Abortion providers, advocates, and organizers have been preparing for the end of Roe v. Wade for years, setting up support networks and ways to get people the abortion care they need. They’ve had to, even before it became clear with Justice Samuel Alito’s leaked decision that the U.S. Supreme Court would overturn Roe, because so many states have worked so hard to make abortion impossible to access, though nominally legal.
Blue states have been preparing as well in recent months and years. But because of the decades-long assault on abortion rights and the centuries-long fight by white men to monopolize the provision of reproductive health services, those blue states keeping abortion legal still have a challenge: having enough providers to handle the need not only for their own populations, but for the influx of patients from surrounding red states.
That means that many of these states are trying to change laws to allow non-doctors—including nurses, midwives, and physician assistants—to provide abortions, and to make up for a huge and long-standing deficit in abortion training to those providers.
“We are likely going to see a serious increase in our patient load from out-of-state patients within weeks,” Maryland Democratic Delegate Ariana Kelly, who sponsored legislation to expand care, told Politico. “We saw what was happening in states adjacent to Texas, the increased wait times for appointments, and we didn’t want that to be what happens in Maryland, both for the sake of patients in Maryland and for the sake of out-of-state patients.” Maryland now allows registered nurses, nurse-midwives, and physician assistants to perform medication and procedural abortion, as does Connecticut.
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Delaware’s legislature recently approved a bill to allow nurse practitioners and nurse-midwives to prescribe abortion pills. In Washington state, lawmakers recently passed a law to allow “advanced practice clinicians” to provide abortions, codifying a 2019 opinion from the state’s attorney general allowing nurse practitioners and physician assistants to perform abortions.
“Just because you have a legal right to certain care does not necessarily always mean that there’s access,” said Dan Rayfield, House speaker in Oregon. That state already allows non-physician professionals to provide abortion, and has created a $15 million fund that trains health care workers in abortion. New Jersey Gov. Phil Murphy is urging that state’s lawmakers to create such a fund and to do what Washington state has done: allow advanced practice clinicians to provide abortions.
That training component is key, because only about half of the nation’s medical schools provide instruction; it’s not mandated even for would-be OB-GYNs. “Abortion is one of the most common medical procedures,” Stanford University researchers wrote about their 2020 survey of abortion training. “Yet abortion-related topics are glaringly absent from medical school curricula.”
Red states have restricted or banned abortion training in medical schools at state universities and other publicly funded institutions, including in Kansas, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, Pennsylvania, and Texas. Forced birth groups like Students for Life of America and the American Association of Pro-Life OB-GYNs are gearing up to fight laws to expand care.
The groups—including some physician groups—are using the same kind of loaded arguments they were parroting in the 19th century, overtly racist and misogynistic arguments that the practice should be “professionalized,” cutting midwives (many of whom were Black and Native American) out of obstetrics.
For example, the Connecticut State Medical Society testified against that state’s expansion of providers, saying it would have “unintended consequences” and that the state would “head down the slippery slope to allowing those procedures that are in fact surgical to be done by mid-level providers, creating patient safety concerns and significant scope of practice issues.”
That’s basically bullshit, says Lauren Thaxton, an abortion provider and researcher at the University of Texas at Austin. “I have spent a decade training to be where I am today, but I also recognize that the majority of abortions in the U.S. happen in the first trimester and are uncomplicated.”
“We also have plenty of data to say that the health care outcomes among people who have advanced practice clinicians who provide abortion care are similar to people who have doctors,” Thaxton told Politico.
She’s backed up bot the American College of Obstetricians and Gynecologists (ACOG), which has been advocating for more providers being allowed to provide abortions for years. Medically, there’s no reason for the vast majority of abortion care to be provided by physicians. The preeminent group of reproductive health physicians says so.
“These providers have already put in IUDs. They’ve done endometrial biopsies. This isn’t a heavy lift for them,” Julie Jenkins, a nurse practitioner who works with the Reproductive Health Access Project, told Politico. “But they still need to be trained, and that’s where we run into a lot of problems.”