Qualified Providers of Abortion Act

Summary: The Qualified Providers of Abortion Act would allow advanced practice clinicians (APCs)—nurse practitioners, certified nurse-midwives and physician assistants—to perform aspiration abortions.

Background Summary

Aspiration abortion is an extremely safe and simple procedure. The aspiration procedure is completed like any outpatient procedure in a family doctor’s office or clinic. It is not surgery and requires no operating room or recovery room. The entire procedure takes just a few minutes to complete. In fact, aspiration abortion is one of the safest medical procedures in the United States.

The American College of Obstetricians and Gynecologists (ACOG) recommends allowing advanced practice clinicians (APCs)—nurse practitioners, certified nurse-midwives and physician assistants—to perform aspiration abortions. APCs already provide a large proportion of primary health care to reproductive-aged women and play a prominent role in family planning services, making up 66 percent of full-time clinical service providers in Title X family planning centers.

Approximately 200,000 advanced-practice clinicians currently practice in the United States. The majority of APCs provide primary care to women of reproductive age who are at risk for unintended pregnancy. They care for patients in diverse settings, are more likely to provide care to poor and underserved populations, and are critical to the expansion of health care access. Therefore, APCs are well positioned within the health care system to address women’s needs for reproductive health services that include abortion care.

Studies show that aspiration abortion performed by advanced-practice clinicians is just as safe as when performed by physicians. A major study concluded: “Abortion complications were clinically equivalent between newly trained NPs, CNMs, and PAs and physicians….” Another study found that “physicians and mid-level clinicians are equally competent, safe surgical abortion providers.” In fact, research going back for decades has supported this conclusion.

The number of abortion providers has decreased due to practice restrictions and threats of violence. Women in rural areas are disproportionately affected by lack of access to abortion care. Permitting advanced-practice clinicians to perform aspiration abortions can make safe and legal abortion more accessible and affordable.

California, Montana, New Hampshire, Oregon and Vermont allow trained and licensed APCs to perform aspiration abortions. The policy has been proven to work. 


Model Legislation

SECTION 1. SHORT TITLE

This Act may be cited as the “Qualified Providers of Abortion Act.”

SECTION 2. FINDINGS AND PURPOSE

(A) FINDINGS—The legislature finds that:

1)      The American College of Obstetricians and Gynecologists (ACOG) recommends expanding the pool of non-obstetrician/gynecologist abortion providers by training advanced-practice clinicians (APCs)—nurse practitioners, certified nurse-midwives and physician assistants—to perform aspiration abortions.

2)      APCs provide a large proportion of primary health care to reproductive-aged women, and their contribution is expected to increase.

3)      Research found no difference in outcomes in aspiration abortion by provider type and verified that trained APCs can provide abortion services safely.

4)      The number of abortion providers has decreased due to practice restrictions and the threat of violence abortion providers face every day.

5)      Women in rural areas are disproportionately affected by lack of access to abortion care.

6)      APCs play a prominent role in family planning services, making up 66 percent of full-time clinical service providers in health centers that receive Title X family planning funding.

7)      Abortion in the first trimester is extremely safe, with major complications occurring in less than 0.05% of cases. In fact, abortion is one of the safest medical procedures in the United States.

8)      California, Montana, New Hampshire, Oregon and Vermont allow trained and licensed clinicians to perform aspiration abortions.

(B) PURPOSE—This law is enacted to protect the health, safety and welfare of women by increasing access to early abortion services.

SECTION 3. INCREASED ACCESS TO ASPIRATION ABORTION

After section XXX, the following new section XXX shall be inserted:

(A) DEFINITIONS—In this section:

1)      “Aspiration abortion” means medical treatment intended to induce the termination of a pregnancy through dilating the cervix and using suction to remove the fetus and related pregnancy material from the uterus.

[Bill drafting note: the California statute on which this model is based does not define aspiration abortion; it was easier and more politically palatable to avoid such language. Determine whether or not you need to define the term in your state.]

2)      “Certified nurse-midwife” means a person licensed under [insert relevant provision].

[Bill drafting note: some states license “certified professional midwives, and they should be included in the legislation in such states.]

3)      “Nurse practitioner” means a person licensed under [insert relevant provision].

4)      “Physician assistant” means a person licensed under [insert relevant provision].

(B) QUALIFIED PROVIDERS TO INCLUDE NURSE PRACTITIONERS AND NURSE-MIDWIVES

1)      A nurse practitioner or a certified nurse-midwife is authorized to perform an aspiration abortion if he or she has successfully completed training and achieved clinical competency and adheres to standardized procedures approved by the [insert relevant board governing nurse practitioners and certified nurse-midwives].

2)      It is unprofessional conduct for any nurse practitioner or certified nurse-midwife to prescribe or supervise an aspiration abortion without prior successful completion of training and validation of clinical competency.

3)      Within 180 days of the enactment of this Act, the [insert relevant board governing nurse practitioners and certified nurse-midwives] shall issue rules for training, clinical competency, and standardized procedures for aspiration abortion.

(C) QUALIFIED PROVIDERS TO INCLUDE PHYSICIAN ASSISTANTS

1)      A physician assistant is authorized to perform an aspiration abortion if he or she has successfully completed training and achieved clinical competency and adheres to standardized procedures approved by the [insert relevant board governing physician assistants].

2)      It is unprofessional conduct for any physician assistant to perform an aspiration abortion without prior successful completion of training and validation of clinical competency.

3)      Within 180 days of the enactment of this Act, the [insert relevant board governing physician assistants] shall issue rules for training, clinical competency, and standardized procedures for aspiration abortion.

SECTION 4. REPEAL

The following sections are hereby repealed: [list existing provisions inconsistent with this Act].

SECTION 5. SEVERABILITY

The provisions of this Act shall be severable, and if any phrase, clause, sentence or provision is declared to be invalid or is preempted by federal law or regulation, the validity of the remainder of this Act shall not be affected.

SECTION 6. EFFECTIVE DATE

This Act shall take effect on XXXX 1, 2016.

[Bill drafting note: You will have to consult with local advocates and the affected healthcare professional associations before writing this bill. Healthcare regulatory schemes often differ from state to state. In addition, there are various ways to achieve the same goal, depending on the wording of your state’s “physician-only” provision (that is, existing statutory language that an abortion can be performed only by a physician):

a)      A few states have used regulatory processes and a few have used Attorney General opinions to allow APCs to practice despite so-called “physician-only” laws. These non-legislative avenues might be possible in your state.

b)      Depending on the state, you might simply repeal the “physician-only” provision; the underlying statutory and regulatory scheme might be sufficient to allow APCs to handle both aspiration and medication abortions.

c)      Alternatively, by inserting definitions of APCs or by using current definitions in state law, you might amend the existing “physician-only” provision to add APCs, making it a physician and APCs only law. Unless you add additional restrictions, this approach would cover both aspiration and medication abortions.]

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