• APC Toolkit Home

• Executive Summary

• Introduction

• Module One: Understanding Abortion Care

  • Section I. Abortion In Context
    • A. An Overview of the Abortion Care Specialty
    • B. Basic Types of Abortion Procedures
    • C. Who Can Provide Abortion Care?
    • Section I Summary
    • Section I References
  • Section II. Advanced Practice Clinicians as Abortion Providers
    • A. APCs within the Health Care System
    • B. APCs' History of Providing Comprehensive Women's Health Care, Including Abortion
    • C. Barriers to Abortion Provision by APCs
    • Summary
    • Section II References

• Module Two: Advancing Scope of Practice to Include Abortion Care

  • Section III. APC Practice Regulation: Roles of Legislatures, Licensing Boards, and Professional Organizations
    • A. State Abortion Laws and APCs
    • B. Credentialing Framework for APCs
    • C. General Legal and Regulartory Requirements
    • D. Understanding Scope of Practice
    • E. Who Determines Scope of Practice
    • F. How Individual APCs Can Participate in Scope of Practice Determinations
    • G. Getting to Know Your Professional Community
    • Summary
    • Section III References
  • Section IV. Advancing Abortion into APC Scope of Practice: Evidence and Methods
    • A. Professional-Organization Position Statements on Abortion Care by APCs
    • B. Essential Elements of Professional Practice That Establish APCs as Qualified Providers of Abortion Care
    • C. Evidence of Education and Training in Abortion Care
    • D. Evidence of Legislative, Legal & Regulatory Environments: Provider Restrictions and Legal Strategies for Establishing Abortion as within APC Scope of Practice
    • E. Applying the Evidence: How Professional and Licensing Boards Assess or Advance Scope of Practice
    • F. Strategies for Working with State APC Regulatory Boards
    • G. Case Studies: Montana, New York, Oregon, Arizona, and Alaska
    • Summary
    • Section IV References
  • Section V. Becoming Clinically Competent and Documenting Competency in Abortion Care
    • A. Specialty Education and Training in Abortion Care: Opportunities and Resources
    • B. The Professional Portfolio: Proactive Documentation of Professional Credentials
    • C. Case Study: Developing a Portfolio in Response to a Challenge
    • Summary
    • Section V References

• Appendix

SECTION I REFERENCES

Advancing New Standards in Reproductive Health. (2006). Abortion provision in California: A need for expanded access. San Francisco: University of California, San Francisco, Access Through Primary Care Initiative.

American Academy of Family Physicians, American College of Obstetricians and Gynecologists, Council on Residency Education in Obstetrics and Gynecology, & Association of Professors in Obstetrics and Gynecology. (1992). Recommended core educational guidelines for family practice residents; Obstetrics and Gynecology. Leawood, Kansas.

American College of Obstetricians and Gynecologists. (2005). ACOG practice bulletin. Clinical management guidelines of obstetrician-gynecologists. Number 67, October. Medical management of abortion. Obstetrics and Gynecology, 106(4), 871–882.

American College of Obstetricians and Gynecologists. (2009). Abortion access and training. Committee Opinion Number 424, January.

Berer, M. (2009). Provision of abortion by mid-level providers: International policy, practice and perspectives. Bulletin of the World Health Organization, 87, 58–63.

Boonstra, H., Benson Gold, R., Richards, C., & Finer, L. (2006). Abortion in women’s lives. New York: Guttmacher Institute.

Carbonell JL, Rodriguez J, Velazco A et.al. (2003) Oral and vaginal misoprostol 800 microg every 8 h for early abortion. Contraception 67(6):457–62.

Cheng, L. (2008). Surgical versus medical methods for second-trimester induced abortion. The WHO Reproductive Health Library. Retrieved from http://www.who.int/rhl/fertility/abortion/ CD006714_chengl_com/en/index.html

Chien, P., & Thomson, M. (2006). Medical versus surgical methods for first trimester termination of pregnancy: RHL commentary. The WHO Reproductive Health Library. Retrieved from http://www.who.int/rhl/fertility/abortion/pcguide/en/

Creinin, M. D. (2000). Medical abortion regimens: Historical context and overview. American Journal of Obstetrics and Gynecology, 183(2 Suppl), S3–9.

Darroch, J. E., Singh, S., & Frost, J. J. (2001). Differences in teenage pregnancy rates among five developed countries: The roles of sexual activity and contraceptive use. Family Planning Perspectives, 33(6), 244–250, 281.

Delbanco, S., Lundy, J., Hoff, T., Parker, M., & Smith, M. D. (1997). Public knowledge and perceptions about unplanned pregnancy and contraception in three countries. Family Planning Perspectives, 29(2), 70–75.

Dower, C., Christian, S., & O’Neil, E. (2007). Promising scopes of practice models for the health professions. San Francisco: University of California, San Francisco, The Center for Health Professions.

Eastwood, K. L., Kacmar, J. E., Steinauer, J., Weitzen, S., & Boardman, L. A. (2006). Abortion training in United States obstetrics and gynecology residency programs. Obstetrics and Gynecology, 108(2),303–308.

Federation of State Medical Boards. (2005). Assessing scope of practice in health care delivery: Critical questions in assuring public access and safety. Dallas, TX.

Finer, L. B., & Henshaw, S. K. (2006). Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspectives on Sexual and Reproductive Health, 38(2), 90–96.

