Advanced practice clinicians and abortion provision
Eve Espey, MD, MPH
District VIII was well represented at the ACOG Congressional Leadership Conference, The President’s Conference (CLC), in Washington, DC, this year. Immediately prior to the CLC, District VIII attendees held a legislative meeting where several controversial issues were discussed, including the topic of abortion provision by advanced practice clinicians (APCs).
Current legislation pending in the states of California and New York looks to expand APC practice to include provision of medical and/or aspiration abortion. Statutory restrictions deviate from the standard way in which scope of practice is regulated. Typically, state licensing boards, not legislation, delineate the training, supervision, and competency requirements for differing types of health care providers. Most states restrict the provision of abortion to physicians, although APCs in two states, Vermont and Oregon, have provided abortions since 1973.
What’s new is a study just published in the American Journal of Public Health comparing outcomes of more than 12,000 first-trimester aspiration abortions performed by APCs trained to competency and by experienced physicians. In this study, complication rates were low and did not differ by type of provider. The study adds to the literature on this issue, which now includes almost 20,000 women, and concludes that first-trimester medical and surgical abortion in the hands of APCs is safe.
Particularly in District VIII, with our large but sparsely populated rural states, abortion access is a major problem that could be improved with an increased number of appropriately trained providers. In 2011, the American Public Health Association endorsed the expansion of abortion provision to APCs. The Society of Family Planning made a similar endorsement in 2013.
Our discussion reviewed a number of issues including scope of practice, abortion access needs, and review of the evidence relative to patient safety in first-trimester abortion. In these difficult times for abortion restrictions across the country, we look to ACOG national for guidance.