Who Can Provide Abortion Care?
Advanced Practice Clinicians as Abortion Providers
Although much of this Toolkit is directed at Midwives, Nurse Practitioners (NPs), and Physician Associates (PAs), collectively referred to as Advanced Practice Clinicians (APCs), it is important to note the critical role played by all members of the abortion care team, including nurses, medical assistants, pharmacists, physicians, and other frontline clinicians.
Globally, WHO provides guidelines about the provision of safe abortion care, including the role of Midwives, Nurses, Nurse Practitioners, and Physician Associates. Midwifery as a profession is also unique because it exists globally, and the International Confederation of Midwives supports Midwives’ Provision of Comprehensive Abortion Care.
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, but 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)."
Supporting APCs to practice to their full scope in sexual and reproductive care, including abortion, aligns with the reproductive justice movement and frameowrk. Developed by Black women in the 1990s, "Reproductive Justice (RJ) combines reproductive rights and social justice" and outlines four principles: "maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities." Access to bodily and decisional autonomy, birth and parenting, and community safety are all components of primary and preventative care provided by APCs, who staff rural and free clinics, and midwives who work in home and birth center settings. These APCs are already meeting patients where they are, and providing abortion care as part of full scope practice is done so in community and in continuity by providers know to those settings.
Midwives, Nurse Practitioners, and Physician Associates: Critical Players in the Health Care System
Midwives, NPs, and PAs are a significant portion of the healthcare workforce who provide primary and preventative care. This means that APCs are poised to address longstanding gaps in the healthcare workforce, particularly in full scope sexual and reproductive care. APCs who hold primary care clinical positions can be part of the solution to increase rural and community-based access to vital care including contraception, all options counseling, direct abortion care, post-abortion follow-up including post-abortion contraception, and serve as important providers within interdisciplinary referral networks and on collaborative teams.
When sexual and reproductive health services are separated from routine primary and preventative care, patients experience an interference in continuity as well as in timely access, and the protective effects of primary and preventative care are disrupted. Many of the skills utilized by APCs in primary care are the same skills used in medication and procedural abortion, and APCs who are interested in integrating these services into their work can be quickly trained to do so given this experience. There are currently five non-profit, state, or university-based training programs designed with experienced APCs or learners in mind To learn more, see the Training and Curricular Resources page of this toolkit.
Midwives, NPs, and PAs: Training and Clinical Roles
Certified Nurse-Midwives and Certified Midwives
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). The vast majority of midwives in the U.S. are CNMs.
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.
As of February 2026, there are 14,808 CNMs and 142 CMs in the U.S according to the American College of Nurse Midwives. While midwives are well-known for attending births, 55.1% of CNMs/CMs identify reproductive care and 38.5% identlfy 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.
Nurse Practitioner
Physician Associate
Physician Associates (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. As of August, 2026 there are more than 200,000 certified PAs in the U.S.