APC Training Urgency and Training Resources

As legal and clinical trends in supporting APCs to provide abortion to their full scope of practice continue, local, regional, and national training opportunities must revise or expand to meet the training needs of these clinicians and learners. In particular, procedural abortion opportunities must be made available - and in some practice or geographical areas, prioritized - for APCs. Procedural care will become more necessary as abortion restrictions worsen and people who need abortion care have further to travel. These time-sensitive and geographic implications most impact BIPOC, low income, under- and uninsured, and rural populations, and are especially logistically challenging for parents requiring childcare, immigrant, refugee, and asylee populations, among others.

Across the country, Advanced Practice Clinicians are extensively involved in providing medication abortion, however, integrating procedural abortion into practice has proven to be more challenging. This can be attributed to several factors, the most basic of which is the lack of training opportunities in procedural abortion. Without established programs and pathways to learn how to perform procedural abortion, these providers are not equipped to practice to the full extent of their licensure and scope of practice. Though removing legal and regulatory barriers is a critical first step, without actual training in procedural abortion, Advanced Practice Clinicians’ long-recognized potential to alleviate shortages in the abortion workforce (ACOG, 2014; APHA, 2011; National Abortion Federation [NAF], 1997) remains unrealized.

For more details about the state of abortion care in a post-Dobbs landscape, please see the toolkit section on Understanding Abortion Care. 

Training APCs to provide procedural abortion care can increase access in lower-resource and rural areas, where most providers are primary care clinicians (Agency for Healthcare Research and Quality [AHRQ], 2018; Barry & Rugg, 2015). In rural areas in particular, APCs already fill a vital need in these communities (AHRQ, 2018; Barry & Rugg, 2015). With approximately 90% of U.S. counties currently lacking an abortion provider and rural areas disproportionately represented among them (Jones et al., 2019), APCs have untapped potential to fill the gap in abortion services in the U.S., including in primary care settings. This outcome has already been exemplified in states where APCs can provide medication abortion via telehealth technology (Brooks, 2020).

Advanced Practice Clinicians could provide a critical link to ensuring abortion access to both geographic and other resource-limited communities (Barry & Rugg, 2015; Nash & Donovan, 2019). The provision of abortion in primary care settings enhances continuity of care. Evidence indicates both improved access as well as patient satisfaction among patients who receive sexual and reproductive healthcare from a provider they know. It is best practice for patients to receive abortion care from community providers, rather than having to seek it from outside providers (Beaman et al., 2020; Casas & Chuang, 2020; Summit et al., 2016). As an important and growing sector of the primary care workforce, APCs are in a unique position to bring greater continuity to abortion care, a reproductive health service that historically has been siloed from other health services (AHRQ, 2018; Barry & Rugg, 2015; Nash & Donovan, 2019).

Where previously very few formal training opportunities for Advanced Practice Clinicians existed, in 2024, five state based training programs for APCs were established. These programs-- RHSC at TEACH in California, RADIANT at UIC in Illinois, MARCH at UMB in Maryland, RTEI at Rutgers in NJ, and GCSRH at UW in Washington--have made a significant difference in the training landscape for APCs. New York joined these states in 2025, funding a training program thtough the New York Midwives, and in late 2026 funding was approved for the New York State Abortion Training Initiative. However, due to the fact that all but one of these programs (the GCSRH at the University of Washington) are state-funded, it can still be difficult for APCs from outside of these states (California, Illinois, Maryland, New Jersey, and New York) to access training. With 22 states where APCs can now provide procedural care, there is still a gap in training for many Advanced Practice Clinicians who would seek it. 

The Individual Clinical Training Program through Repro TLC- formerly known as the Midwest Access Project (MAP) has been a notable exception in the APC training landscape. Repro TLC's program is not state based and is independent of employment, meaning that APCs and midwives can access training without committing to work at a specific facility. From 2007-2021, Repro TLC trained a total of 343 people, seven (~2%) of whom were Certified Nurse Midwives (CNMs), Family Nurse Practitioners (FNPs), and Women’s Health Nurse Practitioners (WHNPs). All seven were trained in either Minnesota or Illinois. And in recent years, Repro TLC has welcomed Advanced Practice Clinicians in greater numbers and broader geographic locations. However, one organization cannot close the gap on between states that have overturned their APC bans and the potential providers in those states that would seek training.

For more details about programs offering abortion training and resources for Advanced Practice Clinicians, please see the toolkit section on Training and Curricular Resources. 

While removing legal barriers to providing medication and procedural abortion for Advanced Practice Clinicians is essential to addressing provider shortages, if it is not accompanied with a continued and robust commitment to developing and expanding training in more states and for more providers, these efforts will fall short in their potential to expand the abortion workforce. 

As APCs continue to advocate for their scope of practice to include abortion, it is critical to simultaneously advocate for and develop further training opportunities for this sector of the health workforce. This commitment also requires incorporating abortion into the curriculum of APC programs. These combined efforts will create pathways that connect advances in scope of practice to education and training so APCs can fulfill their potential to contribute fully to the abortion workforce and increase abortion access for those most in need.

For more information on documenting procedural abortion care competency and building a professional portfolio in abortion care please see the Documenting Competency section of this Toolkit.