Advocacy
CIAC 2025 Call to Action
APCs in the abortion care workforce, as well as trainees and advocates, must understand their value to institutions. They must be able to articulate that value to the organizations they hope to work with, and they must have a working knowledge of scope of practice, the history of APCs in abortion care, and current best practices in messaging and use of abortion terminology.
APCs must understand that the terminology that they use to reference abortion care influences legislation, institutions, and the media, and thus informs everyday usage and understanding. Abortion messaging and shifting abortion terminology are powerful tools for countering abortion stigma and abortion exceptionalism.
The employment of APCs in abortion care is also a critically effective strategy, which helps to correct the misunderstanding that, as this care—and often this care alone—is the purview of physicians, it must therefore be complex and high risk. This misperception is yet another part of the political determinants of health that inhibit access to abortion care.
Expanding the abortion provider workforce through the training of APC providers can affect the abortion landscape directly by increasing provider numbers and geographical access, but it also has the potential to influence and impact the public perception of abortion care itself.
State Organizations and Boards
Continuous engagement with the relevant board (nursing, medical, PA, or midwifery) is vital to protecting and promoting professionally appropriate practice scopes. Although a proceeding on a specific practice issue may draw focused APC attention, engaging in ongoing dialogue with board members and staff to keep them updated on developing clinical abilities and the need for continual realignment of ability-based regulatory authorization is critical. This “early and often” relationship with licensing boards is an essential activity of state professional organizations.
Delaware Case Study: The Importance of Working with Regulatory Boards and Professional Organizations
In Delaware, legislation passed in 2022 changed the existing physician-only language to allow advanced practice clinicians to provide abortion care “before viability.” Shortly thereafter, the Board of Nursing created regulations which stipulated that CNPs and CNMs “may perform medication and manual vacuum aspiration (MVA) abortion to 12 weeks gestation.” The language specifying manual vacuum aspiration was taken from the 2018 ACNM Position Statement Midwives as Abortion Providers. In 2024, after reaching out to the Executive Director of the Delaware Nurses Association, advocates presented to the organization’s Advocacy Committee regarding changing the language in the regulations to “procedural abortion” in order to remove restrictions on the use of electric vacuum aspiration. These suggestions were then brought directly to the Board of Nursing, who approved the change as suggested. To avoid a similar issue with the Physician Associate regulations, advocates were active throughout the process of creating these regulations. The Delaware Nurses Association has also taken a supportive role in assisting advocates in revising the Office-Based Surgery regulations, under which abortion is regulated, which currently state that, “A physician/dentist/podiatrist must be available onsite during patient treatment and until the patients are medically discharged.”
Critical Role of Professional Organizations In APC Abortion Provision
Professional organizations have long been allies in the effort to promote NPs, midwives, and PAs as abortion care providers. In 1991 and 1992, four professional organizations adopted policy resolutions acknowledging the practice of abortion as within the scope of practice of these clinicians:
- the American Public Health Association;
- the National Association of Nurse Practitioners in Women’s Health (NPWH)
- the American College of Nurse-Midwives (ACNM)
- the American Academy of Physician Associates (AAPA)
More information on the development of the ACNM statement on abortion can be found here. The APHA Policy Statements from 1991 and 2011 (revised from the 1999 Policy Statement) are also available.
Physicians’ organizations have also adopted position statements to address the shortage of abortion providers and the need for APCs:
- In their Committee Opinion on “Abortion Training and Education,” reaffirmed in 2022, ACOG recommended that the pool of abortion providers be expanded to include “advanced practice clinicians.”
- In 2023, ACOG released an Issue Brief titled “Advanced Practice Clinicians and Abortion Care Provision” which states, “integrating advanced practice clinicians (APCs)...into abortion care can help expand and increase access to this essential care” and calls for APCs to seek out abortion training, institutional leaders to support APC provision of abortion care, and legislators to repeal physician-only laws.
- The American Medical Women's Association (AMWA) has also endorsed the addition of “nurse-midwives, NPs and PAs to the pool of potential abortion providers.”
CLINICIANS IN ABORTION CARE
NAF’s Clinicians in Abortion Care has a downloadable fact sheet with each of these organization’s early position statements. For more recent position statements see here: *
What Professional Organizations Do for Individual Practitioners
Although the essential practice documents of each professional role are developed at the national level, each of the professional organizations has regional or state chapters or affiliates. The constituent and state nurses associations (C/SNAs) affiliated with the American Nurses Association can be found here. They provide a variety of services to members, including lobbying at the state legislature and representing the profession before government agencies. C/SNAs also review and implement standards of practice and education, and in many states provide collective bargaining services. They encompass an active community of peers that can effect change and respond to challenges in politics, practice, and labor as well as advocate for nursing and quality health care.
