NEW HAVEN, Conn. — Abortion rights advocates saw a problem: There's a limited pool of medical providers who can legally perform abortions. In some states, one solution has been to authorize more providers beyond just physicians.
But to allow other providers — such as advanced practice registered nurses, physician assistants and certified nurse midwives — to perform early term abortions, changes in state laws were needed.
These legislative drives gained increased urgency once a leaked Supreme Court draft opinion showed the justices appear ready to overturn Roe v. Wade.
The proposed provider expansions face pushback from critics. They say letting non-doctors perform abortions could put women’s health at risk, especially if medical complications arise, and they question whether mid-level practitioners are qualified.
“All of these restrictions and bans that we’re seeing across the country are pointing more progressive states in the direction of, ‘How do we expand care?’” said Elizabeth Nash, state policy analysist for the Guttmacher Institute in New York, a think tank that supports abortion rights.
Here’s a look at how the provider issue is playing out:
What would these laws do?
The goal, supporters say, is to expand abortion access ahead of a potential influx of out-of-state patients from places where abortion might become illegal. Having more providers will also reduce wait times for in-state patients, and improve access for underserved communities.
The various proposals authorize advance practice clinicians to provide medication abortions, in-clinic abortions or both.
Abortion rights advocates say these clinicians often perform more complicated procedures such as IUD insertions, early miscarriage management and endometrial biopsies, a procedure where a small piece of the lining of the uterus is removed to check for cancer or other issues.
Supporters say randomized trials have shown aspiration abortions — a common early term abortion that involves a suctioning procedure — can be safely performed by these clinicians.
“We know that this procedure is effective and has an incredibly low 1% complication rate,” said Amanda Skinner, CEO of Planned Parenthood of Southern New England.
Who is opposed?
When lawmakers in Connecticut considered a provider expansion bill earlier this year, the state’s medical society warned of a potential “slippery slope” toward what it called “mid-level providers” doing surgical procedures, which are more risky. In its submitted testimony, the Connecticut Medical Society said any new law should be very clear about limiting these providers to only in-clinic or in-office aspiration abortions.
Among those who are against expanding abortion is Carol Tobias, president of the National Right to Life Committee.
“It’s not a surprise that the states would loosen or change the requirements of who can do them,” she said, calling it “a sign of desperation that they’re willing to put more women’s lives at risk.”
The focus, she said, should instead be on helping women “get through a difficult situation.”
Where have new laws passed?
Responding to the Supreme Court leak, New Jersey Gov. Phil Murphy, a Democrat, recently announced he wants to codify into law regulations adopted in 2021 by the State Board of Medical Examiners, which allow a range of medical providers to perform aspiration abortions, and to set up a fund to pay for training.
Four months earlier, he had signed a law guaranteeing abortion rights.
“We know without access,” Murphy said, “rights mean nothing.”
In Connecticut — a Democratic-leaning state where Roe is codified into state law — a provider expansion bill that passed with bipartisan support was signed into law earlier this month.
Abortion clinics in the state are already starting to see patients arrive from Texas, more than 1,800 miles (2,900 kilometers) away, where a new law restricts abortion after roughly six weeks.
That’s according to Skinner, the regional Planned Parenthood CEO, during an interview at a clinic in New Haven.
Right now, she says women face a frustrating two-week wait for in-clinic abortions at Planned Parenthood, which is the largest provider in the state.
Besides Connecticut, laws were enacted in Maryland, Washington and Delaware this year to help shore up their provider pools by allowing non-physicians to perform certain early term abortions. And lawmakers in California are currently considering a bill that would update a 2013 law and allow some nurse practitioners to perform abortions without the supervision of a doctor, as currently required.
What about more conservative states?
Lawmakers in some states where Republicans control the legislature, the governor’s office, or both have tried to pass legislation expanding the pool of abortion providers.
The bills have faced an uphill battle.
North Carolina is surrounded by states with so-called trigger laws, which would immediately ban abortion if Roe is overturned.
The state has a shortage of physicians who perform abortions, and that will likely get worse if out-of-state women start seeking abortions there, said state Rep. Julie von Haefen, a Democrat.
“We have 100 counties in North Carolina. Ninety-three of those counties do not have an abortion provider. All of our abortion clinics are centralized in our urban areas,” she said. “So that is going to cause a big problem — even just for women just traveling within our state. We have a large state.”
Von Haefen filed a comprehensive bill last year to remove what she calls “barriers” to abortions, including ending a ban on non-physicians performing abortions.
That legislation failed, and von Haefen is not optimistic it will come up for a vote this year. The state has a Republican-controlled General Assembly and a Democratic governor.
Similar bills to expand the abortion provider pool were proposed in Arizona and Nebraska, but they faltered as well.
Instead, abortion-rights lawmakers and lobbyists in Nebraska said they focused on successfully fighting off a trigger law and two other anti-abortion bills this year, according to Sofia Jawed-Wessel, an associate professor of health and kinesiology at the University of Nebraska at Omaha.
“I’m certain we will continue to push those pro-choice bills in future sessions, depending on the outcome of Roe and the very likely special session that will be called should Roe be overturned,” she said via email.