory barriers to health care (ACOG Committee on Health Care for Underserved Women et al., 2020; Nash & Cross, 2021a). In lieu of the U.S. Supreme Court decision to overturn Roe v. Wade, expanding access to abortion care could not be more pertinent. Given the increasingly restrictive post-Dobbs landscape on abortion access, it is imperative for APCs to provide to their full scope, including accessing training opportunities to do so, so that they can meet the needs of patients in their state and fully participate in the abortion workforce alongside physician colleagues in states where abortion care is legal. As of July 2025, 41 states actively have abortion bans with few exceptions. According to a report in 2022, 89% of all U.S. counties lack an abortion provider (Jones, 2022). Restrictions on abortion have compelled thousands of people to travel to states where abortion services are still accessible, creating influx states, to which people from areas with limited access will travel for care. In 2024, 155,000 patients traveled out of state seeking abortion care, representing 15% of all abortions provided in states without total bans. Not only does this place tremendous burden on the people in need of abortions, it also strains the abortion workforce in the states to which these people turn.

Advanced Practice Clinicians have the potential to bolster the under-resourced, over- burdened abortion workforce and help preserve access. In states where APCs provide medication and procedural abortions, there has been an influx of out-of-state patients after the Dobbs decision. Advanced practice clinicians could be leveraged to help repond to the increased demand. When APCs are able to provide abortion care to the full extent of their licensure, physicians with more advanced training and skills are able to focus on providing care to patients who are more medically complex. This efficient use of providers can help sustain the abortion workforce and ensure patients get the care they need.

In 2009, against the backdrop of an abortion provision landscape that saw only four states where advanced practice clinicians were legally able to provide procedural abortion care, a group of dedicated clinical researchers and advocates at Abortion Access Project, Advancing New Standards in Reproductive Health Care (ANSIRH) at UCSF, and the National Abortion Federation (NAF) set out to develop a resource for APCs who were either already involved in or interested in the provision of abortion care.  

Diana Taylor, RNP, PhD, University of California, San Francisco, Barbara Safriet, JD, LLM, University of California, San Francisco, Grayson Dempsey, Abortion Access Project, Beth Kruse, MS, ARNP, CNM, National Abortion Federation, Courtney Jackson, PhD, Abortion Access Project were the authors who were instrumental in the development of what would become Providing Abortion Care: A Professional Toolkit for Nurse-Midwives,Nurse Practitioners, and Physician Assistants, the FIRST EDITION of this project published in 2009. The Toolkit was the first resource of its kind to help clinicians compile evidence to support the integration of abortion care as an essential part of the care they provide.

By 2018, the abortion landscape had changed, and efforts to recognize APCs as qualified, competent, expert providers of abortion care were well underway in a number of states. This was due in part to the work of many dedicated advocates who had already engaged with the original APC Toolkit, the overturning of APC Bans in California and Colorado through legislative efforts, and the work of the Health Worker Pilot Project in California, culminating in the 2018 release of the National Academies of Sciences, Engineering, and Medicine (NASEM) report The safety and quality of abortion care in the United States. 

The role of APCs as abortion providers across the country had already begun to shift, with six states then permitting APCs to work to their full scope of practice, but new research had been conducted, new data was available, and the regulatory environment had changed enough that the Toolkit was ready for a SECOND EDITION. Lisa Summers, along with a number of the original authors, including Diana Taylor, Barbara Safriet, Beth Kruse, and Grayson Dempsey, took on the effort of drafting and publishing the updated version, Abortion Provider Toolkit, 2018.

Like its predecessor, the SECOND EDITION acted as a guide for midwives, NPs, and PAs in their role as either current or future abortion providers. It included essential information and statistics about abortion care and access, professional standards and competencies, and the roles of state and national professional organizations and state licensing boards.

This THIRD EDITION of the Toolkit is housed at the National Abortion Federation’s Clinicians in Abortion Care (CIAC) program, an APC community and advocacy program at NAF. In moving the Toolkit to CIAC, the torch was passed to a new generation of clinician advocates who could carry on the profound work that began nearly two decades earlier. As with the prior edition, the newest iteration aims to update and expand upon the previous work. By 2026, the APC abortion provision landscape has changed radically. The tireless efforts of advocates dismantled APC bans in some 25 states, while the broader legal environment surrounding abortion care had been fundamentally altered. The rapidly changing landscape, the volatile pace of change in these areas, as well as the growing body of research around APC provision made it clear that this THIRD EDITION had to be more than an update. It needed to be developed as a living document that can be updated immediately to reflect major changes, and where new data and resources can be shared as they become available. This THIRD EDITION will serve as an up-to-date repository of resources and information about, and for, APCs as abortion care providers.