In Connecticut and Maryland, lawmakers passed bills this spring allowing registered nurses, nurse-midwives and physician assistants to perform medication and procedural abortions. In Delaware, legislators recently approved a bill letting nurse practitioners and nurse-midwives prescribe abortion pills. In Washington state, lawmakers codified an attorney general opinion that allows what are known as “advanced practice clinicians” to provide abortions.
While those policies were in the works ahead of an expected Supreme Court ruling on Roe v. Wade this term, more efforts are now underway in the wake of the draft opinion POLITICO published two weeks ago.
New Jersey Gov. Phil Murphy is pushing lawmakers to create a “reproductive health access fund” with grants to train abortion providers and enact legislation that cements existing rules allowing advanced practice clinicians to perform abortions. And California Gov. Gavin Newsom released an amended budget proposal on Wednesday that includes an additional $57 million to prepare the state’s clinics to absorb an increase in patients seeking abortions.
Advocates believe the policies will allow abortion-supportive states to start shoring up their networks of providers.
But a swath of challenges remain.
Anti-abortion-rights groups like Students for Life of America and the American Association of Pro-Life OB/GYNs have mobilized to fight these state laws, sending people to testify against them and lobbying legislatures to oppose them.
In Maryland, Republican Gov. Larry Hogan recently vetoed the bill to allow non-physicians to provide abortions, arguing the policy “endangers the health and lives of women” and “risks lowering the high standard of reproductive health care services.” When the legislature overrode that veto, Hogan withheld the $3.5 million appropriated to the new abortion provider training fund, hampering efforts to start teaching non-physicians when the law is implemented this summer.
The Connecticut State Medical Society also criticized their state’s move, testifying to the legislature in March that the policy would have “unintended consequences.”
“We head down the slippery slope to allowing those procedures that are in fact surgical to be done by mid-level providers, creating patient safety concerns and significant scope of practice issues,” they wrote.
Yet many individual physicians and medical groups have embraced the expansion of who can provide abortions, including the World Health Organization, the American Public Health Association and the American College of Obstetricians and Gynecologists.
“I have spent a decade training to be where I am today, but I also recognize that the majority of abortions in the U.S. happen in the first trimester and are uncomplicated,” said Lauren Thaxton, an abortion provider and researcher at the University of Texas at Austin. “We also have plenty of data to say that the health care outcomes among people who have advanced practice clinicians who provide abortion care are similar to people who have doctors.”
Roughly 10 percent of the nation’s abortion providers practice in the 23 states poised to immediately ban most, if not all, abortions if Roe is overturned, according to the Guttmacher Institute’s last abortion provider census in 2017.
Of the remaining states, 18 allow non-physicians to perform abortions, either by law, regulation, court case, attorney general opinion or board of nursing decision, according to Guttmacher and a POLITICO review of state policies.
Though many low-income patients might not be able to travel for the procedure if the Supreme Court allows sweeping bans, Thaxton and other researchers worry not enough states are ready to handle the volume of patients who can and will make the trip.
Planned Parenthood, for example, reported that after Texas’ six-week ban took effect in September, there was an 800 percent increase in patients seeking abortions in surrounding states. Now, many of those same states are set to enact bans.
“I worry about how this will look when care is restricted in more states than one,” Thaxton said. “How will all of that patient care get absorbed? I worry that will create delays in care that are unsafe.”
Longer wait times
Those delays are set to hit blue state residents as well as those traveling from states that ban abortion, especially those living in rural areas with few or no clinics. Unless the provider workforce is expanded quickly, progressive advocates fear they could push patients past the window where they can legally get the procedure. Abortion pills are only approved by the FDA for use within the first 10 weeks of pregnancy, and several blue states, including California and New York, only allow procedural abortions up to the point of fetal viability, which generally occurs around 24 weeks of pregnancy.
Washington state, for instance, is expecting a 385 percent increase in patients seeking abortion from Idaho and other nearby states if Roe is overturned, according to the Guttmacher Institute.
“If we aren’t prepared for what’s going to happen … the inequities that we see when access to reproductive care is not available for everybody will be exacerbated, and that has already historically excluded communities,” Kia Guarino, executive director of Pro-Choice Washington said.
Furthering the crunch, states like Kansas and Indiana have laws on the books saying that only a physician can perform an abortion. Others, such as Pennsylvania and New Jersey, have laws saying that nurse practitioners can only work under supervision by a doctor — not just for abortions but for many kinds of procedures.