Regulations around abortion providers in the U.S. (American Journal of Public Health)

Tuesday afternoon, on the 40th anniversary of Roe v. Wade, a group of state lawmakers and women’s advocates announced the introduction of a bill in the California Legislature aimed at expanding a woman’s access to abortion. Currently in California, only physicians are authorized to conduct early abortions. This new bill, AB 154, would authorize other clinicians — specially-trained nurse practitioners, certified nurse midwives and physician assistants — to perform early abortions.

“As a former administrator of a health clinic, I know how important timely care is for women,” Assemblymember Toni Atkins (D-San Diego), author of AB 154, said in a statement. “This bill will ensure that early abortion care will be available for women in California who need it.”

Four other states permit nonphysician clinicians to perform early abortions. Still, clinical evidence of safety had been lacking. Last week, a new study led by researchers at UCSF showed that early abortions performed by trained nurse practitioners, certified nurse midwives and physician assistants are “clinically equivalent” to those performed by physicians.

“Early abortion is safer than we thought overall, and there’s no difference in the complication rate between the two groups,” said lead author Tracy Weitz, UCSF professor of obstetrics and gynecology. The research team found a two percent complication rate — below the four percent rate they had expected. Complications were mostly minor.

In the study, published online by the American Journal of Public Health, researchers received a waiver from the state of California to permit training of nurse practitioners, certified nurse midwives and physician assistants to perform what are called surgical or aspiration abortions. Altogether, researchers analyzed more than 11,000 procedures.

These nonphysician providers are already authorized in California to prescribe medications that  can induce an abortion.

Access to an abortion provider is a significant issue across much of the country. According to the Guttmacher Institute, 87 percent of counties in the U.S. lack an abortion provider. In California, 22 percent of counties lack a provider, but only about one percent of women of reproductive age live in those counties. Overall, 54 of California’s 58 counties lack what Guttmacher calls a “regular provider” of abortions. The institute defined “regular” as a facility where 400 or more abortions are performed annually. ”Facilities that do fewer than 400 abortions per year are less likely to advertise, and women may not know that abortion services are available at these facilities,” says Rachel Jones, the Guttmacher researcher who crunched the California numbers.

Amy Everitt, executive director of NARAL Pro-Choice California, an advocacy group promoting the bill, says some women may have to travel five hours to seek care. ”These barriers to accessing care can force women to delay abortions into advanced stages of pregnancy which can result in a more complicated procedure,” she said.

Nationally, 92 percent of abortions take place in the first trimester. In California, among women who receive Medi-Cal, the health insurance program for the poor, the first trimester abortion rate falls to 87 percent, meaning that many women delay getting an abortion putting them at risk of higher complication rates. Researchers believe that increasing providers is one way to alleviate the disparity.

The language of AB 154 will be worked out in the coming weeks. The “spot bill” language is brief: ”It is the intent of the legislature to enact legislation that would expand access to reproductive health care in CA by allowing qualified health care professionals to perform early abortions, provided that the functions are within the scope of their licenses.”

Weitz, the UCSF author of the study, pointed out that while abortion is a socially complicated question, it is not a medically complicated one. “We often want to regulate abortion as if we want to solve its social complexity,” she told me. “The take home from our study is it’s incredibly safe and that it can be offered in an outpatient facility by either physicians, nurse practitioners, certified nurse midwives or physician assistants. Women can feel safe that the care is high quality.”

Everitt acknowledged that a social goal is for California to be a “harbinger” for change. “We do hope that other states will pay attention and will broaden access to care.”

This post was updated to clarify why 400 abortions per year is the study’s threshold to be defined as a “regular provider” of abortions.

Learn More: Democratic Lawmakers Revive California Bill on Early Abortion Providers (Sacramento Bee)

(Brandi Korte: Flickr)

Reaction has been swift since the AP broke the news yesterday that the breast cancer charity, Susan G. Komen for the Cure is withdrawing future funding of any Planned Parenthood affiliates.

The Planned Parenthood Federation of America said pressure from anti-abortion groups sparked the Komen decision. The Komen Foundation counters that its guidelines do not permit funding if any organization is under a governmental investigation.

But those guidelines appear to be recent and have political underpinnings. As Jezebel reports:

Interestingly, this brand new rule that suddenly appeared in the books of the Komen Foundation just so happened to coincide with a Congressional investigation launched by a Republican legislator, who himself was pressured by the pro-life group Americans United for Life. And last year’s assault on Planned Parenthood also coincided with the addition of a vocally anti-abortion ex-politician to the ranks of Susan G Komen For the Cure.

Karen Handel, who was endorsed by Sarah Palin during her unsuccessful bid for governor of Georgia in 2010, has been the Foundation’s Senior Vice President for Public Policy since April 2011. During her gubernatorial candidacy, she ran on an anti-choice platform, vowing that if elected, she’d defund Planned Parenthood.

Planned Parenthood now has a banner on its homepage announcing the end of Komen funding and asking viewers to “Help Us Continue Lifesaving Breast Cancer Screenings.”

“We are alarmed and saddened that the Susan G. Komen for the Cure Foundation appears to have succumbed to political pressure,” said Cecile Richards, president of Planned Parenthood Federation of America in a statement. “Our greatest desire is for Komen to reconsider this policy and recommit to the partnership on which so many women count.”

The clinic serving Orange and San Bernardino Counties appears to be the only Planned Parenthood affiliate in California to receive funds from Komen. That funding has been significant. For the last seven years, Komen has helped to fund breast cancer screening this affiliate does annually for 15-20,000 women, Stephanie Kight, Sr. Vice President of the affiliate told State of Health.

Last year, 400 women needed diagnostic services and Komen covered a little over half of those. “Komen was also a key funder in education and screening in marginalized communities, especially the Vietnamese community, which has so little information about health care and breast cancer,” Kight said.  “Women’s health care and breast cancer care are way too important, and way too important to women all over this country, to be used as a political football. It’s just tragic.”

Meanwhile public comments on Twitter and Facebook have been heated. A non-scientific sampling showed sentiment running against Komen, even on its own message board, as this post demonstrates:

I am with all of you. I will return any Komen solicitations from friends with an explanation that i will no longer donate to Breast Cancer research through this organization. What a shame! It’s outrageous that this organization, like so many others, is allowing itself to be bullied by the virulently anti-woman minority in Congress. Shame, shame, shame

Those who support Komen’s move echo this tweet:

“Awesome news broke today!” tweeted @LilaGraceRose, “Susan G. Komen has finally stopped funding Planned Parenthood!”

Many other tweets show people responding with their wallets. “I just donated to Planned Parenthood to make up shortfall from shameful abandonment by Susan G. #Komen Fdn,” tweeted @KTKeith.