Advancing scope of practice for advanced practice clinicians: more than a matter of access.

The declining availability of abortion care has been the topic of many studies, commentaries, conferences and advocacy initiatives over the last 20 years. Among the ideas suggested to ameliorate this problem is increasing the number of physician assistants (PAs), nurse practitioners (NPs), and certified nurse midwives (CNMs) who perform first-trimester abortion [1–6]. While addressing access through this strategy holds great promise, it is not simply a matter of access that calls for more clinicians to participate in abortion care. Rather, as health professionals, we should expect that professional scope of practice determinations are based upon whether the “profession can provide this proposed service in a safe and effective manner” [7] and not solely on the lack of physicians available to provide the service. It is time to acknowledge that PAs, NPs and CNMs [collectively known as advanced practice clinicians (APCs)] are capable and qualified to provide abortion care services, but that current efforts to provide this care are thwarted by both the politics of health care and the politics of abortion [8]. Outdated laws, restrictive regulations, lack of clinical training opportunities, professional turf battles and politically-motivated challenges impede APCs abilities to provide abortion care. APCs, physicians, reproductive health and rights advocates and attorneys must join together to promote the provision of abortion by APCs, thereby protecting both women's access to abortion care and practitioners' rights to provide essential care for their patients. APCs have a long history of providing comprehensive reproductive health services within primary care and family planning settings. In 2004, APCs saw six times as many women for publicly-funded family planning services as did physicians [9]. Noteworthy is that APCs have been providing abortions in some states since 1973 when abortion was nationally legalized in the United States [10]. There is a growing body of evidence that APCs are safe, efficacious providers of abortion, via both medication and aspiration methods. Studies published in 1986, 2004 and 2006, comparing abortions performed by physicians to abortions performed by NPs and PAs found comparable rates of safety and efficacy [11–13]. Despite this evidence, many states have “physician-only” laws which prohibit the performance of abortions by anyone