California Counters National Abortion Trend

As many states crack down on the procedure, a new bill may expand access

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Stephen Lam / REUTERS

A pro-choice demonstrator in San Francisco, Jan. 26, 2013.

Leave it to California to buck a national trend. As states across the U.S. enact new laws restricting abortion, Golden State lawmakers are on the cusp of passing legislation that could greatly expand access to the procedure by allowing nurse practitioners, physicians’ assistants and certified nurse midwives to perform first-trimester abortions. The bill passed the state senate Monday and is expected to be approved by the California assembly this week.

Pro-life groups say the new law could put women’s health at risk, though a recently published study found abortions administered by these professionals, known as advanced-practice clinicians, are as safe as those performed by physicians. Supporters used that study, conducted by researchers at the University of California, San Francisco, to help secure the bill’s passage. (Four other states — Oregon, Montana, Vermont and New Hampshire — already allow advance-practice clinicians to provide abortions or do not explicitly ban them from doing so.) Pro-choice groups, meanwhile, are heralding advancement of the California bill as an increasingly rare victory in the effort to make abortion easier to access.

The state would seem to have little need to broaden abortion access. California has more than 500 abortion providers, according to the reproductive-rights organization the Guttmacher Institute and nearly 30% of all abortion providers in the U.S. were located there in 2008, the most recent year for which data is available. The abortion rate in the state that year was 27.6 abortions per 1,000 women ages 15 to 44, 40% higher than the national average.

(MORE: Doctors Urge More Hospitals to Perform Abortions)

But those statistics don’t accurately reflect access to abortion in California, says Tracy Weitz, director of UCSF’s Advancing New Standards in Reproductive Health program and lead author of the nonphysician abortion study. About half of all abortion providers in the state are hospitals that only offer the procedure in cases where fetuses have abnormalities or a mother’s health or life is at risk. Excluding these facilities, nearly half of the state’s counties currently have no abortion provider.

If the places where advanced-practice clinicians legally provide abortions are any guide, California’s legislation could increase abortion access for low-income women in rural areas. Montana has allowed the practice since 1999, when the state supreme court struck down a state law limiting the procedure to physicians. Letting such clinicians provide abortions is “very important, especially in Montana,” says Annie Hansen, director of the Blue Mountain Clinic in Missoula, which has a physician’s assistant on staff who performs abortions. “We’re so rural. There’s really about only four places doing this service and we’re all really spread out.”

The California legislation reflects another trend: the growing abortion access gap among states. Proposals to make abortions easier to get typically emerge in states where laws already favor widespread availability. Similar measures are rarely proposed, let alone passed, in states like North Dakota and Mississippi, which have a single abortion provider each.

(PHOTOS: 40 Years After Roe: Inside North Dakota’s Only Abortion Clinic)

New York State, like California, has relatively unfettered access to abortion. Yet, Governor Andrew Cuomo recently pushed for a law affirming a woman’s right to an abortion after 24 weeks if her health is threatened. Current state law permits abortions in the third trimester only if a woman’s life is in danger. But Roe v. Wade holds that such late-term abortions are legal to protect the life and health of mothers, so Cuomo’s proposal, which did not pass, would have simply codified this into state law. And the procedures that would have been affected are extremely rare: nationwide, less than 2% of abortions take place after 21 weeks.

If California legislators pass the bill to allow advanced-practice clinicians to perform first-trimester abortions, many are poised to step in. Some already have. In order to conduct the study on the safety of nonphysician abortions, Weitz and her fellow researchers were granted a waiver from the state allowing clinicians to perform the procedures. Working at Planned Parenthood locations and facilities in the Kaiser Permanente health system in Northern California, the clinicians were trained to provide abortions and the researchers designed a study to measure complication rates.

