September 18, 2013 — "The success of bringing scientific research to bear on California's abortion debate shows how much influence medical professors and physicians can wield when they decide to venture into the political sphere," Amelia Thomson-Deveaux writes in the American Prospect.
Thomson-Deveaux, a writing fellow at the magazine, explains that California is close to enacting "a law that would allow advanced-practice clinicians -- a technical term for nurse practitioners, physician's assistants, and certified nurse midwives -- to perform surgical first-trimester abortions." If California Gov. Jerry Brown (D) signs the measure, which the Legislature approved last month, the state would become the fifth to allow non-physicians to perform first-trimester abortions, according to Thomson-Deveaux.
The move toward expanding abortion access in California "buck[s] the trend" of the "barrage of abortion restrictions that came out of state legislatures this year," she continues. In California, securing physicians' support and providing evidence of the proposal's safety were key to its passage, she argues.
In the California debate, antiabortion-rights groups argued that allowing clinicians other than physicians to perform abortions would be dangerous to women's health. Although abortion-rights advocates had been pushing since 2003 to allow advanced-practice clinicians to perform first-trimester surgical abortions, there was little research on whether the type of provider affects the safety of the procedure.
A group of University of California-San Francisco researchers "designed a six-year study to find out whether the abortion opponents' health arguments held water," Thomson-Deveaux writes. The study was released in January and proved that surgical first-trimester abortions performed by specially trained advanced-practice clinicians were just as safe as those performed by physicians. Supporters of the bill said the research was vital to reassuring politicians of the measure's safety and quashing opponents' arguments.
Providers Speaking Out
"As abortion restrictions grow tighter in states across the country, members of the medical community are venting their frustration about infringements on their ability to provide basic healthcare" and "urging an end to restrictions on abortion access -- not from an ideological perspective, but as a matter of public health," Thomson-Deveaux continues.
For example, the American Journal of Obstetrics and Gynecology recently published a letter from 100 medical professors calling for more doctors to be trained in abortion care and for more hospitals to offer the procedure. In a USA Today op-ed last year, two physicians and teachers at Harvard Medical School urged doctors to engage in "civil disobedience" against laws that require them to give patients medically inaccurate information about abortion. Additionally, medical students and younger doctors are increasingly calling for the inclusion of abortion training in medical education, Thomson-Deveaux writes.
Despite physicians' more vocal involvement, hospitals to date have not embraced the calls to perform more abortions, she continues. According to Carole Joffe, a professor at UCSF's Bixby Center for Global Reproductive Health, hospital administrators "do not want the hassle" of dealing with antiabortion-rights protesters and possible backlash from their vendors.
Meanwhile, abortion-rights advocates hope that the California bill, if enacted, would serve as a model for expanding abortion access in other states. "Many states are in a defensive posture right now on reproductive health," said Phyllida Burlingame, reproductive justice policy director for the American Civil Liberties Union of Northern California, which pushed for the California bill. She added, "In California, we tried to create a road map for other states to think about increasing access, not just blocking the next barrier" (Thomson-Deveaux, American Prospect, 9/17).