We examined advanced practice clinicians’ (APCs: nurse practitioners [NPs], certified nurse midwives [CNMs], physician assistants) interest in training to provide medication and aspiration abortion in Colorado, where abortion provision by APCs is legal.
We surveyed a stratified random sample of APCs, oversampling women's health (CNMs/women's health nurse practitioners [WHNPs]) and rural APCs. We examined prevalence and predictors of interest in abortion training using weighted χ2 tests.
Of 512 participants (21% response), the weighted sample is 50% NPs, 41% physician assistants, and 9% CNMs/WHNPs; 55% provide primary care. Only 12% are aware they can legally provide abortion. A minority of participants disagree that medication abortion (15%) or aspiration abortion (25%) should be in APC scope of practice. Almost one-third (29%) are interested in medication abortion training and 16% are possibly interested; interest is highest among CNMs/WHNPs (52%) (p < .01). Interest in aspiration abortion training is 15% with another 11% who are possibly interested; interest is highest among CNMs/WHNPs (34%) (p < .01). There are no significant differences in abortion training interest by rural practice location or by receipt of abortion education in graduate school. Participants not interested in medication and aspiration abortion training cited abortion being outside their specialty practice scope (44% and 38%, respectively) and religious or personal objections (42% and 34%). Among clinicians interested in medication abortion training, 33% believe their clinical facility is likely to allow them to provide this service, compared with 16% for aspiration abortion.
Interest in abortion training among Colorado APCs is substantial. However, facility barriers to abortion provision must be addressed to increase abortion access with APCs.
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- Motivations and experiences of people seeking medication abortion online in the United States.Perspectives on Sexual and Reproductive Health. 2018; 50: 157-163
- ACNM position statement: Midwives as abortion providers.(Available:)www.midwife.org/acnm/files/acnmlibrarydata/uploadfilename/000000000314/ps-midwives-as-abortion-providers-final-19-mar-18.pdfDate: 2018Date accessed: December 4, 2019
- Increasing access to abortion. Committee Opinion No. 613.Obstetrics & Gynecology. 2014; 124: 1060-1065
- Provision of abortion care by advanced practice nurses and physician assistants (No. 20112; Policy Statements).Author, Washington, DC2011
- Expanding the abortion provider workforce: A qualitative study of organizations implementing a new California policy.Perspectives on Sexual and Reproductive Health. 2018; 50: 33-39
- A state-by-state alert system if Roe fell.Center for Reproductive Rights, New York2018: 1
- Colorado’s primary care workforce. Colorado Health Institute.(Available:)www.colorado.gov/pacific/sites/default/files/Com%20Cap2%20for%20web%202%2011%2014.pdfDate: 2014Date accessed: May 2, 2019
- Medical management of first-trimester abortion.Contraception. 2014; 89: 148-161
- Medical liability insurance as a barrier to the provision of abortion services in family medicine.American Journal of Public Health. 2008; 98: 1770-1774
- Estimating abortion provision and abortion referrals among United States obstetrician-gynecologists in private practice.Contraception. 2018; 97: 297-302
- Knowledge of state-level abortion laws and regulations among reproductive health care providers.Women’s Health Issues. 2013; 23: e281-e286
- 2016 county designations [Map]. Colorado Rural Health Center.(Available:)https://coruralhealth.org/resource/2016-county-designationsDate: 2016Date accessed: March 12, 2019
- Abortion education in nurse practitioner, physician assistant and certified nurse–midwifery programs: a national survey.Contraception. 2006; 73: 408-414
- Dramatic decreases in US abortion rates: Public health achievement or failure?.American Journal of Public Health. 2017; 107: 1860-1862
- Obstacles to the integration of abortion into obstetrics and gynecology practice.Perspectives on Sexual and Reproductive Health. 2010; 42: 146-151
- Texas women’s decisions and experiences regarding self-managed abortion.BMC Women’s Health. 2020; 20: 6
- State facts about abortion: Colorado. Guttmacher Institute.(Available:)www.guttmacher.org/fact-sheet/state-facts-about-abortion-coloradoDate: 2020Date accessed: October 3, 2020
- An overview of abortion laws.(Available:)www.guttmacher.org/state-policy/explore/overview-abortion-lawsDate: 2020Date accessed: October 3, 2020
- Abortion has shifted earlier within the first trimester.(Available:)www.guttmacher.org/infographic/2016/abortion-has-shifted-earlier-within-first-trimesterDate: 2016Date accessed: December 8, 2016
- Counseling and provision of long-acting reversible contraception in the US: National survey of nurse practitioners.Preventive Medicine. 2013; 57: 883-888
- Research Electronic Data Capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support.Journal of Biomedical Informatics. 2009; 42: 377-381
