Although much of this Toolkit is directed at NPs, midwives, and PAs, it is important to note the critical role played by all members of the abortion care team, including registered nurses, medical assistants, and other frontline clinicians.
In the global context, the WHO has provided detailed guidelines about the tasks involved in providing safe abortion care and the role of nurses, midwives, and “advanced associated clinicians”1–a category that includes PAs and NPs–as well as community health workers and pharmacists. Reproductive Health in Nursing (RhN) compiled resources that specifically address the development of competencies for nurses.
An analysis of 2014 data revealed a decline in the number of clinics providing abortion between 2011 and 2014. The majority of abortions (59%) were performed at specialized clinics that provide a large number of abortions; nonspecialty clinics provided 31% of abortions, and the remainder were performed in hospitals (4%) and private physician offices (1%).2
Although there are no regulatory or legislative restrictions related to which categories of physician may provide abortion care, most abortions are currently provided by obstetrician-gynecologists. While the inclusion of abortion care education in obstetric/gynecology residency programs has varied over the years, the most recent study3 indicates that 54% of residency programs provide routine training, 30% provide opt-in training, and 16% report that elective abortion training was not available.
Obstetrician-gynecologists may be trained in first-trimester as well as second-trimester procedures (often referred to as D&Es, or dilation and extraction). The American College of Obstetrics and Gynecology (ACOG) has recently reaffirmed their Committee Opinion4 emphasizing the need for all medical school and obstetric/gynecology residency programs to implement the Accreditation Council for Graduate Medical Education (ACGME) requirement that all ob-gyn residency programs provide training in comprehensive patients’ reproductive health care, including opt-out abortion training (training is routinely integrated into residency but those with religious or moral objection can opt out of participation).
Moving Abortion Care Into Mainstream Primary Care
Although Abortion is legal in the United States, it has become increasingly marginalized from mainstream medical care. It is often the only essential health care service not offered by a patient’s usual health care provider and within a patient’s usual health care system.
This Toolkit seeks to change that, responding to a growing interest among primary care providers interested in including abortion care among the comprehensive range of services they offer within their practices. Primary care clinicians, a category that includes family physicians, NPs, PAs, and CNMs8 are much more likely9 to provide care to patients at risk for unintended pregnancy who live in medically-underserved areas than are specialists such as obstetrician-gynecologists.
- WHO, Health worker roles in providing safe abortion care and post abortion contraception, 2015 ↵
- Jones RK and Jerman J, Abortion incidence and service availability in the United States, 2014, Perspectives on Sexual and Reproductive Health, 2017, 49(1):1931-2393. ↵
- Turk JK, Preskil F, Landy U, Rocca CH, Steinauer JE, Availability and characteristics of abortion training in US ob-gyn residency programs: a national survey, Contraception, 2014, 89(4):271-277. ↵
- ACOG, Abortion training and education, Committee Opinion, 2014, 612. ↵
- Taylor D, Battistelli M, McLemore M, Arida J (2017) Fact Sheet: Nurses as abortion care providers. Oakland, CA: UCSF Advancing New Standards for Reproductive Health (ANSIRH). Available at https://rhnursing.org/wp-content/uploads/2017/07/Fact1_Nurses-Abortion-Care_HWPP-background.pdf ↵
- American Public Health Association. Provision of Abortion Care by Advanced Practice Nurses and Physician Assistants. 2011. https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/28/16/00/provision-of-abortion-care-by-advanced-practice-nurses-and-physician-assistants ↵
- ACOG, Increasing access to abortion, Committee Opinion, 2014, 613. ↵
- Institute of Medicine Committee on the Future of Primary Care and Donaldson MS, Primary Care – America’s Health in a New Era, 1996. ↵
- Grumbach K, Hart L, Mertz E, Coffman J, and Palazzo L, Who is caring for the underserved? A comparison of primary care physicians and nonphysician clinicians in California and Washington, Annals of Family Medicine, 2003, 1(2):97-104. ↵
- Joffe C and Yanow, S, Advanced practice clinicians as abortion providers: current developments in the United States, Reproductive Health Matters, 2004, 12(24):198-206. ↵