Summary: The Access to Medication Abortion Act would allow advanced practice clinicians (APCs)—nurse practitioners, certified nurse-midwives and physician assistants—to prescribe and supervise medication abortions.
Medication abortion, approved by the U.S. Food and Drug Administration since 2000, is an extremely safe treatment. The “abortion pill,” called mifepristone, and marketed as Mifeprex, has been available in the United States since 2000 and in other countries since 1981. Combined with another drug, misoprostol, more than two million American women, and at least three million European women have used medication abortion since it was approved. It causes no serious complications in more than 99.9 percent of cases, making it safer for use than Tylenol, aspirin and Viagra.
The American College of Obstetricians and Gynecologists (ACOG) recommends allowing advanced-practice clinicians (APCs)—nurse practitioners, certified nurse-midwives and physician assistants—to supervise medication abortions. APCs already provide a large proportion of primary health care to reproductive-aged women and play a prominent role in family planning services, making up 66 percent of full-time clinical service providers in Title X family planning centers.
Approximately 200,000 advanced practice clinicians currently practice in the United States. The majority of APCs provide primary care to women of reproductive age who are at risk for unintended pregnancy. They care for patients in diverse settings, are more likely to provide care to poor and underserved populations, and are critical to the expansion of health care access. Therefore, APCs are well positioned within the health care system to address women’s needs for reproductive health services that include abortion care.
Medication abortion supervised by advanced practice clinicians is just as safe as if supervised by physicians. APCs are now supervising medication abortion in 18 states. Based on a great deal of experience, it is widely recognized that APCs are fully capable of supervising medication abortion.
The number of abortion providers has decreased due to practice restrictions and threats of violence. Women in rural areas are disproportionately affected by lack of access to abortion care. Permitting advanced practice clinicians to supervise medication abortions can make safe and legal abortion more accessible and affordable.
SECTION 1. SHORT TITLE
This Act may be cited as the “Access to Medication Abortion Act.”
SECTION 2. FINDINGS AND PURPOSE
(A) FINDINGS—The legislature finds that:
1) The use of medication for abortion is a safe, non-invasive method for terminating a pregnancy.
2) More than two million women in the United States have used medication to end a pregnancy since 2000.
3) Medication abortions have increased from six percent of all abortions in 2001 to 23 percent in 2011.
4) There is overwhelming evidence that medication abortion is safe for virtually all women; complications from medication abortion are exceedingly rare.
5) The number of abortion providers has decreased due to practice restrictions and the threat of violence abortion providers face every day.
6) Women in rural areas are disproportionately affected by lack of access to abortion care.
7) Advanced practice clinicians (APCs), including nurse-practitioners, physician assistants and certified nurse–midwives, provide a large proportion of primary health care to reproductive-aged women, and their contribution is expected to increase.
8) APCs also play a prominent role in family planning services, making up 66 percent of full-time clinical service providers in health centers that receive Title X family planning funding.
9) Studies show that trained APCs can provide medication abortion services safely.
10) The American College of Obstetricians and Gynecologists supports the provision of medication abortion by APCs.
11) Permitting APCs to provide medication abortion can safely expand access and allow women to obtain integrated reproductive health.
(B) PURPOSE—This law is enacted to protect the health, safety and welfare of women by increasing access to medication abortion.
SECTION 3. INCREASED ACCESS TO MEDICATION ABORTION
After section XXX, the following new section XXX shall be inserted:
(A) DEFINITIONS—In this section:
1) “Certified nurse-midwife” means a person licensed under [insert relevant provision].
[Bill drafting note: some states license “certified professional midwives, and they should be included in the legislation in such states.]
2) “Medication abortion” means the use of medication intended to terminate a pregnancy so that it does not result in a live birth.
3) “Nurse practitioner” means a person licensed under [insert relevant provision].
4) “Physician assistant” means a person licensed under [insert relevant provision].
(B) QUALIFIED PROVIDERS TO INCLUDE NURSE PRACTITIONERS AND NURSE-MIDWIVES
1) A nurse practitioner or a certified nurse-midwife is authorized to prescribe and supervise medication abortions if he or she has successfully completed training and achieved clinical competency and adheres to standardized procedures approved by the [insert relevant board governing nurse practitioners and certified nurse-midwives].
2) It is unprofessional conduct for any nurse practitioner or certified nurse-midwife to prescribe or supervise medication abortions without successful prior completion of training and validation of clinical competency.
3) Within 180 days of the enactment of this Act, the [insert relevant board governing nurse practitioners and certified nurse-midwives] shall issue rules for training, clinical competency, and standardized procedures for medication abortion.
(C) QUALIFIED PROVIDERS TO INCLUDE PHYSICIAN ASSISTANTS
1) A physician assistant is authorized to prescribe and supervise medication abortions if he or she has successfully completed training and achieved clinical competency and adheres to standardized procedures approved by the [insert relevant board governing physician assistants].
2) It is unprofessional conduct for any physician assistant to prescribe or supervise medication abortions without prior successful completion of training and validation of clinical competency.
3) Within 180 days of the enactment of this Act, the [insert relevant board governing physician assistants] shall issue rules for training, clinical competency, and standardized procedures for medication abortion.
SECTION 4. REPEAL
The following sections are hereby repealed: [list existing provisions inconsistent with this Act].
SECTION 5. SEVERABILITY
The provisions of this Act shall be severable, and if any phrase, clause, sentence or provision is declared to be invalid or is preempted by federal law or regulation, the validity of the remainder of this Act shall not be affected.
SECTION 6. EFFECTIVE DATE
This Act shall take effect on XXXX 1, 2016.
[Bill drafting note: You will have to consult with local advocates and the affected healthcare professional associations before writing this bill. Healthcare regulatory schemes often differ from state to state. In addition, there are various ways to achieve the same goal, depending on the wording of your state’s “physician-only” provision (that is, existing statutory language that an abortion can be performed only by a physician):
a) A few states have used regulatory processes and a few have used Attorney General opinions to allow APCs to practice despite so-called “physician-only” laws. These non-legislative avenues might be possible in your state.
b) Depending on the state, you might simply repeal the “physician-only” provision; the underlying statutory and regulatory scheme might be sufficient to allow APCs to handle both aspiration and medication abortions.
c) Alternatively, by inserting definitions of APCs or by using current definitions in state law, you might amend the existing “physician-only” provision to add APCs, making it a physician and APCs only law. Unless you add additional restrictions, this approach would cover both aspiration and medication abortions.]