Who may perform abortions?

Under California law, abortions may only be performed by medical doctors. But a new bill, which just won approval in the Legislature, would allow certified nurse midwives, nurse practitioners and physician assistants who complete special training to perform certain routine first trimester abortions.

The bill, AB 154, by Assembly Majority Leader Toni Atkins (D-San Diego), is a reasonable and sensible measure that Gov. Jerry Brown should sign.

California has taken steps over the years to make sure that abortion is not just legal but available. Still, according to a statement in support of the bill from the California Women’s Health Alliance, “over half of our counties do not have an accessible abortion provider.” In rural areas, that means women have to travel hours, often by train or bus, to get to a doctor who can perform the procedure. In underserved urban areas, women face delays in getting medical appointments at clinics. When a woman can’t get an abortion in the first trimester, she may end up getting one in the later stages of pregnancy, which can mean a more complicated and more expensive abortion.

In the last few years there has been a troubling increase in the number of states passing restrictive laws that attempt to curtail abortion by limiting the window of time in which women may have one or setting unnecessary and onerous preconditions — such as waiting periods and mandatory counseling. Some of these laws have been challenged in court and rightly struck down.

The fact is that since the Supreme Court’s decision in Roe vs. Wade 40 years ago, the United States has recognized a woman’s right to have an abortion until the fetus is viable outside the womb (about 24 weeks). Given that, it is incumbent on government to help ensure that abortion is a safe and accessible medical procedure.

AB 154 will not lower the standard of care for women, as some opponents have argued. If anything, it will raise the standard of care by increasing the number of trained practitioners who can perform abortions by medication or routine aspiration techniques in California, and by offering more opportunities for women seeking the procedure to be seen and treated earlier in their pregnancies. A multiyear pilot study conducted by researchers at the Bixby Center for Global Reproductive Health at UC San Francisco compared complication rates for abortions performed by doctors and by other healthcare providers trained to carry out the procedure. The rates for both groups were under 2%, and the majority of complications were minor.

AB 154 seeks to broaden access to women who want an abortion but have difficulty getting to a doctor. It is a sound solution to the problem.