Foster, A. M., Polis, C., Allee, M. K., Simmonds, K., Zurek, M., & Brown, A. (2006). Abortion education in nurse practitioner, physician assistant and certified nurse-midwifery programs: A national survey. Contraception, 73(4), 408–414.

Frost,J. J., & Frohwirth, L. (2005). Family planning annual report: 2004 summary, Part 1. New York: Guttmacher Institute.

Grimes, D. A. (2005). Risks of mifepristone abortion in context. Contraception, 71(3), 161.

Grossman, D. (2004). Medical methods for first trimester abortion: RHL commentary. The WHO Reproductive Health Library. Retrieved from http://www.who.int/rhl/fertility/abortion/dgcom/en/

Grumbach, K., Hart, L., Mertz, E., Coffman, J., & Palazzo, L. (2003). Who is caring for the underserved? A comparison of primary care physicians and nonphysician clinicians in California and Washington. Annals of Family Medicine, 1(2), 97–104.

Hwang, A. C., Koyama, A., Taylor, D., Henderson, J. T., & Miller, S. (2005). Advanced practice clinicians’ interest in providing medical abortion: Results of a California survey. Perspectives on Sexual and Reproductive Health, 37(2), 92–97.

Institute of Medicine Committee on the Future of Primary Care, & Donaldson, M. S. (1996). Primary care: America’s health in a new era. Washington, DC: National Academy Press.

Joffe, C., & Yanow, S. (2004). Advanced practice clinicians as abortion providers: Current developments in the United States. Reproductive Health Matters, 12(24 Suppl), 198–206.

Jones, R. K., Zolna, M. R., Henshaw, S. K., & Finer, L. B. (2008). Abortion in the United States: Incidence and access to services, 2005. Perspectives on Sexual and Reproductive Health, 40(1), 6–16.

McKee, K. & Adams, E. (1994). Nurse midwives’ attitude towards abortion performance and related procedures. J Nurse Midwifery, 39(5), 300–311.

National Abortion Federation. (1997). The role of physician assistants, nurse practitioners, and nursemidwives in providing abortions: Strategies for expanding abortion access. Washington, DC: National Abortion Federation.

National Abortion Federation. (2008a). NAF protocol for mifepristone/misoprostol in early abortion (pp. 1–6). Washington, DC: Author. Available at http://www.prochoice.org/pubs_research/publications/ downloads/professional_education/medical_abortion/protocol_mife_miso.pdf

National Abortion Federation. (2008b). Timeline of work to enhance the role of certified nurse-midwives (CNMs), nurse practitioners (NPs), and physician assistants (PAs) in abortion care. Retrieved from http://www.prochoice.org/cfc/resources/timeline.html

National Abortion Federation. (2009). First-trimester abortion: A comparison of procedures. Retrieved February 22, 2009, from http://www.prochoice.org/about_abortion/facts/first_trimester.html

New York Center for Health Workforce Studies. (2006). The United States Health Workforce Profile (No. HRSA U79-HP000010801). Rensselaer, NY: School of Public Health, University at Albany, State University of New York.

Odusoga, O., & Olatunji, O. (2002). Surgical methods for first trimester termination of pregnancy: RHL commentary. The WHO Reproductive Health Library. Retrieved from http://www.who.int/rhl/fertility/ abortion/oolguide/en/

Paul, M., Lichtenberg, S., Borgatta, L., Grimes, D., Stubblefield, P., & Creinin, M. (eds.). (2009). Management of unintended and abnormal pregnancy: Comprehensive abortion care. Washington, DC: National Abortion Federation & Wiley-Blackwell.

Paul, M. E., Mitchell, C. M., Rogers, A. J., Fox, M. C., & Lackie, E. G. (2002). Early surgical abortion: Efficacy and safety. American Journal of Obstetrics and Gynecology, 187(2), 407–411.

Pymar, H. C., & Creinin, M. D. (2000). Alternatives to mifepristone regimens for medical abortion. American Journal of Obstetrics and Gynecology, 183(2 Suppl), S54–S64.

Safriet, B. (2002). Closing the gap between can and may in healthcare providers’ scopes of practice: A primer for policymakers. Yale Journal on Regulation, 19, 301.

Schwarz, E. B., Luetkemeyer, A., Foster, D. G., Weitz, T. A., Lindes, D., & Stewart, F. H. (2005). Willing and able? Provision of medication for abortion by future internists. Womens Health Issues, 15(1), 39–44.

Sedgh, G., Henshaw, S. K., Singh, S., Bankole, A., & Drescher, J. (2007). Legal abortion worldwide: Incidence and recent trends. International Family Planning Perspectives, 33(3), 106–116.

Singh K, Fong YF, Dong F. (2003) A viable alternative to surgical aspiration abortion: repeated doses of intravaginal misoprostol over 9 hours for medical termination of pregnancies up to eight weeks. BJOG, 110(2):75–80.

Soper, D. E. (2007). Abortion and clostridial toxic shock syndrome. Obstetrics and Gynecology, 110: 970– 971.

Steinauer, J. E., DePineres, T., Robert, A. M., Westfall, J., & Darney, P. (1997). Training family practice residents in abortion and other reproductive health care: A nationwide survey. Family Planning Perspectives, 29(5), 222–227.

U.S. Department of Health and Human Services. (2000). Healthy People 2010: Understanding and improving health and objectives for improving health. Washington, DC: Author.

Weitz, T. A., Foster, A., Ellertson, C., Grossman, D., & Stewart, F. H. (2004)."Medical" and "surgical" abortion: Rethinking the modifiers. Contraception, 69(1), 77–78

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