NPs, midwives, and PAs have long played a vital role in providing comprehensive reproductive health care, particularly in clinics and other settings that serve low-income patients. A 2004 study1 found that NPs, PAs, and CNMs saw six times as many patients as did physicians for publicly funded family planning services; another2 found that “nurse clinicians” and PAs performed 73% of initial contraceptive exams in publicly funded clinics.

In 2015, NPs, CNMs, and PAs accounted for 63% of all clinical service providers delivering Title X-funded care.3

Courtesy of The Historical Collections of the Health Sciences Library, SUNY Upstate Medical University.

NPs, Midwives, and PAs are Prepared in A Wide Range of Technical Skills

NPs, midwives, and PAs are prepared in a wide range of procedures and skills that require a broad knowledge base and the development of specialized skills. Examples of such skills abound in specialty care (i.e. cardiovascular procedures such as central venous catheter insertion), but clinicians who focus on reproductive health and/or primary care have also acquired numerous “advanced skills” that are now considered common practice: administering local anesthesia (including paracervical), inserting intrauterine devices, performing colposcopies and biopsies, performing and interpreting ultrasound exams, conducting intrauterine inseminations, performing and repairing episiotomies, suturing lacerations–the list goes on. They also prescribe a wide variety of medications, including hormonal contraception and, in many states, controlled substances. For many years, NPs, midwives, and PAs providing reproductive health care have provided assessment and appropriate referrals as well as follow-up care for patients seeking pregnancy termination. Providing early abortion care is a natural extension of this practice.

In fact, clinicians other than physicians have been providing safe abortion care to patients since 19734 the same year that Roe v. Wade made abortion legal throughout the United States.

Eight years after the major social, legal, and medical milestone of legal abortion care, the first study was conducted in Vermont comparing PA and physician complication rates in first-trimester abortion; the study5 found no difference in overall, immediate, or delayed complication rates between physicians and PAs providing abortion care. Subsequent studies6 have continued to document the safety of abortion care provided by NPs, midwives, and PAs.7

Conclusive evidence that abortion is very safe, whether it is provided by a nurse practitioner (NP), a certified nurse midwife (CNM), a physician assistant (PA), or a physician

The California Health Workforce Pilot Project #171 (HWPP-171) was a California-based, multi-site, six-year study of CNMs, NPs, and PAs as providers of early aspiration abortion care in community-based clinics.8 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 resulting in con­clusive evidence that abortion is very safe, whether it is provided by a nurse practitioner (NP), a certified nurse midwife (CNM), a physician assistant (PA), or a physi­cian. Additionally, more than 2,500 patients surveyed at 25 separate facilities across the state of California rated the abortion care they received in this study as being extremely positive (9.4/10), regardless of whether the care had been provided by a NP, CNM, PA, or MD/DO9.

In addition to confirming the safety of abortion by trained professionals, the California study findings also:

Background information and findings from the California HWPP study can also be found in four published fact sheets.

  1. Frost JJ and Frohwirth L, Family planning annual report, 2004 summary, The Alan Guttmacher Institute, 2005, 35. ↵
  2. Finer LB, Darroch JE, and Frost JJ, US agencies providing publicly funded contraceptive services in 1999, Perspectives on Sexual and Reproductive Health, 2002, 34(1):15-24. ↵
  3. Fowler CI, Gable J, Wang J, and Lasater B, Title X family planning annual report, 2015 national summary, Office of Population Affairs, 2016. Annual reports can be retrieved from https://www.hhs.gov/opa/title-x-family-planning/fp-annual-report/index.html ↵
  4. National Abortion Federation, The role of Physician Assistants, Nurse Practitioners, and Nurse-Midwives in providing abortions – strategies for expanding abortion access, 1996, Recommendations from a National Symposium. ↵
  5. Freedman M, Jillson D, Coffin R, and Novick L, Comparison of complication rates in first trimester abortions performed by physician assistants and physicians, American Journal of Public Health, 1986, 76(5):550-554. ↵
  6. Weitz TA, Taylor D, Desai S, Upadhyay UD, Waldman J, Battistelli MF, et al., Safety of aspiration abortion performed by Nurse Practitioners, Certified Nurse Midwives, and physician Assistants under a California legal waiver, American Journal of Public Health, 2013. ↵
  7. Barnard S, Kim C, Park MH, Ngo TD, Doctors or mid-level providers for abortion, Cochrane Database System Review, 2015, 27(7):CD011242. ↵
  8. Taylor D, Battistelli M (2017). Abortion provider safety: Methods & Findings from the California Health Workforce Study. Oakland, CA: UCSF Advancing New Standards for Reproductive Health (ANSIRH) https://rhnursing.org/wp-content/uploads/2017/07/Fact2_HWPP-Study-Findings-and-Methods.pdf ↵
  9. Taylor D, Postlethwaite D, Desai S, et al. Multiple Determinants of the Abortion Care Experience: From the Patient’s Perspective. Am J Med Qual. 2013;28(6):510-518. doi:10.1177/1062860613484295. ↵
  10. Taylor D, Battistelli M (2017). Research-informed policy change: Safety, acceptability and utilization of NPs, CNMs and PAs as abortion providers. Oakland, CA: UCSF Advancing New Standards for Reproductive Health (ANSIRH). Available at https://rhnursing.org/wp-content/uploads/2017/07/Fact3_HWPP-Evidence4PolicyChange_SafetyAcceptability-NPCNMPA-AbortionCare.pdf ↵
  11. Taylor D, Upadhyay U, Fjerstad M, Battistelli M, Weitz TA, Paul M (2017). Standardizing the taxonomy of procedural abortion incidents: The PAIRS Framework. Contraception, 96(l):1-3, web access, https://doi.org/10.1016/j.contraception.2017.05.004 ↵

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