California Measure Would Have Expanded Abortion Access

Today, my blog on the withdrawal of a California state bill that would have allowed advanced practice clinicians to provide first trimester aspiration abortion care, was posted on RH Reality Check: 

In late February, California Sen. Christine Kehoe (D-San Diego) introduced a bill in the state Senate that would allow nurse practitioners (NPs), physician assistants (PAs), and nurse midwives (CNMs) to provide first trimester aspiration abortion care. Although the bill had support from leading medical groups in the state, and was even co-sponsored by the heads of both legislative houses, Sen. Kehoe withdrew the bill Friday because it lacked enough votes to pass a key legislative committee.

NPs, CNMs, and PAs—collectively referred to as advanced practice clinicians (APCs)— play an increasingly important role in the delivery of a range of health care services in the United States, and are competent  providers of prenatal and postpartum care; family planning services; and gynecological care. In some parts of California—especially rural areas—women may see an APC for the rest of their health care, but are forced to travel outside their communities in order to obtain the abortion care they need. This legislation would have allowed women to obtain safe, early abortion care in their communities, from their current health care providers.

Abortion is well within the scope of practice of APCs and it’s unfortunate that some California Senators missed this point.

We’ve known for years that appropriately trained NPs, CNMs, and PAs have the skills and expertise to provide safe first trimester abortion care and increase women’s access to care. Abortion is one of the safest medical procedures provided in the United States, whether it is provided by a NP, CNM, PA, or physician.

There is a growing body of evidence, including studies published in 1986, 2004, and 2006, which have found comparable rates of safety and efficacy between first trimester abortion procedures provided by CNMs, NPs, and PAs and those provided by physicians. An on-going study from the University of California, San Francisco (UCSF) also confirmed that NPs, CNMs, and PAs can be successfully trained to competence in aspiration abortion care, and can provide first trimester abortion care that is clinically as safe as care provided by physicians. The study’s authors testified in support of the bill.

The UCSF study is based on outcomes from a multi-year pilot program that has trained more than 40 NPs, CNMs, and PAs at numerous health centers across the state to provide first trimester abortion care. In an effort to garner support, Sen. Kehoe even narrowed the bill to only allow NPs, CNMs, and PAs who had been trained by this specific program to provide first trimester abortion care. Yet the bill still stalled in committee.

In addition to leading pro-choice and women’s groups in the state, many health care organizations supported this bill, including the California Medical Association, California Academy of Physician Assistants, California Association of Nurse Practitioners, California Nurse Midwives Association, American Nurses Association of California, California Family Health Council, and Health and Women's Health Specialists California.

California has historically supported increasing women’s access to abortion care and it’s extremely disappointing that this bill isn’t moving forward.