Similarly, support, leadership and community at the state level is provided by the organizations that represent NPs, PAs, and midwives:
- American Association of Nurse Practitioners (AANP) is organized into regions, each comprised of states in their geographic area (as is NPWH)
- American College of Nurse-Midwives (ACNM) works at the state and local level through a network of affiliates.
- American Academy of Physician Associates (AAPA) is organized into constituent chapters–based within five regions (for state chapters) and five federal service areas.
How Individual Practitioners Can Participate in the Determination of Practice Authority
Participation in our professional organizations is a responsibility for all health professionals. If the professions fail to provide leadership in developing, maintaining, and advancing professional standards and responsibilities, then licensing boards and legislatures will take the lead.
APC Advocacy Training Initiative
BACKGROUND AND PURPOSE
For the healthcare system to fully benefit from the invaluable resource of Advanced Practice Clinicians (APCs) as abortion providers, a well-planned, systematic, and comprehensive initiative that fosters APCs as practitioners who can advocate for their practice within their organizations and in the broader culture is essential.
Expansion of the abortion workforce in the post-Roe landscape should involve the training of APCs to their full scope of practice to address both continuity of care and the need to increase access in communities that lack an abortion provider. Any training program that hopes to enable trainees to continue their work in abortion care must also highlight the importance of advocacy and equip APCs with the tools and knowledge to advocate within their profession. APCs must be prepared to demonstrate the strategic efficacy of their roles in healthcare systems. Institutions must recognize the value of APCs in the workforce, and trainees must be able to articulate their value and advocate for their roles within those systems. To accomplish this end, it is important to develop a training initiative focused on fostering the fundamentals of advocacy for APCs who are thought leaders and influencers in their field.
APCs providing abortion care must have a working knowledge of scope of practice, the history of APCs in abortion care, and current best practices in messaging and use of accurate abortion terminology. Trainees must understand that specific terminology influences legislation, institutions, and the media, and thus informs everyday usage and understanding.
Strategically, it is important to develop a training program that both attracts practitioners who are currently engaged in advocacy efforts and also those who are in positions of influence to change the dynamic and perception of APC provision of abortion care.
An advocacy leadership training initiative should first focus on supporting existing APC training programs by helping them integrate more comprehensive advocacy education within their curricula. As such, clinical educators, administrators, and curriculum developers from each of the four public APC training projects that will operate in various regions of the country would form the initial “pilot group” for such an initiative. Future training cohorts will consist of trainees from these programs and others, and may include practitioners, educators, and clinical leaders from all areas where APCs provide abortion care. The training initiative will help support the development of clinicians and advocates who are prepared and capable of disseminating strategic advocacy skills throughout the workforce.
Relevant efficacy data for an APC-specific training project of this type is not currently available. This lack of data is due to the truly novel nature of the proposed program. Despite an acknowledged need for this type of opportunity for a critical workforce in reproductive healthcare, no such program has yet been developed. The creation and implementation of a training program that prepares APCs—specifically in the field of advocacy, and with the intention of educating and supporting other clinical advocates—will have broad implications to healthcare service delivery as a whole, especially within underserved communities in a political and cultural landscape that is often complex, sometimes volatile, and ever-changing.
IMPLEMENTATION PLAN
The training program will take place over the course of 12 to 18 months and will include direct instruction, interactive discussion, scenario building, and the development of example advocacy projects, which will guide learners from the strategic planning stages, to resource and coalition building, to the creation of advocacy materials, and finally to action and implementation. Training will consist of a combination of both virtual and in-person instruction.
Our “Pilot Group” of training participants will consist of clinical educators, administrators, and curriculum developers from the four public APC training projects that will operate in various regions of the country. Future trainees will likely be practitioners, educators, and clinical leaders from all areas where APCs provide abortion care. Instructors will include knowledgeable educators of adult learners, clinical experts, and advocates with proven experience successfully implementing real-world legislative and institutional advocacy initiatives in reproductive healthcare. Our objective is to develop an advocacy training initiative that will help support clinical educators, thought-leaders, advocates, and influencer clinicians who will in turn help disseminate strategic advocacy skills throughout the healthcare workforce.