C. WHO CAN PROVIDE ABORTION CARE?

In 2005 the majority of abortions (69%) were performed at specialized clinics that provide a large number of abortions; nonspecialty clinics provided 25% of abortions, and the remainder were performed in hospitals (5%) and private physician practices (2%) (Jones et al., 2008).

Specialist Providers of Abortion Care

Although there are no regulatory or legislative restrictions related to which categories of physician may provide abortion care, most abortions are currently provided by obstetrician-gynecologists. While the inclusion of abortion care education in obstetric/gynecology residency programs has varied over the past 20 years, the most recent study indicates that more than half of residency programs provide routine training in abortion care and another 40% provide opportunities for residents to train in their elective time (Eastwood, Kacmar, Steinauer, Weitzen, & Boardman, 2006). Only 10% of programs do not provide training opportunities in abortion care to their residents (Eastwood, Kacmar, Steinauer, Weitzen, & Boardman, 2006). Obstetrician-gynecologists may be trained in first trimester as well as second trimester procedures (often refereed to as D&Es, or dilation and extraction). Recently the American College of Obstetrics and Gynecology (ACOG) issued a formal Committee Opinion emphasizing the need for all medical school and obstetric/gynecology residency programs to integrate abortion care training into their curricula to ensure the "availability of safe, legal and accessible abortion care" (ACOG, 2009). While obstetrician-gynecologists comprise an important constituency of abortion prooviders, other clinicians—in particular, those providing primary care services—are well positions within the health care system to provide abortion care.

Primary Care Providers of Abortion Care

A variety of primary care providers are showing a growing interest in including abortion care among the comprehensive range of services they offer within their practices. Primary care clinicians, a category which includes family physicians, NPs, PAs, and CNMs (IOM Committee & Donaldson, 1996), are much more likely to provide care to women at risk for unintended pregnancy who live in medically underserved areas than are specialists such as obstetriciangynecologists (Grumbach et al., 2003).

PAs in Vermont and Montana were among the first providers of aspiration abortion after the Supreme Court decision in Roe v. Wade legalized abortion in the United States in 1973 (Joffe & Yanow, 2004). In Vermont, PAs and NPs have continued to provide a significant proportion of the state’s abortion care services, and their training program for physicians as well as for other APCs is one of the most respected in the nation. Although physician-only laws in other states may be daunting, there has been growing interest in defining abortion care as within the scope of practice of APCs. In a survey conducted in 1992, 52% of CNMs surveyed believed that they should be allowed to perform abortions, 19% said they might be willing to perform aspiration abortions themselves, and 57% indicated that they wanted prescriptive authority for medication abortion (McKee & Adams, 1994). More recently, approximately one quarter of APCs in a California study expressed interest in obtaining medication abortion training (Hwang, Koyama, Taylor, Henderson, & Miller, 2005). At the time of publication of this APC Toolkit, APCs are providing medication and/or aspiration abortion care in numerous states in a variety of clinical settings (Berer, 2009). A timeline of important historical events in APC provision of abortion care can be found on the Clinicians for Choice website at http://www. prochoice.org/cfc/resources/timeline.html (National Abortion Federation, 2008b).