Interest in Medication and Aspiration Abortion Training among Colorado Nurse Practitioners, Nurse Midwives, and Physician Assistants

Privileging Midwives for Abortion Care

Since the US Supreme Court overturned Dobbs v Jackson, expanded access to abortion has been critical. Abortion is safe, and related complications are rare. The safety of abortion provision by advanced practice clinicians (APCs) is well documented. Despite the increase in targeted restrictions for patients and clinicians in many states post-Dobbs, in recent years there have been meaningful gains in recognition and codification of abortion as part of an expanded scope of practice for APCs. Thus, creating a formal written pathway for midwives to obtain privileges in abortion provision could also improve abortion access. In New York City's public health care system, the largest in the United States, midwives provide a significant portion of perinatal and gynecologic care. Yet, until recently, a process to privilege midwives in the provision of abortion services did not exist. In response, midwives and physicians at a large New York City hospital system sought key stakeholder support to develop a pathway for certified nurse-midwives and certified midwives, licensed midwives in New York state, to obtain the necessary training needed for independent abortion provision. This article describes the development of a midwifery-led pilot program to improve abortion access by increasing the availability of trained midwifery abortion providers, along with the results of staff meetings exploring attitudes toward abortion care by APCs. We report our safety statistics from this pilot program and share existing evidence for safety of abortion provision by midwives and other APCs.

Abortion Knowledge Among Advanced Practice Clinicians in Colorado

INTRODUCTION

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

METHODS

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.

RESULTS

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).

CONCLUSIONS

Abortion knowledge is low among Colorado advanced practice clinicians and education is needed.

The Space in the Middle: Attitudes of Women's Health and Neonatal Nurses in the United States about Abortion

INTRODUCTION

Despite playing an integral part in sexual and reproductive health care, including abortion care, nurses are rarely the focus of research regarding their attitudes about abortion.

METHODS

A sample of 1,820 nurse members of the Association of Women's Health, Obstetric, and Neonatal Nurses were surveyed about their demographic and professional backgrounds, religious beliefs, and abortion attitudes. Scores on the Abortion Attitudes Scale were analyzed categorically and trichotomized in multinomial regression analyses.

RESULTS

Almost one-third of the sample (32%) had moderately proabortion attitudes, 29% were unsure, 16% had strongly proabortion attitudes, 13% had strongly antiabortion attitudes, and 11% had moderately antiabortion attitudes. Using trichotomized Abortion Attitudes Scale scores (proabortion, unsure, antiabortion), adjusted regression models showed that the following characteristics were associated with proabortion attitudes: being non-Christian, residence in the North or West, having no children, and having had an abortion.

CONCLUSIONS

Understanding nurses' attitudes toward abortion, and what characteristics may influence their attitudes, is critical to sustaining nursing care for patients considering and seeking abortion. Additionally, because personal characteristics were associated with antiabortion attitudes, it is likely that personal experiences may influence attitudes toward abortion. A large percentage of nurses held attitudes that placed them in the "unsure" category. Given the current ubiquitous polarization of abortion discourse, this finding indicates that the binary narrative of this topic is less pervasive than expected, which lends itself to an emphasis on empathetic and compassionate nursing care.

Pregnancy Options Counseling and Abortion Referral Practices Among Colorado Nurse Practitioners, Nurse-Midwives, and Physician Assistants

INTRODUCTION

Access to abortion is a public health priority. Yet little is known about pregnancy options counseling and abortion referral practices, both essential to timely abortion care, among advanced practice clinicians (APCs; nurse practitioners, nurse-midwives, physician assistants).

METHODS

Data were drawn from a stratified random sample of Colorado APCs, oversampling certified nurse-midwives (CNMs), women's health nurse practitioners (WHNPs), and rural clinicians. Pregnancy options counseling and abortion referral practices were described. Weighted multivariate logistic regression models were used to examine associations between participant characteristics and providing options counseling, referring for abortion, and referring to crisis pregnancy centers.

RESULTS

Of 513 participants (response rate 21%), 419 provided pregnancy testing. Only 201(48%) reported they were willing and able to counsel on all 3 options. Religious or personal objection was the primary rationale for unwillingness to present abortion as an option (63%). However, lack of knowledge was the main rationale for unwillingness (64%) and inability to counsel (79%), whereas institutional barriers fueled inability to refer (59%). Although 53% referred for abortion care, 31% referred to crisis pregnancy centers. Characteristics positively associated with providing options counseling included being a CNM or WHNP (odds ratio [OR], 2.73; 95% CI, 1.32-5.66), having received options counseling training (OR, 2.84; 95% CI, 1.48-5.43), and feeling adequately trained on abortion counseling (OR, 6.61; 95% CI, 3.62-12.08). Characteristics positively associated with referring for abortion included being a CNM or WHNP (OR, 2.27; 95% CI, 1.18-4.36), having received options counseling training (OR, 2.39; 95% CI, 1.36-4.22), and feeling adequately trained on abortion counseling (OR, 3.5; 95% CI, 2.00-6.11). Only provider type was associated with referring to crisis pregnancy centers; CNMs and WHNPs had the lowest odds (OR, 0.29; 95% CI, 0.15-0.54).

DISCUSSION

Pregnant patients in Colorado may not receive evidence-based pregnancy options counseling or abortion referrals. Clinician training on options counseling and abortion referrals is needed.