In summary

The state’s shortage of doctors is creating a barrier to abortion access. Senate Bill 1375 would allow qualified nurse practitioners, nurse midwives and physician assistants to perform abortions without physician supervision.

By Debbie Bamberger, Special to CalMatters

Debbie Bamberger, a nurse practitioner, has provided sexual and reproductive health care for almost 30 years.

I’ll never forget my first positive pregnancy test. My stomach dropped, my breath caught. I was flooded with shame — a feeling that took me by surprise. I was 23 years old and working as a medical assistant and counselor for an OB/GYN at a practice in San Francisco. For me, getting an abortion wasn’t a choice — it was a given.

I wasn’t ashamed to have an abortion. I was embarrassed that I got myself into a situation where I needed one. I had been having sex and using contraception since high school. I was proudly sex positive, but I had a method failure.

I was lucky in that I worked for an abortion provider who was skilled, nonjudgmental and able to help me. I had the same procedure that I had seen done for other patients hundreds of times. I left work that day relieved.

I had my second positive pregnancy test five years later, while living in Merced and working as a women’s health nurse practitioner. This time, my options were far more limited. Access is a real hurdle for far too many, especially the tens of thousands of women who live in the 40% of California counties without a clinic that provides abortions.

Unlike before, the two OB/GYN doctors I worked with would not perform abortions. There were no nearby options, and the doctor in San Francisco who had performed my first abortion couldn’t fit me into his schedule. Luckily, a nurse practitioner friend at San Francisco General Hospital asked the doctor she worked for if he’d help me, and he said yes. 

Most women aren’t so fortunate. 

There is a solution in the works that would help take luck out of the equation: more abortion care providers

California already has a large number of highly skilled, highly trained nurse practitioners whom many patients trust and see for their primary and reproductive care needs. While state law allows nurse practitioners to provide first-trimester abortions under the supervision of a physician, with a shortage of doctors in the state and an anticipated rise in need now that the U.S. Supreme Court has overturned Roe v. Wade, it is critical to allow qualified nurse practitioners to perform that care without physician oversight.

Nurse practitioners, nurse midwives and physician assistants can provide first-trimester aspiration abortion procedures with physician oversight under a law passed in 2013. That law was a huge step forward in the health care industry, and I was proud to be the first nurse practitioner in the state legally trained to perform abortions.

Since then, we’ve learned that requiring physician oversight is a barrier to abortion access, because it doesn’t address California’s doctor shortage.

California legislators have the opportunity to remedy this by passing Senate Bill 1375, authored by state Senate President pro Tempore Toni Atkins, which would clarify the law and allow nurse practitioners to practice first-trimester abortions and other reproductive care services without a doctor. 

To qualify, nurse practitioners must have at least the equivalent of three full-time years of experience working under a doctor and must meet other standards to ensure the quality of care remains high. Patient health and safety is, and will always be, the top priority.

Lawmakers have the chance to lift up a workforce that is ready to meet demand and help more patients. Pregnant women don’t have time to wait for appointments, and many may be unable to take time to drive to clinics hours away. Luck shouldn’t be a factor in someone’s ability to have an abortion. Nurse practitioners should.

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