In California, A Measure To Expand Access to Safe Abortion Care Fails

In late February, California Sen. Christine Kehoe (D-San Diego) introduced a bill in the state Senate that would allow nurse practitioners (NPs), physician assistants (PAs), and nurse midwives (CNMs) to provide first trimester aspiration abortion care. Although the bill had support from leading medical groups in the state, and was even co-sponsored by the heads of both legislative houses, Sen. Kehoe withdrew the bill Friday because it lacked enough votes to pass a key legislative committee.

NPs, CNMs, and PAs — collectively referred to as advanced practice clinicians (APCs) — play an increasingly important role in the delivery of a range of health care services in the United States, and are competent providers of prenatal and postpartum care; family planning services; and gynecological care. In some parts of California—especially rural areas — women may see an APC for the rest of their health care, but are forced to travel outside their communities in order to obtain the abortion care they need. This legislation would have allowed women to obtain safe, early abortion care in their communities, from their current health care providers.

Abortion is well within the scope of practice of APCs and it’s unfortunate that some California Senators missed this point.

We’ve known for years that appropriately trained NPs, CNMs, and PAs have the skills and expertise to provide safe first trimester abortion care and increase women’s access to care. Abortion is one of the safest medical procedures provided in the United States, whether it is provided by an NP, CNM, PA, or physician.

There is a growing body of evidence, including studies published in 1986, 2004, and 2006, which have found comparable rates of safety and efficacy between first trimester abortion procedures provided by CNMs, NPs, and PAs and those provided by physicians. An on-going study from the University of California, San Francisco (UCSF) also confirmed that NPs, CNMs, and PAs can be successfully trained to competence in aspiration abortion care, and can provide first trimester abortion care that is clinically as safe as care provided by physicians. The study’s authors testified in support of the bill.

The UCSF study is based on outcomes from a multi-year pilot program that has trained more than 40 NPs, CNMs, and PAs at numerous health centers across the state to provide first trimester abortion care. In an effort to garner support, Sen. Kehoe even narrowed the bill to only allow NPs, CNMs, and PAs who had been trained by this specific program to provide first trimester abortion care. Yet the bill still stalled in committee.

In addition to leading pro-choice and women’s groups in the state, many health care organizations supported this bill, including the California Medical Association, California Academy of Physician Assistants, California Association of Nurse Practitioners, California Nurse Midwives Association, American Nurses Association of California, California Family Health Council, and Health and Women’s Health Specialists California.

California has historically supported increasing women’s access to abortion care and it’s extremely disappointing that this bill isn’t moving forward.

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  • bglickstein

    Clinical professions have mechanisms in place for just this reason, when we attempt to legislate our practice we fail because of politics, especially in these times when it comes to access to reproductive health care. There already are other states where thislevel of advanced practitioners perform early terminations without issue. I understand that the California Nurses Association and State Senator Juan Vargas had their hands in this bill being killed. Shame on them.

    As a feminist, public health nurse and health care activist, my concern is that we’ve not only limited access to women in getting reproductive health care, but this political game just set us back on advancing the scope of practice for advanced nurse practititioners. Total bummer.

    Even Florence Nightingale was pro-choice. 




  • dianataylor50

    At first glance, California Senate Bill 1338 (Senator Kehoe’s Safe & Early Access Bill) should have easily moved through the legislative process.  It was co-authored by legislative leaders in the state senate and the assembly and surprisingly was supported by all professional nursing organizations—The American Nurses Association of California, the California Association of NPs and the California Nurse Midwives Association, as well as multiple medical groups including the California Medical Association, the Association of Reproductive Health Professionals and Physicians for Reproductive Choice & Health. Because half of all California counties are without an abortion provider, these health professional organizations, along with many others, recognize the public health imperative to increase access to early and therefore safer services. Anti-abortion opposition was expected. But what was unexpected was the aggressive opposition of the nurses’ union which claims to be pro-choice. What was their rationale? That the study was not complete even though the study sponsor had indicated that in their assessment, the study results had demonstrated NP/CNM/PA safety and competency. The California Nurses Association—a union affiliated with the Teamsters—chose not to stand with professional nursing, medicine and the reproductive health communities to improve the lives and health of all women in California on the basis that they are opposed to any legislation that advances scope of nursing practice. Who will hold this group accountable for opposing one of the only pieces of state legislation this year that improves access to early abortion and reproductive health services?