Welcome to the Abortion Provider Toolkit!

In 2011, nearly half of pregnancies in the U.S. were unintended.² Forty-two percent of those pregnancies (excluding miscarriages) were terminated, a small shift from 2008, when 40% ended in abortion. While the precise percentage of all patients who will have an abortion at some point during their lives remains an elusive and politically charged data point, it is clear that abortion remains one of the most common “surgical” procedures in the United States. The need to seek out specialized abortion clinics may contribute to a delay in obtaining abortion care, along with increasing cost, especially for patients in nonmetropolitan areas. Although abortion is an extremely safe procedure, at more advanced gestations it becomes more complicated and costly.³

NPs, midwives, and PAs have long been recognized as a competent source of patients’ primary care, particularly in medically underserved settings.⁴ In 2015, PAs, NPs and CNMs accounted for 63% of the total FTEs providing publicly funded family planning services. On average, there were 2.9 FTEs filled by PAs, NPs and CNMs for every 1.0 physician FTE.⁵ Despite the partisan divide that has impacted health system reform, it is clear that there is rising demand for primary care and a growing realization that NPs, midwives and PAs have an important role to play.⁶ Primary care providers are an obvious entry point to the health care system for patients facing unintended pregnancies and if early aspiration and/or medication abortion care were included in a program of comprehensive reproductive health services, patients would be much more likely to receive timely, low-risk intervention.

The Toolkit presents abortion as a scope of practice issue and explores the provision of abortion care as a natural extension of the work of NPs, midwives and PAs. It is pro-patient and pro-clinician, acknowledging the political nature of abortion while encouraging a focus on patients’ and clinicians’ abilities to meet those needs. When a specific clinical procedure is singled out as off-limits to a properly trained and competent health care professional, this undermines professional rights and responsibilities and reduces patient access to care. At a minimum, professional practice is curtailed; at worst, professional licenses may be suspended or lost. In any event, patients and communities lose access to services. Professional practice environments vary widely from state to state and discipline to discipline. In addition, political, social, and professional attitudes toward unintended pregnancy, contraceptive services, and abortion care are complex and multilayered. Although the clinical management of abortion is relatively straightforward, these other factors constantly shift in response to a multitude of influences. Although not state-specific, the Toolkit provides a framework for understanding both barriers to and stratagems for advancing scope of practice at the state level.

Scope of practice addresses the questions of who can do what for whom in what clinical setting and under what circumstances. It underpins the framework of our health provider licensing system. With increased attention to the need for interprofessional, team-based care, the focus of clinical competencies is shifting from the specific health professional toward patient needs and conditions. While the Toolkit provides background information and documents specific to the NP, midwife, and PA role, it is important to look for opportunities to establish standards and education that are provider-neutral and/or encompass all clinicians who can competently provide abortion care.