Democratic states train non-physicians to provide abortions to increase U.S. access

Democratic states across the country are embarking on a groundbreaking effort to expand access to abortion people who are not doctors learn to offer and perform the procedure.

A first-of-its-kind pilot program, the Pharmacist Abortion Access Project, was announced in Washington state this week it trained ten pharmacists to prescribe abortion pills; so far they have prescribed abortions to 43 people.

With Roe v Wade gone and abortion all but eliminated in a dozen states, the project is the latest effort to expand access to the procedure in parts of the country where it is still possible. Connecticut and Delaware have passed legislation in recent years allowing physician assistants, midwives and some nurses to perform abortions, while Oregon, Maryland and Illinois are now spending millions of state dollars on programs that train similar professions in the procedure.

“Even in Washington state, where abortion is legal, people face barriers to accessing abortion care — especially people who struggle to make ends meet, live in rural areas, or don’t have easy access to reproductive health care,” says Beth. Rivin, director of the Pharmacist Abortion Access Project and president of Uplift International, which partnered with online pharmacy Honeybee Health to provide the abortion pills. “This expands access to abortion by bringing a new profession to abortion provision.”

Of the states that still allow abortions, 14 say only doctors can perform the procedure, according to a review by the Guttmacher Institute, which tracks abortion restrictions. But in the years since the U.S. Supreme Court overturned Roe in the 2022 Dobbs v Jackson Women’s Health Organization ruling, doctors — already in short supply in the U.S. — have struggled to receive training in performing abortions.

Abortion rights advocates have long said that non-physicians should be allowed to perform abortions earlier in pregnancy if they involve pills or simpler procedures. The American College of Obstetricians and Gynecologists, the leading membership organization for obstetricians in the US, supports allowing certified nurse-midwives, nurse midwives, and physician assistants to perform abortions, as studies have found no “significant difference” in the complications of medication abortions performed by physicians compared to other trained physicians.

“Let’s free up caregivers who can do complex things so they can do complex things,” said Kylea Laina Liese, an assistant professor in the Department of Human Development Nursing Science at New York University. University of Illinois. In 2024, the University of Illinois College of Nursing became one of three organizations to receive $2 million from the state’s public health department to expand abortion training — money that Liese is now using to train the first class of physicians and non-physicians .

Midwives, nurses and physician assistants, says Liese, “are much more likely to represent the communities in which they work. That’s something that’s really lacking in abortion care. If Bipoc communities can get their reproductive and sexual health services from providers that look like them and that they trust – it reduces those burdens.” More than 60% of all practicing US physicians identify as whitewhile many smaller fractions identify as Black, Indigenous or people of color.

In addition to expanding access, advocates say, these programs can help destigmatize abortion by taking it out of the silo of specialty abortion providers and clinics. In Maryland, where the state health department has awarded more than $10 million to the University of Maryland to train new abortion providers, the program also aims to educate emergency room physicians and pediatricians — the types of specialties that typically don’t offer abortion training. .

“My dream for all primary care is: you see someone has a positive pregnancy test, you tell them they have a positive pregnancy test, and then you can give them whatever option they want,” says Jessica Lee, an associate professor of medicine at the University of Maryland School of Medicine, who helps run the program.

Don Downing, co-director of the Pharmacist Abortion Access Project and professor emeritus of pharmacy at the University of Washington, was surprised by how many patients and pharmacists were interested in the project.

“I really thought, about two or three years ago, that we might have trouble finding pharmacists willing to prescribe a medication abortion,” Downing said. “Well, it turned out that the pharmacists were just as angry as I was about the Dobbs decision, and we got our ten pharmacists – we wanted to keep it small – sorted out very quickly.”

The ability of pharmacists to prescribe medications varies from state to state. In Washington state, the Pharmacist Abortion Access Project takes advantage of decades-old legislation that authorizes pharmacists to prescribe medications. Recent changes in the Food and Drug Administration’s regulation of the generic abortion pill mifepristone have also expanded the types of providers who can prescribe medications and provide the drug to certified non-physicians.

But those changes could be short-lived. Shortly after Roe fell, anti-abortion activists filed a lawsuit asking a court to reverse the FDA’s 2000 approval of mifepristone. That case eventually reached the U.S. Supreme Court last year, which unanimously ruled that access to mifepristone should be preserved — but did so on technical grounds, leaving the door open for further attacks on the drug. That lawsuit will now continue in a lower court. Abortion pills now account for roughly two-thirds of all abortions in the US.

There is also the prospect of narrower rollbacks. The new Trump administration could do that undoing more recent regulatory changes for mifepristone – including changes that have allowed pharmacists to prescribe the drug.

“It’s quite scary,” Downing said. “It would be like saying that pharmacists can no longer provide flu shots or Covid injections.”

If these rollbacks happen, Liese and Lee say their states’ respective programs would focus on teaching providers how to offer surgical abortions, as well as medication abortions that use only the drug misoprostol (which is safe but leads to more complications can lead).

Whatever happens, Rivin hopes other blue states will try to copy the Pharmacist Abortion Access Project. In New York — where some non-physicians, such as physician assistants and nurses, are already allowed to perform abortions — lawmakers have introduced a bill that would effectively allow pharmacists to administer abortion pills. That bill stalled, but a similar measure has already been introduced this year. Lawmakers have also introduced a bill to create a state training program for abortion providers.

“Our model is definitely one that these states might be interested in. It is more important than ever in 2025 and the years to come,” Rivin said. “So we encourage leaders in those states to reach out to us.”