Abortion Knowledge Among Advanced Practice Clinicians in Colorado



      Our objective was to quantify abortion law and care knowledge among Colorado advanced practice clinicians.


      We conducted a stratified random survey of advanced practice clinicians, oversampling women’s health and rural clinicians. We assessed sample characteristics, positions on abortion legality, and knowledge of abortion law and care. Mean knowledge scores were compared by sample characteristics. Survey responses were compared by provision of pregnancy options counseling and positions on abortion legality. Linear regression models were used to examine knowledge scores.


      A total of 513 participants completed the survey; the response rate was 21%. Abortion law knowledge questions (mean score, 1.7/7.0) ranged from 12% (physician-only law) to 45% (parental consent law) correct. For five of seven questions, “I don’t know” was the most frequently chosen response. Abortion care knowledge questions (mean score, 2.8/8.0) ranged from 19% (abortion prevalence) to 60% (no elevated risk of breast cancer) correct. For four of eight questions, “I don’t know” was the most frequently chosen response. Practicing in all other areas (e.g., family practice) was associated with lower abortion law and care knowledge than practicing in women’s health. Providing options counseling was positively associated with abortion knowledge (law, β = 0.44; 95% confidence interval [CI], 0.10–0.78; care, β = 0.52; 95% CI, 0.08–0.95). Compared with participants who believe abortion should be legal in all circumstances, those who believe abortion should be illegal in all circumstances had similar abortion law knowledge (β = −0.03; 95% CI, −0.65 to 0.59), but lower abortion care knowledge (β = −1.85; 95% CI, −2.34 to −1.36).


