Barriers to Abortion Provision by Nurse Practitioners, Midwives, and Physician Assistants

As the rhetorical claims of the anti-abortion movement intersect with challenges to scope of practice, NPs, midwives, and PAs face a multiplicity of barriers to abortion provision, including:

• Interstate variation of regulatory environments. Each state is governed by a complex set of laws, regulations, and education standards.
• Long-standing efforts of organized medicine to use the political process to control scope of practice. For example, the American Medical Association and other national physician organizations launched the Scope of Practice Partnership in 2006 and consistently and explicitly oppose any expansion of scopes of practice by providers “other than medical doctors.”
• “Physician-only laws.” Many states have laws that specify that only physicians can perform abortion procedures. In most cases these laws were not created specifically to exclude other providers but were meant to protect patients from being harmed by untrained providers.
• Lack of training opportunities. National surveys have shown that both didactic and clinical training in abortion is limited. Including the principles of abortion care in basic and post-graduate educational programs is an important way to disseminate the recognition that abortion is within the scope of practice of NPs, midwives, and PAs.
• Fear of reprimand. Increasing support and enthusiasm for NPs, midwives, and PAs as abortion providers in recent years has been undermined by unclear laws and other regulatory and professional barriers that either explicitly discourage these clinicians from providing abortion care, or create enough confusion that clinicians and their advocates are hesitant to move forward with training and service provision for fear of reprimand or professional consequence.

Critical Role of Professional Organizations

Professional organizations have long been allies in the effort to promote NPs, midwives, and PAs as abortion care providers. In 1991 and 1992, four professional organizations adopted policy resolutions acknowledging the practice of abortion as within the scope of practice of these clinicians:

• the American Public Health Association;¹
• the National Association of Nurse Practitioners in Reproductive Health (NANPRH), now Nurse Practitioners in Patient’s Health;²
• the American College of Nurse-Midwives;³, and
• the American Association of Physician Assistants.⁴

Physicians’ organizations have also adopted position statements to address the shortage of abortion providers:

• In their 2014 Committee Opinion, “Abortion Training and Education,” ACOG recommended that the pool of abortion providers be expanded to include “advanced practice clinicians.”
• The American Medical Patient’s Association (AMWA) has also endorsed the addition of “nurse-midwives, NPs and PAs to the pool of potential abortion providers.”