Who Can Provide Abortion Care?
Advanced Practice Clinicians as Abortion Providers
Although much of this Toolkit is directed at NPs, midwives, and PAs (APCs), it is important to note the critical role played by all members of the abortion care team, including nurses, medical assistants, pharmacists, and other frontline clinicians.
Globally, WHO provides guidelines about the provision of safe abortion care, including the role of nurses, midwives, and APCs.
According to the 2020 Abortion Incidence and Service Availability in the United States Report, between 2017 and 2020, the number and share of abortions provided with medication(s) increased across all facility caseloads. In the largest facilities, the majority of abortions in both years were procedural (66% and 51%). In 2020, at least 26% of all non-hospital facilities (including providers’ offices) and 31% of clinics provided only medication abortion; these figures were very similar to 2017 (25% and 30%, respectively).
NPs, Midwives, and PAs: Critical Players in the Health Care System
Although access to quality healthcare services is not a new problem, the national debate about how best to reform the healthcare system has highlighted the gaps in the healthcare workforce. There is a growing understanding of the role played by NPs, midwives, and PAs, particularly in providing primary and preventive care.
As primary care providers for patients, NPs, midwives, and PAs can be a part of the solution to increase community access to early abortion and post-abortion contraceptive care.
The marginalization and separation of reproductive health services, including abortion, from other health care services interferes with continuity of care and disrupts the protective effect of primary care NASEM. The skills used in early aspiration abortion are also necessary tools for safely providing full spectrum care.
As of this year there are five new state training programs in development specifically for abortion care for APCs. To learn more, see the Training and Curricular Resources page of this toolkit.
NPs, Midwives, and PAs: Training and Clinical Roles
Nurse Practitioner
Certified Nurse-Midwife/Certified Midwife
Certified Nurse-Midwives (CNMs) are educated in two disciplines: midwifery and nursing. They earn graduate degrees, complete a midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME), and pass a national certification examination administered by the American Midwifery Certification Board (AMCB). Certified Midwives (CMs) are educated in the discipline of midwifery. They earn graduate degrees, meet health and science education requirements, complete a midwifery education program accredited by ACME, and pass the same national certification examination as CNMs to receive the professional designation of CM. CNMs have prescriptive authority in some form in all states. The vast majority of midwives in the U.S. are CNMs. As of April 2022, there were over 13,524 CNMs and CMs. While midwives are well-known for attending births, 76% of CNMs/CMs identify reproductive care and 49% identify primary care as main responsibilities in their full-time positions.
Examples include annual exams, writing prescriptions, basic nutrition counseling, parenting education, patient education, and reproductive health visits.
Physician Associate / Physician Assistant
Physician associates/assistants (PAs) are nationally certified and state-licensed medical professionals. PAs practice medicine on health care teams with physicians and other providers, providing services ranging from primary care to specialized surgical services. There are more than 168,300 certified PAs in the U.S.