With Roe in doubt, states are considering allowing nurses to perform abortions

NEW HAVEN, Conn. – Abortion rights advocates saw a problem: There are only a limited number of medical providers who can legally perform abortions. In some states, one solution has been to authorize more providers than just physicians.

But to allow other providers — such as advanced practice nurses, physician assistants and board-certified nurse midwives — to perform early abortions required changes to state laws.

These legislative efforts gained urgency after the Supreme Court was leaked Draft report indicated that the judges appear ready to award Roe v. to fall Wade.

“All of these restrictions and bans that we’re seeing across the country point more progressive states in the direction of, ‘How do we expand coverage?'” said Elizabeth Nash, government policy analyst for the Guttmacher Institute in New York, a think tank that focuses on advocates for abortion rights.

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The proposed provider extensions are rejected by critics. They say that having abortions performed by non-physicians could endanger women’s health, especially when medical complications arise, and they question whether mid-level doctors are qualified.

Here’s a look at how the provider problem is developing:

WHAT WOULD THESE LAWS DO?

The goal, proponents say, is to expand access to abortion before a potential influx of out-of-state patients arrives from places where abortion could become illegal. Having more providers will also reduce patient wait times in the state and improve access for underserved communities.

The various proposals authorize advanced clinicians to perform medical abortion, in-hospital abortion, or both.

Abortion rights advocates say these clinicians often perform more complicated procedures like IUD insertions, early miscarriage management, and more endometrial biopsies, a procedure in which a small piece of the lining of the womb is removed to check for cancer or other problems.

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Proponents say randomized trials have shown that aspiration abortions — a common premature abortion that involves a suction procedure — can be safely performed by these clinicians.

“We know this procedure is effective and has an incredibly low 1% complication rate,” said Amanda Skinner, CEO of Planned Parenthood of Southern New England.

WHO IS AGAINST?

As Connecticut lawmakers considered legislation to expand providers earlier this year, the state’s medical society warned of a possible “lopsided trajectory” toward so-called “intermediate providers” who perform higher-risk surgical procedures. In statements submitted, the Connecticut Medical Society said that any new legislation should be very clear about restricting these providers to performing only in-clinic or in-office aspiration abortions.

Among those opposed to the expansion of abortion is Carol Tobias, president of the National Right to Life Committee.

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“It’s no surprise that states are relaxing or changing the requirements for who can do them,” she said, calling it “a sign of desperation that they are willing to put more women’s lives on the line.”

Instead, the focus should be on helping women “get through a tough situation.”

WHERE HAVE NEW LAWS BEEN PASSED?

New Jersey Gov. Phil Murphy, a Democrat, recently responded to the Supreme Court leak announced that he wants to codify it into law Regulations passed by the State Board of Medical Examiners in 2021, allowing a number of medical providers to perform aspiration abortions and creating a fund to fund training.

Four months earlier he had signed a law guaranteeing the right to an abortion.

“We know that rights mean nothing without access,” Murphy said.

In Connecticut – a democratic state where Roe is codified into state law – legislation was passed to expand the provider bipartisan support and was signed into law last month.

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Abortion clinics across the state are already beginning to receive patients arriving from Texas, more than 1,800 miles (2,900 kilometers) away, where a new law restricts abortion after about six weeks.

So says Skinner, the regional CEO of Planned Parenthood, speaking during an interview at a New Haven clinic.

Right now, she says, women at Planned Parenthood, the state’s largest provider, have to wait a frustrating two weeks for in-clinic abortions.

In addition to Connecticut, Maryland, Washington and Delaware passed laws this year to prop up their provider pools by allowing non-physicians to perform certain early abortions.

California lawmakers are currently considering a bill that would update a 2013 law and allow some nurses to perform abortions without the supervision of a physician, as is currently required.

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WHAT ABOUT MORE CONSERVATIVE STATES?

Lawmakers in some states where Republicans control the legislature, the governor’s office, or both have attempted to pass legislation expanding the pool of abortion providers.

The Bills faced an uphill battle.

North Carolina is surrounded by states with so-called trigger laws that would ban abortion immediately if Roe is overthrown.

The state already has a shortage of doctors performing abortions, and this is likely to get worse if women from out of state start requesting abortions there, said Rep. Julie von Haefen, a Democrat.

“We have 100 counties in North Carolina. 93 of these counties do not have an abortion provider. All of our abortion clinics are centralized in our urban areas,” she said. “So that’s going to cause a big problem — even just for women who are just traveling within our state.” We have a big state.”

Von Haefen filed a sweeping bill last year to remove what she calls “barriers” to abortion, including lifting a ban on non-physicians from performing abortions.

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That law failed, and von Haefen is not optimistic it will come to a vote this year. The state has a Republican-controlled General Assembly and a Democratic governor.

Similar bills to expand the pool of abortion providers were proposed in Arizona and Nebraska but also failed.

Instead, Nebraska lawmakers and abortion rights lobbyists said they were focused on successfully fending off a trigger law and two other anti-abortion laws this year.

So says Sofia Jawed-Wessel, associate professor of health and kinesiology at the University of Nebraska at Omaha, who spoke via email as a private person and not on behalf of the university.

“I’m sure we’ll continue to push these pro-choice bills in future sessions, depending on the outcome of Roe and the very likely special session that will be called if Roe is quashed,” she said.