Maybe The Future of Abortion Lies With Nurses, Midwives
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Starting with the 40th anniversary of Roe v. Wade this week, we got the welcome news that for the first time, the majority of Americans want abortion to be legal in all or most cases. As you can imagine, the sex-hating religious extremists are working to spin those results. And of course they continue to place every possible legal obstacle between women and an affordable, safe, legal abortion. (Hell, they even oppose contraception, which would seem to be the logical solution to their abortion qualms!)
But eventually that tide will change, just as is now happening with gay marriage. The most significant long-term news is this new study in the American Journal of Public Health, whose lead author was Tracy Weitz, associate professor and director of Advancing New Standards in Reproductive Health at UCSF.
This is significant because the shrinking number of abortion clinics (and more importantly, the declining number of physicians willing to perform abortions) has made the legal right to have an abortion an empty promise in many states. And many doctors now graduate medical school without ever learning how to perform an abortion.
The public health solution? The six-year study says that abortions performed by midwives, nurses and nurse practitioners are just as safe as those performed by doctors. We now know for a fact that there's no medical basis for requiring higher-paid doctors to provide first-term abortions, and that means eventually the policy will shift:
Currently in the United States, a patchwork of state regulations determines who can provide abortions, with several states specifically prohibiting non-physician clinicians from performing the procedure.
The new study was designed to evaluate the safety of early aspiration abortions when performed by nurse practitioners, physician assistants and certified nurse midwives trained in the procedure. The study was conducted under a legal waiver from the Health Workforce Pilot Projects Program, a division of the California Office of Statewide Health Planning and Development. California law requires a legal clarification about who can perform aspiration abortions.
The researchers report in their study that the results show the pool of abortion providers could be safely expanded beyond physicians to include other trained health care professionals. They found that:
- Nurse practitioners, certified nurse midwives and physician assistants can provide early abortion care that is clinically as safe as physicians;
- Outpatient abortion is very safe, whether it is provided by physicians or by nurse practitioners, certified nurse midwives or physician assistants.
Nationally, 92 percent of abortions take place in the first trimester but studies find that black, uninsured and low-income women continue to have less access to this care, according to the researchers.
In California, 13 percent of women using state Medicaid insurance obtain abortions after the first trimester. Because the average cost of a second trimester abortion is substantially higher than a first trimester procedure and abortion complications increase as the pregnancy advances, shifting the population distribution of abortions to earlier gestations may result in safer, less costly care, according to the research team.
“Increasing the types of health care professionals who can provide early aspiration abortion care is one way to reduce this health care disparity,’’ said lead author Tracy Weitz. “Policy makers can now feel confident that expanding access to care in this way is evidence-based and will promote women’s health.’’
Currently, non-physicians are allowed to perform aspiration abortions in four states: Montana, Oregon, New Hampshire and Vermont. In other states, non-physician clinicians are permitted to perform medication but not aspiration abortions. In recent years, in an effort to limit abortion availability, several states have put laws on the books to prohibit non-physician clinicians from performing abortions.
In the study, 40 nurse practitioners, certified nurse midwives and physician assistants from four Planned Parenthood affiliates and from Kaiser Permanente of Northern California were trained to perform aspiration abortions. They were compared to a group of nearly 100 physicians, who had a mean of 14 years of experience providing abortions.
Altogether, 5,675 abortions were performed in the study by nurse practitioners, certified nurse midwives and physician assistants, compared to 5,812 abortions by physicians. The abortions were performed between August 2007 and August 2011 at 22 clinical facilities in California.
And skilled abortion doctors can be reserved for the higher-risk second- and third-term abortions. It won't happen overnight (the Republicans still control too many state legislatures for that), but this is an important piece of science that will eventually make it easier and safer for women to have abortions.