When Politics Trumps Evidence: Legislative or Regulatory Exclusion of Abortion From Advanced Practice Clinician Scope of Practice

Abstract

The topic of abortion elicits strong opinions among the general public as well as individual clinicians. The professionally relevant question addressed in this commentary, however, is not whether abortion should be legal or not but whether appropriately trained certified nurse-midwives (CNMs), nurse practitioners (NPs), and physician assistants (PAs), who are collectively referred to as advanced practice clinicians in this commentary, are professionally capable of performing abortion procedures. 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.’’ CNMs and NPs have a long history of providing reproductive health services. Abortion laws, many of which were enacted prior to both the expansion of advanced practice nursing roles and the development of newer and simpler abortion technologies, have created a confusing situation for those clinicians who want to offer abortion care. In the years directly following the Roe v Wade Supreme Court decision legalizing abortion, many states enacted physician-only laws to protect women from unsafe, unlicensed abortion providers. These laws were not meant to prohibit the future evolving scope of practice by advanced practice clinicians. However, this exclusion has de facto become a restrictive legacy, in part because of hesitation on the part of health professional organizations to address the issue of women’s access to abortion services. Most recently, newer ‘‘physician-only laws’’ have been used explicitly (and covertly) to limit access to abortion, sacrificing fully competent professionals’ scope of practice in the name of a political agenda against legal abortion. For example, in Arizona (one of six states without a physician-only abortion provision statute), legislation was passed in 2007 to prohibit PAs from performing abortions, and a new bill, introduced in the 2008 Arizona legislature that would prohibit nurses from performing