Of the 11,487 abortions provided between 2007 and 2011 included in the study, which was published in January in the American Journal of Public Health, 1.3% had complications. The rate of complication for advanced-practice clinicians was 1.8%; for physicians, it was 0.9%, which the study authors wrote was “clinically equivalent.” (Just six abortions in the entire study had complications that required hospital-based care.)

MORE: Texas Abortion Bill: Is There a Medical Case for More Regulation of Outpatient Clinics?

31 comments
kidneystew
kidneystew

what part of " you're killing a human being when you have an abortion" do people not understand?

dpharisee
dpharisee

TO NURSES with CONSCIENCE: 

ABORTION is not a health problem. It is not in your code of ethics. You will never get a woman WELL through abortion for they keep coming back to want some more. A medically sick person seeks your profession to get well, get healthy, get strong, get better and move on in her life. A woman with abortion in mind will never get well so she will always return to you.

dpharisee
dpharisee

That vagina is unholy, defiled, used, abused so why go there? It is naive and ignorant for one to go there anyway.

BratWingz
BratWingz

On behalf of millions of women across the country, I thank you California for caring for women in need and following Roe V Wade. Too many Conservatives are sticking their noses in place they don't belong. Stay the F*** out of my vagina! and mind your own business! Thanks to states like Cali and NY with legislators who can relate to their constituency, maybe others will get into the 21st century instead of digressing like the GOP want you to do into the past centuries. 

And to those who just commented before me? You sound like idiots.

routtookc
routtookc

Isnt cali porn-land?  just have more butt seks and thus less need for unwanted babies?  amiright?

bojimbo26
bojimbo26

Have the baby , then give to pro-lifers .

laugh.or.retch
laugh.or.retch

@dpharisee Hmmm, "get strong" and "move on in her life"... As in get strong enough to actually be a decent parent to a child? As in move on with her life so that later, when she's well off enough to afford to bring up a child? Those sound like the best reasons to have an abortion.

laugh.or.retch
laugh.or.retch

@dpharisee And what do you say about the christian sects that deny their children life saving medical attention on religious grounds? Are they murderers if they fail to pray their child well? Will you take their CHOICE away from them as well? Or will you make an exception for those who are "holy"?

the.david.wilson
the.david.wilson

That unborn child is actually in a woman's uterus and it is a living human being. Your comment is ignorant and naive. Your logic would require that we not intervene when a parent abuses, or kills, thier child or when a country commits genocide. None of our business, right?

No man is an island,
Entire of itself.
Each is a piece of the continent,
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were.
As well as if a manor of thine own
Or of thine friend's were.
Each man's death diminishes me,
For I am involved in mankind.
Therefore, send not to know
For whom the bell tolls,
It tolls for thee.

Piacevole
Piacevole

@routtookc There are several ways to avoid having babies that don't involve anal sex.  You might google "contraception."

Hollywooddeed
Hollywooddeed

@the.david.wilson   Actually, since it's a matter of bodily autonomy , it really is none of your business.  If you are ever in the position to choose, feel free to have the courage of your convictions.  If I am in that same position, feel free to keep your pointy nose out of it.  Women make personal decisions all the time and they don't include you.

hollywooddeed
hollywooddeed

@jdmullane I'll give up control of my bodily autonomy and most personal decisions to the government right after you do.

hollywooddeed
hollywooddeed

@jdmullane Not on my side, cupcake. People who would take away early, safe and legal abortion create more Gosnells. People like you.

Hollywooddeed
Hollywooddeed

@bob.finger59  Well, gee, bob, when you're faced with an unplanned, unwanted pregnancy, be sure to make your choice.

The Supreme Court disagrees with you.  When it comes to legal and personal, mind your own business.  I'll give up my bodily autonomy and personal decisions to the government right after you do.


bob.finger59
bob.finger59

Hollywooddeed, I bet you're glad your mom chose to carry you for nine months, right?  Having the conviction to choose to abort a baby is not courageous.  It is the conviction of a self-centered coward; unaware that there is a great price to pay for that conviction.