Tuesday afternoon, on the 40th anniversary of Roe v. Wade, a group of state lawmakers and women's advocates announced the introduction of a bill in the California Legislature aimed at expanding a woman's access to abortion. Currently in California, only physicians are authorized to conduct early abortions. This new bill, AB 154, would authorize other clinicians -- specially-trained nurse practitioners, certified nurse midwives and physician assistants -- to perform early abortions.
"As a former administrator of a health clinic, I know how important timely care is for women," Assemblymember Toni Atkins (D-San Diego), author of AB 154, said in a statement. "This bill will ensure that early abortion care will be available for women in California who need it."
Four other states permit nonphysician clinicians to perform early abortions. Still, clinical evidence of safety had been lacking. Last week, a new study led by researchers at UCSF showed that early abortions performed by trained nurse practitioners, certified nurse midwives and physician assistants are "clinically equivalent" to those performed by physicians.
"Early abortion is safer than we thought overall, and there's no difference in the complication rate between the two groups," said lead author Tracy Weitz, UCSF professor of obstetrics and gynecology. The research team found a two percent complication rate -- below the four percent rate they had expected. Complications were mostly minor.
In the study, published online by the American Journal of Public Health, researchers received a waiver from the state of California to permit training of nurse practitioners, certified nurse midwives and physician assistants to perform what are called surgical or aspiration abortions. Altogether, researchers analyzed more than 11,000 procedures.
These nonphysician providers are already authorized in California to prescribe medications that can induce an abortion.
Access to an abortion provider is a significant issue across much of the country. According to the Guttmacher Institute, 87 percent of counties in the U.S. lack an abortion provider. In California, 22 percent of counties lack a provider, but only about one percent of women of reproductive age live in those counties. Overall, 54 of California's 58 counties lack what Guttmacher calls a "regular provider" of abortions. The institute defined "regular" as a facility where 400 or more abortions are performed annually. "Facilities that do fewer than 400 abortions per year are less likely to advertise, and women may not know that abortion services are available at these facilities," says Rachel Jones, the Guttmacher researcher who crunched the California numbers.
Amy Everitt, executive director of NARAL Pro-Choice California, an advocacy group promoting the bill, says some women may have to travel five hours to seek care. "These barriers to accessing care can force women to delay abortions into advanced stages of pregnancy which can result in a more complicated procedure," she said.
Nationally, 92 percent of abortions take place in the first trimester. In California, among women who receive Medi-Cal, the health insurance program for the poor, the first trimester abortion rate falls to 87 percent, meaning that many women delay getting an abortion putting them at risk of higher complication rates. Researchers believe that increasing providers is one way to alleviate the disparity.
The language of AB 154 will be worked out in the coming weeks. The "spot bill" language is brief: "It is the intent of the legislature to enact legislation that would expand access to reproductive health care in CA by allowing qualified health care professionals to perform early abortions, provided that the functions are within the scope of their licenses."
Weitz, the UCSF author of the study, pointed out that while abortion is a socially complicated question, it is not a medically complicated one. "We often want to regulate abortion as if we want to solve its social complexity," she told me. "The take home from our study is it's incredibly safe and that it can be offered in an outpatient facility by either physicians, nurse practitioners, certified nurse midwives or physician assistants. Women can feel safe that the care is high quality."
Everitt acknowledged that a social goal is for California to be a "harbinger" for change. "We do hope that other states will pay attention and will broaden access to care."
This post was updated to clarify why 400 abortions per year is the study's threshold to be defined as a "regular provider" of abortions.
Learn More: Democratic Lawmakers Revive California Bill on Early Abortion Providers (Sacramento Bee)