Certified nurse-midwives (CNMs), nurse practitioners (NPs), and physician assistants (PAs) are currently involved in abortion care across the U.S. Clinicians for Choice (CFC) seeks to ensure that these three professions are encouraged to practice to the full extent of their scope of practice. However, scope of practice differs from state to state as do laws affecting the provision of abortion care. The legal and regulatory situation controlling who may provide abortions is exceedingly complex and in most cases there is not a simple answer to the question of whether these clinicians can provide abortion services in any given state. Furthermore, the situation can change positively or negatively as laws are passed and power in the legislature, administration, and/or nursing boards shifts.
Many states have "physician-only” laws that prohibit anyone other than a licensed physician from performing an abortion. At the same time, state practice acts authorize specific health care providers, such as certified nurse-midwives, nurse practitioners, and physician assistants, to prescribe and/or dispense certain medications and perform certain procedures. In most cases these state practice acts are more recent and more specific than physician-only laws. As a result, it is unclear in many instances to what degree a physician-only law limits the ability of certified nurse-midwives, nurse practitioners, and physician assistants to provide abortion care.
Legislation, administrative rule changes, and/or attorney general opinions in various states have specifically established abortion provision within CNM, NP, and/or PA scope of practice in those states. However, in the absence of clarifications such as these, a physician-only law could limit the ability of certified nurse-midwives, nurse practitioners, and physician assistants to provide abortion care.
NAF supports the participation of these qualified health care professionals in various aspects of abortion care for which they are trained, and as permitted by state regulations. CFC, an organization of NAF, works in collaboration with partner organizations to explore different strategies for expanding scope of practice in states, depending upon the legal situation. If you have a question about a particular state, please email naf@prochoice.org. We can let you know what other work is taking place in your state so efforts are not duplicated, and we can put you in touch with partner organizations and CFC members working on these issues nationally.
For more information on legal practice issues, please see Providing Abortion Care: A Professional Toolkit for Nurse-Midwives, Nurse Practitioners, and Physician Assistants, available at www.apctoolkit.org.
For more information on dates and specific states where CNMs, NPs, and/or PAs can provide abortion care, please see CFC's Timeline.
In addition to NAF and CFC, there are several organizations that can provide guidance in evaluating the laws and regulations in your area:
Advancing New Standards in Reproductive Health (a program of the University of California, San Francisco)
Abortion Access Project
American Civil Liberties Union Reproductive Freedom Project
Center for Reproductive Rights
New York Civil Liberties Union Reproductive Rights Project
Planned Parenthood Federation of America
Further information on legal issues regarding certified nurse-midwives, nurse practitioners, and physician assistants and abortion care can be found in the NAF-sponsored August 2000 American Journal of Obstetrics and Gynecology supplement on medical abortion.
Read our symposium report, "The Role of Physician Assistants, Nurse Practitioners, and Nurse-midwives in Providing Abortions" (PDF file, 209K).
Order hard copies of this report and the report from the first symposium, "Who will Provide Abortions?: Ensuring the Availability of Qualified Practitioners."
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