- Advanced practice clinicians’ interest in providing medical abortion: Results of a California survey.Perspectives on Sexual and Reproductive Health. 2005; 37: 92-97
- Population group abortion rates and lifetime incidence of abortion: United States, 2008–2014.American Journal of Public Health. 2017; 107: 1904-1909
- The role of advanced nurse practitioners in the availability of abortion services.Best Practice & Research Clinical Obstetrics & Gynaecology. 2010; 24: 569-578
- The efficacy, safety and acceptability of medical termination of pregnancy provided by standard care by doctors or by nurse-midwives: a randomised controlled equivalence trial.BJOG: An International Journal of Obstetrics & Gynaecology. 2015; 122: 510-517
- Can mifepristone medication abortion be successfully integrated into medical practices that do not offer surgical abortion?.Contraception. 2007; 76: 96-100
- Analysis of complex survey samples.Journal of Statistical Software. 2004; 9: 1-19
- Complex surveys: A guide to analysis using R.John Wiley & Sons, New York2011
- Findings from a California RN survey regarding abortion care.Manuscript Submitted for Publication. 2019;
- Nurse practitioners’ job satisfaction and intent to leave current positions, the nursing profession, and the nurse practitioner role as a direct care provider.Journal of the American Academy of Nurse Practitioners. 2011; 23: 42-50
- State policy trends at mid-year 2019: States race to ban or protect abortion. Guttmacher Institute.(Available:)www.guttmacher.org/article/2019/07/state-policy-trends-mid-year-2019-states-race-ban-or-protect-abortionDate: 2019Date accessed: July 9, 2019
- Safety and effectiveness of termination services performed by doctors versus midlevel providers: A systematic review and analysis.International Journal of Women’s Health. 2013; 5: 9-17
- Access to abortion in central Appalachian states: Examining county of residence and county-level attributes.Perspectives on Sexual and Reproductive Health. 2018; 50: 165-172
- Primary care workforce data and the need for nurse practitioner full practice authority. Affairs Blog.(Available:)www.healthaffairs.org/do/10.1377/hblog20181211.872778/full/Date: 2018Date accessed: July 9, 2019
- Evaluating the capacity of California’s publicly-funded universities to provide medication abortion.Contraception. 2018; 98: 306-311
- Attitudes and intentions of future health care providers toward abortion provision.Perspectives on Sexual and Reproductive Health. 2004; 36: 58-63
- Medical abortion provided by nurse-midwives or physicians in a high resource setting: A cost-effectiveness analysis.PLoS One. 2016; 11
- Stata statistical software: Release 13.StataCorp LP, College Station, TX2013
- Impact of partial participation in integrated family planning training on medical knowledge, patient communication and professionalism.Contraception. 2014; 89: 278-285
- Mifeprex (mifepristone) Information. U.S. Food & Drug Administration.(Available:)www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/mifeprex-mifepristone-informationDate: 2018Date accessed: November 3, 2019
- Advancing scope of practice for advanced practice clinicians: more than a matter of access.Contraception. 2009; 80: 105-107
- Safety of aspiration abortion performed by nurse practitioners, certified nurse midwives, and physician assistants under a California legal waiver.American Journal of Public Health. 2013; 103: 454-461
- Research informs abortion care policy change in California.American Journal of Public Health. 2014; 104: e3-e4
- Women’s satisfaction with abortion care in academic family medicine centers.Family Medicine. 2015; 47: 98-106
- It is time to integrate abortion into primary care.American Journal of Public Health. 2013; 103: 14-16
Kate Coleman-Minahan, PhD, RN, FNP-BC, is an Assistant Professor at the University of Colorado College of Nursing and a CU Population Center Research Affiliate. She is a nurse practitioner and social scientist who studies access to contraception and abortion among marginalized populations.
Jeanelle Sheeder, MSPH, PhD, is Professor, Divisions of Family Planning and Adolescent Medicine, University of Colorado School of Medicine. Her expertise is in clinical research with a focus on family planning, contraceptive decision making, adolescents, and adolescent pregnancy.
Jaron Arbet, PhD, is a Research Associate in the Department of Biostatistics and Informatics at the Colorado School of Public Health. His research interests include statistical genetics, machine learning, and working with “big data.”
Monica R. McLemore, PhD, MPH, RN, FAAN, is an Associate Professor in the Family Health Care Nursing Department and affiliated scientist with Advancing New Standards in Reproductive Health, University of California, San Francisco. Her research is focused on reproductive health and justice.
Published online: April 21, 2020
Accepted: February 7, 2020
Received in revised form: February 3, 2020
Received: July 30, 2019
This project was funded by the University of Colorado College of Nursing. The authors have no conflicts of interest to declare.
© 2020 Jacobs Institute of Women's Health. Published by Elsevier Inc.