Advanced practice clinicians and medication abortion safety: A 10-year retrospective review
Awarded 2018
Increasing access to medication abortion
Ila Dayananda, MD, MPH
Planned Parenthood of New York City

Background: Expanding the pool of trained, competent medication abortion providers is necessary to fill gaps in access to safe abortion in the US. The scope of practice for advanced practice clinicians (APCs), including nurse practitioners (NPs), certified nurse midwives (CNMs) and physician assistants (PAs), extends well beyond the skills required to safely manage medication abortion with mifepristone and misoprostol. Despite a compelling public health argument for APCs as abortion providers and the recent label change to mifepristone, 34 states currently mandate that clinicians providing medication abortion must be physicians. There is an urgent need for empirical evidence demonstrating the safety and effectiveness of APC provision of medication abortion in the US to challenge these restrictions. At Planned Parenthood of New York City (PPNYC), over 40 APCs, including CNMs, NPs and PAs, have provided more than 50,000 medication abortions since 2009.
Methods: We propose a 10-year retrospective review of our clinical experience to report the effectiveness and safety of medication abortion when managed by APCs at our health centers, and describe our APC provider characteristics, patient characteristics and their association with medication abortion outcomes.
Proposed Analysis: We hope to demonstrate clearly that medication abortion is highly effective and safe when provided by APCs to a diverse population of clinically well, reproductive age patients through 70 days’ gestation. These results will arm advocates with necessary evidence to leverage the political will needed to overturn backwards legislation and restrictive practices, allowing for greater engagement of APCs as medication abortion providers.