APCs: Advancing access to abortion care

clinician training session Throughout the country, women in many medically underserved and rural areas who choose to terminate a pregnancy must leave their communities—often driving long distances and delaying access to care—to find a clinician who provides abortions. The growing shortage of abortion providers creates a significant barrier for women and girls living in the 87% of U.S. counties that do not have a healthcare practitioner providing abortion services (see footnote #1). Fortunately, three categories of licensed health care providers—nurse practitioners, certified nurse-midwives, and physician assistants, collectively referred to here as Advanced Practice Clinicians, or APCs (see footnote #2)—are increasingly trained and competent in abortion care. Allowing these skilled primary care clinicians to incorporate early abortion services into comprehensive reproductive health care helps to secure and promote access to abortion care across the country.

Restrictions on APCs

In many states, fully competent APCs are prevented from providing abortions, both by abortion-specific laws, and by complex clinician scope of practice statutes and regulations. States hold much of the authority to regulate both abortion and clinician scope of practice. Therefore, fostering increased understanding among state-level experts on health professional regulation and education, as well as reproductive rights, could contribute to more effective strategies for the integration of early abortion into the scope of practice of all trained and qualified clinicians.

Issue briefs

In an effort to inform the conversations of state and national experts working to advance primary care clinician scope of practice to include the full range of unintended pregnancy care, ANSIRH's Primary Care Initiative completed a series of three briefing papers:

These papers are intended to provide a brief introduction to the myriad legal, clinical and educational issues that affect and frame the provision of abortion by APCs.

ANSIRH’s briefing papers complement the new resources available in Providing Abortion Care: A Professional Toolkit for Nurse-Midwives, Nurse Practitioners, and Physician Assistants. The outcome of collaborative work undertaken by the Abortion Access Project, ANSIRH, and the National Abortion Federation, the Toolkit is a professional guide for nurse practitioners, physician assistants and certified nurse-midwives in the United States who are either currently providing or would like to offer abortion care within their practices. It also offers background information, resources, and guidelines for professional advancement regardless of a particular area of practice.

For more information, email: Patricia Anderson (ph: 510-986-8938); Diana Taylor (ph: 510-986-8945); Erin Schultz (ph: 510-986-8934).

¹Jones RK et al. Abortion in the United States: Incidence and Access to Services, 2005 Perspectives on Sexual and Reproductive Health, 2008, 40(1):6-16.

²Both the briefing papers and the toolkit use the umbrella term advanced practice clinicians (APC) to refer collectively to the roles of nurse practitioner (NP), certified nurse-midwife (CNM), and physician assistant (PA). We recognize the clear distinctions among these three professional roles and, with this caveat, use the term of advanced practice clinician for the sake of convenience throughout these documents. In the United States, CNMs, NPs, and PAs have also been categorically referred to in some policy statements, statutes and regulations as “midlevel providers” or “non-physician providers,” neither of which adequately reflects their contribution as fully licensed, qualified primary care professionals. We recognize that the ideal taxonomy has yet to be identified and thank you for your understanding.

ANSIRH’s Primary Care Initiative issue briefs are provided to help state and national experts working to advance primary care clinician scope of practice to include the full range of unintended pregnancy care.