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Research project

Health Workforce Pilot Project (HWPP) /AB 154

On January 1, 2014, California enacted legislation (AB 154) culminating a decade worth of work to expand the pool of safe, qualified professionals authorized to provide early abortion care.  

This law removes barriers to abortion provision for certified nurse midwives (CNMs), nurse practitioners (NPs), and physician assistants (PAs), allowing them to perform to the fullest extent of their education and competency. The law is based on ANSIRH’s six-year study, Health Workforce Pilot Project (HWPP) #171. The HWPP study demonstrated that these skilled health care professionals can safely and competently provide early abortion care and that women appreciate receiving care from providers they know and trust.

What was the Health Workforce Pilot Project (HWPP) #171 study?

HWPP #171 was a California-based, multi-site, six-year study of CNMs, NPs, and PAs as providers of early aspiration abortion care. This study was designed to answer several questions:

  • Can CNMs, NPs, and PAs be trained to competence in aspiration abortion?
  • Can they perform those procedures with comparable outcomes as their physician counterparts?
  • Will patients accept and be satisfied with abortion care provided by CNMs, NPs, and PAs?

Operated under a mechanism of the California Office of Statewide Health Planning and Development, HWPP #171 was a pilot project of CNMs, NPs, and PAs who were trained in abortion provision at health facilities around the state using ANSIRH’s Early Abortion Training Workbook

Between 2007 and 2013, HWPP #171 collected data from almost 20,000 patients and trained nearly 50 CNMs, NPs, and PAs to competency in aspiration abortion care. Study recruitment and data collection were completed in December 2013. Study results confirm:

  • CNMs, NPs, and PAs can provide early abortion care that is clinically as safe as the care provided by physicians
  • CNMs, NPs, and PAs can be successfully trained to competence in aspiration abortion care
  • Outpatient abortion is very safe, whether performed by a CNM, NP, PA or a physician
  • Patients report high satisfaction during their abortion experience whether they are seen by a CNM, NP, PA or a physician

More detailed information on the HWPP study design and results can be found here or read the study’s published articles.

What is next? Advancing patient-centered abortion care

Since January 1, 2014, CNMs, NPs, and PAs in California have been providing aspiration abortion care as part of their clinical practice. ANSIRH is currently conducting research examining the impact of the law change on clinician practice and employment patterns. Specifically, this study is focused on the impact of the law change on the clinicians trained as part of the HWPP #171 and the organizations that employ them.  This study aims to further develop our understanding of the challenges and opportunities faced by clinicians and organizations that strive to provide patient-centered abortion care.

Essential components for the training primary care clinicians in early abortion care:

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ANSIRH is a program within the UCSF Bixby Center for Global Reproductive Health and is a part of UCSF's Department of Obstetrics, Gynecology & Reproductive Sciences.

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