Bill to Increase Abortion Providers on Governor's Desk

By Elaine Korry

Once again, California has shown it is willing to buck national trends. While other states have been regulating abortion clinics out of existence, lawmakers in the Golden State have passed a measure that actually expands access to abortion services.

The bill, AB154 by Assemblymember Toni Atkins (D-San Diego), would permit certified midwives and specially trained clinicians, such as nurse practitioners and physician assistants, to perform what is called an aspiration abortion during the first trimester of pregnancy. The change in law is designed to broaden access to abortion in areas where few, if any, doctors perform the procedure.

In nearly half of California's 58 counties, there are no abortion providers except for hospitals, which provide urgent care in case of emergencies. But especially in rural areas, women who want a first trimester abortion often must travel long distances to obtain one at an unfamiliar clinic. According to Atkins, that geographic disparity is unjustified.

“Women need access to this procedure,” said Atkins, who formerly was the administrator of a health clinic. “And they should be able to get it in their own home communities, from providers they already know and trust.”

Abortion may be a complicated political or social issue, but, according to Atkins, medically it's straightforward; a simple procedure that can be performed safely in an outpatient setting by nurse practitioners, midwives or physician assistants. Under AB154, these clinicians would be in contact with a supervising physician, although the doctor need not be present for the procedure.

In California, trained clinicians are already permitted to prescribe medications that can prevent or abort a pregnancy. But abortion opponents argued that empowering non-physicians to terminate pregnancies surgically would deprive women in rural counties of equal medical care.

“Rather than focus on increasing the number of doctors serving [rural] areas, we're lowering the standard of care,” said Assemblywoman Marie Waldron (R-Escondido). “It’s just to get people out there to perform the procedures, and it is going to put people at risk,” she said.

However, a study earlier this year reached a different conclusion. Researchers at UCSF’s Advancing New Standards in Reproductive Health program obtained waivers from the state to allow midwives, nurse practitioners and physician assistants to perform early abortions.

The study, published earlier this year in the American Journal of Public Health, found the rate of complications was “clinically equivalent,” whether the procedure was performed by a doctor or by a trained clinician.

Tracy Weitz, UCSF professor of obstetrics and gynecology, was the lead author of the study.  “For about five years we collected data on forty clinicians who performed over 5,000 procedures,” said Weitz. “And what we found is that their safety outcomes were the same as their physician colleagues, so that they are safe providers of early abortion care,” she said.

Overall, said Weitz, the rate of complications was quite low -- about 2 percent -- which she says makes abortion a much safer alternative than a full-term pregnancy.

Lawmakers approved AB154 by a wide margin last month. If it is signed by Gov. Brown, California will join four other states (Montana, New Hampshire, Oregon and Vermont) that already permit clinicians other than physicians to perform early abortions.  The governor has until October 13 to sign or veto the legislation.