APC Training Urgency and Training Resources

Nevertheless, given this general trend of an expanding legal landscape in abortion provision for advanced practice clinicians, systems for training to clinical competence need to be available in these localities. 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 permissible 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.

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 advanced practice clinicians to be trained and prepared to fully participate in the abortion workforce in states where it is permitted. As of May 2024, 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 2023, 171,300 patients traveled out of state seeking abortion care. 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.

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

Advanced practice clinicians have the potential to bolster the under-resourced, over- burdened abortion workforce and help preserve access. In states that allow advanced practice clinicians to provide both 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 advanced practice clinicians 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.

Training advanced practice clinicians 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, advanced practice clinicians 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), advanced practice clinicians 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 advanced practice clinicians 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, advanced practice clinicians 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).

Despite the urgency and benefits of incorporating advanced practice clinicians into the abortion workforce, very few formal training opportunities for advanced practice exist. Currently, of the seven abortion training programs across the U.S., only two are open to advanced practice clinicians. These include the Individual Clinical Training Program through the Midwest Access Project (MAP) and the Clinical Abortion Staffing Solutions (CASS) partnership between Planned Parenthood Federation of America and the National Abortion Federation. MAP’s program is independent of employment, meaning that advanced practice clinicians can access training without committing to work at a specific facility. From 2007-2021 MAP 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. CASS provides on-the-job training to providers, however this program requires a hiring facility to have a practicing provider who is willing to train an advanced practice clinician, is aware of the scope of practice laws in their region, and has administrative mechanisms in place to accommodate an advanced practice clinician.

While removing legal barriers to providing abortion for advanced practice clinicians is essential to addressing provider shortages, if it is not accompanied with a commitment to developing and expanding training, these providers will fall short of their potential to contribute to the abortion workforce. 

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