Kathleen Miles is the executive editor of Noema Magazine. She can be reached on Twitter at @mileskathleen.
A bill that has passed the California legislature would allow non-physicians to perform abortions in the first trimester of pregnancy.
The bill would allow nurse practitioners, certified nurse-midwives and physician assistants to be trained to perform first-trimester “manual vacuum aspiration abortions.” An aspiration abortion involves inserting into the uterus a small tube attached to a pump that vacuums out fetal tissue.
Assemblywoman Toni Atkins (D-San Diego), who wrote the measure, said more than half of California counties lack an abortion provider.
“All women should have timely access to reproductive health care, regardless of whether they live in urban or rural areas and without excessive expense or travel,” Atkins said in a statement to The Huffington Post.
Supporters say that increasing access to first-trimester abortions would decrease the number of second-trimester abortions, which are more dangerous and expensive. In order to be certified to do the procedure, non-physicians would have to conduct at least 40 procedures under direct supervision and then receive an assessment of competence.
The bill passed the Assembly and the Senate easily and long party lines. It now awaits approval of amendments in the Assembly before it goes to Gov. Jerry Brown.
Non-physicians are allowed to perform aspiration abortions in four states: Montana, Oregon, New Hampshire and Vermont.
Opponents of Atkins’ bill — including the California Right to Life Committee, the California Catholic Conference and most of the state’s Republican legislators — said it presents health risks. These groups successfully blocked a similar bill in the California legislature last year.
“It is surprising that the legislature would consider approving this lowered standard of care for women, when possible complications from an abortion include incomplete abortion, hemorrhage, infection, cervical injury and uterine perforation — and in rare cases, death,” the California Catholic Conference said to HuffPost.
“I would urge caution, deep and profound … soul-searching before you vote on this bill,” Sen. Jim Nielsen (R-Gerber) said on the floor.
“Abortion is a serious medical procedure with vast complications, and I would argue only the best trained should conduct such an operation,” Nielsen said. “It’s a dangerous direction we’re going.”
A study by University of California, San Francisco, in January found that trained non-physicians can provide early abortion care that is clinically as safe as physicians can. In the six-year pilot program, 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 with a group of nearly 100 physicians. More than 5,500 abortions were conducted by both groups, and both groups had complication rates of fewer than 2 percent.
The bill is supported by the California Medical Association and the American Nurses Association. It is sponsored by the California Women’s Health Alliance, which includes Planned Parenthood, California Church IMPACT, California Latinas for Reproductive Justice and Black Women for Wellness.
Patty Bellasalma, president of the California National Organization of Women, said the bill will improve health care access and jobs for women.
Because nurses are cheaper to hire than doctors, “this is an excellent incentive for health care providers to incorporate full reproductive health care services throughout every service network,” Bellasalma said. “It also expands the earning potential of medical fields occupied by women.”
Atkins’ bill follows a national trend giving nurses authority that previously only doctors had. With President Barack Obama’s Affordable Care Act, 32 million more Americans will gain health insurance within a few years, and there are not enough doctors to meet the demand. In response, 28 states have been considering legislation that would expand nurses’ duties.
Opponents of Atkins’ bill accuse Planned Parenthood of trying to cut costs in order to expand under “Obamacare.”
“It would be a Planned Parenthood financial boon as they could hire many more of the newly-defined ‘abortionists’ at greatly reduced costs to them, but greater risks to mothers,” the California Pro-Life Council said in a statement. In response, the bill’s supporters say the bill is about benefiting patients, not facilities.
California has the highest abortion rate in the country — which opponents say is proof that more providers are not needed.
But according to a study from the Guttmacher Institute, the number of recognized abortion providers in California decreased by 19 percent from 1996 to 2000, leaving 400 providers to serve 7.5 million women of reproductive age in the state.
Tracy Weitz, an OBGYN professor and researcher at UC San Francisco, said she and her colleagues began their study six years ago because women were coming to San Francisco General Hospital from outside of the city seeking second-trimester abortions, saying they could not find a provider earlier where they lived.
“Rural communities are underserved generally in health care,” Weitz said. “And, if you’re trying to find an abortion provider in a conservative community, there’s even less accessibility because of the stigma.”
“Anyone who’s followed this bill sees that when a provider is publicly identified as someone who does abortions, their life is very much as risk, as is the safety of their children and their homes,” Weitz said. She said she believes some nurses in those communities would be willing to face that risk.