      Abortion knowledge is low among Colorado advanced practice clinicians and education is needed.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Barnes H.
        • Richards M.R.
        • McHugh M.D.
        • Martsolf G.
        Rural and nonrural primary care physician practices increasingly rely on nurse practitioners.
        Health Affairs. 2018; 37: 908-914
        • Berglas N.F.
        • Gould H.
        • Turok D.K.
        • Sanders J.N.
        • Perrucci A.C.
        • Roberts S.C.M.
        State-mandated (mis)information and women’s endorsement of common abortion myths.
        Women’s Health Issues. 2017; 27: 129-135
        • Bessett D.
        • Gerdts C.
        • Littman L.L.
        • Kavanaugh M.L.
        • Norris A.
        Does state-level context matter for individuals’ knowledge about abortion, legality and health? Challenging the ‘red states v. blue states’ hypothesis.
        Culture, Health & Sexuality. 2015; 17: 733-746
        • Coleman-Minahan K.
        Pregnancy options counseling and abortion referral practices among Colorado nurse practitioners, nurse-midwives, and physician assistants.
        Journal of Midwifery & Women’s Health. 2021; 66: 470-477
        • Coleman-Minahan K.
        • Sheeder J.
        • Arbet J.
        • McLemore M.R.
        Interest in medication and aspiration abortion training among Colorado nurse practitioners, nurse midwives, and physician assistants.
        Women’s Health Issues. 2020; 30: 167-175
        • Coles M.S.
        • Makino K.K.
        • Phelps R.
        Knowledge of medication abortion among adolescent medicine providers.
        Journal of Adolescent Health. 2012; 50: 383-388
        • De keersmaecker J.
        • Roets A.
        ‘Fake news’: Incorrect, but hard to correct. The role of cognitive ability on the impact of false information on social impressions.
        Intelligence. 2017; 65: 107-110
        • de Moel-Mandel C.
        • Shelley J.M.
        The legal and non-legal barriers to abortion access in Australia: A review of the evidence.
        European Journal of Contraception & Reproductive Health Care. 2017; 22: 114-122
        • Desai S.
        • Jones R.K.
        • Castle K.
        Estimating abortion provision and abortion referrals among United States obstetrician-gynecologists in private practice.
        Contraception. 2018; 97: 297-302
        • Dianat S.
        • Silverstein I.A.
        • Holt K.
        • Steinauer J.
        • Dehlendorf C.
        Breaking the silence in the primary care office: Patients’ attitudes toward discussing abortion during contraceptive counseling.
        Contraception: X. 2020; 2: 100029
        • Dodge L.E.
        • Haider S.
        • Hacker M.R.
        Knowledge of state-level abortion laws and regulations among reproductive health care providers.
        Women’s Health Issues. 2013; 23: e281-e286
        • Eagen-Torkko M.
        • Levi A.J.
        The ethical justification for conscience clauses in nurse-midwifery practice: Context, power, and a changing landscape.
        Journal of Midwifery & Women’s Health. 2020; 65: 759-766
        • French V.A.
        • Anthony R.S.
        • Berrios S.E.
        • Crockett L.D.
        • Steinauer J.E.
        A sense of obligation: Attitudes and referral practices for abortion services among women’s health providers in a rural US state.
        Clinical Obstetrics, Gynecology and Reproductive Medicine. 2016; 2: 204-210
        • Gallo M.F.
        • Casterline J.B.
        • Chakraborty P.
        • Norris A.
        • Bessett D.
        • Turner A.N.
        Passage of abortion ban and women’s accurate understanding of abortion legality.
        American Journal of Obstetrics and Gynecology. 2021; 225: 63.e1-63.e8
        • Guiahi M.
        • Wilson C.
        • Claymore E.
        • Simonson K.
        • Steinauer J.
        Influence of a values clarification workshop on residents training at Catholic Hospital programs.
        Contraception: X. 2021; 3: 100054
        • Kaiser Family Foundation
        Women's Health Indicators: Abortion Statistics and Policies..
        KFF, 2021 (Available:)
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        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
        • Holt K.
        • Janiak E.
        • McCormick M.C.
        • Lieberman E.
        • Dehlendorf C.
        • Kajeepeta S.
        • Langer A.
        Pregnancy options counseling and abortion referrals among US primary care physicians: Results from a national survey.
        Family Medicine. 2017; 49: 527-536
        • Hussein J.
        • Ferguson L.
        Eliminating stigma and discrimination in sexual and reproductive health care: A public health imperative.
        Sexual and Reproductive Health Matters. 2019; 27: 1-5
        • Hwang A.C.
        • Koyama A.
        • Taylor D.
        • Henderson J.T.
        • Miller S.
        Advanced practice clinicians’ interest in providing medical abortion: Results of a California survey.
        Perspectives on Sexual and Reproductive Health. 2005; 37: 92-97
        • Jerman J.
        • Frohwirth L.
        • Kavanaugh M.L.
        • Blades N.
        Barriers to abortion care and their consequences for patients traveling for services: Qualitative findings from two states.
        Perspectives on Sexual and Reproductive Health. 2017; 49: 95-102
        • Jimenez L.
        60 Days After Dobbs: State Legal Developments on Abortion..
        Brennan Center for Justice. 2022; (Available:) (Accessed August 28, 2022)
        • Jones R.K.
        • Witwer E.
        • Jerman J.
        Abortion incidence and service availability in the United States, 2017.
        Guttmacher Institute, New York, NY, 2019 (Available:)
        • Kavanaugh M.L.
        • Bessett D.
        • Littman L.L.
        • Norris A.
        Connecting knowledge about abortion and sexual and reproductive health to belief about abortion restrictions: Findings from an online survey.
        Women’s Health Issues. 2013; 23: e239-e247
        • Lara D.
        • Holt K.
        • Peña M.
        • Grossman D.
        Knowledge of abortion laws and services among low-income women in three United States cities.
        Journal of Immigrant and Minority Health. 2015; 17: 1811-1818
        • Lumley T.
        Complex surveys: A guide to analysis using R.
        John Wiley & Sons, New York2011
        • McLemore M.R.
        • Cretti E.
        • Eagen-Torkko M.
        • Levi A.J.
        • Atzlan E.
        • Swartz A.
        Findings from a California RN survey regarding abortion care.
        Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2020; 49: 475-486
        • McLemore M.R.
        • Levi A.J.
        Expanding access to sexual and reproductive health services through nursing education.
        Journal of Obstetric, Gynecologic & Neonatal Nursing. 2017; 46: e149-e156
        • National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Health Care Services, Board on Population Health and Public Health Practice, & Committee on Reproductive Health Services. Assessing the safety and quality of abortion care in the U.S.
        The Safety and Quality of Abortion Care in the United States.
        National Academies Press (US), Washington (DC)2018 (Available:)
        Date accessed: April 12, 2018
        • Pohl J.M.
        • Thomas A.
        • Bigley M.B.
        • Kopanos T.
        Primary care workforce data and the need for nurse practitioner full practice authority, Health Affairs Blog.
        • Roberts S.C.M.
        • Gould H.
        • Kimport K.
        • Weitz T.A.
        • Foster D.G.
        Out-of-pocket costs and insurance coverage for abortion in the United States.
        Women’s Health Issues. 2014; 24: e211-e218
        • Rozek L.S.
        • Jones P.
        • Menon A.
        • Hicken A.
        • Apsley S.
        • King E.J.
        Understanding vaccine hesitancy in the context of COVID-19: The role of trust and confidence in a seventeen-country survey.
        International Journal of Public Health. 2021; 66: 636255
        • Shotorbani S.
        • Zimmerman F.J.
        • Bell J.F.
        • Ward D.
        • Assefi N.
        Attitudes and intentions of future health care providers toward abortion provision.
        Perspectives on Sexual and Reproductive Health. 2004; 36: 58-63
        • StataCorp
        Stata statistical software: Release 13.
        StataCorp LP, College Station, TX2013
        • Swartz J.J.
        • Rowe C.
        • Morse J.E.
        • Bryant A.G.
        • Stuart G.S.
        Women’s knowledge of their state’s abortion regulations. A national survey.
        Contraception. 2020; 102: 318-326
        • Thomson-DeVeaux A.
        It Can Already Take Weeks To Get An Abortion.
        FiveThirtyEight, April 18, 2022. 2022; (Available:) (Accessed August 30, 2022)
        • Tillman S.
        • Levi A.J.
        Midwives in abortion care: A call to action.
        Journal of Midwifery & Women’s Health. 2020; 65: 195-198
        • Turner K.L.
        • Pearson E.
        • George A.
        • Andersen K.L.
        Values clarification workshops to improve abortion knowledge, attitudes and intentions: A pre-post assessment in 12 countries.
        Reproductive Health. 2018; 15: 40
        • Waddington A.
        • Hahn P.M.
        • Reid R.
        Determinants of late presentation for induced abortion care.
        Journal of Obstetrics and Gynaecology Canada. 2015; 37: 40-45
        • White K.
        • Potter J.E.
        • Stevenson A.J.
        • Fuentes L.
        • Hopkins K.
        • Grossman D.
        Women’s knowledge of and support for abortion restrictions in Texas: Findings from a statewide representative survey.
        Perspectives on Sexual and Reproductive Health. 2016; 48: 189-197


      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 oppressed populations.


      Amy Alspaugh, PhD, CNM, is Assistant Professor of Nursing, University of Tennessee, Knoxville College of Nursing and a Certified Nurse-Midwife. Her research interests include reproductive health in people with the capacity for pregnancy age 35 and older, abortion in nursing, and the midwifery workforce.