Although much of RHAP’s work focuses on supporting family physicians, we also stand behind the critical role nurse practitioners, physician assistants, and nurse midwives play in primary care. These advanced practice clinicians (for lack of a better, all-encompassing term) often provide health care in the most under-served communities in the United States. Advanced practice clinicians (APCs) who are well trained in birth control and abortion can greatly expand access to reproductive health services. That is why RHAP is part of the movement to help APCs become providers of full-spectrum reproductive health care.
APCs have been providing abortion in the United States since 1973 – that’s the same year Roe v. Wade was passed! But national support for APCs as abortion providers gained real momentum in the 1990s. At that time, physician assistants in Vermont and Montana were providing aspiration abortions (mifepristone for medical abortion had not yet been approved in America). In 1994, the ACLU of New York conducted groundbreaking legal research, examining both scope of practice acts and the New York penal code, and convinced the New York Department of Health to rule that physician assistants could provide first trimester abortion care. Since then, there has been a state-by-state effort to allow APCs to provide abortion care. Organizations such as Nursing Students For Choice have also highlighted APCs’ role in reproductive health care by fighting for contraception to be made part of nursing schools’ curriculum.
APCs face many of the same challenges as primary care physicians–including obtaining malpractice coverage, needing additional clinical training, and purchasing equipment and materials. They also face some very unique challenges. For example, over the past few years anti-abortion advocates have succeeded in passing ‘physician only’ laws in several states. These laws require all abortions, even medication abortions, to be done by a physician. These laws do not seem based in medical necessity – instead they focus solely on limiting women’s access to reproductive health care. But with continued advocacy efforts and the growing recognition of the important role APCs play in America’s health care system, we are hopeful that more states will allow nurse practitioners, nurse midwives, and physician assistants to become full spectrum reproductive health care providers.