Expanding the Abortion Provider Workforce: A Qualitative Study of Organizations Implementing a New California Policy

Molly Frances Battistelli, University of California, San Francisco Sara Magnusson, University of California, San Francisco M. Antonia Biggs, University of California, San Francisco Lori Freedman, University of California, San Francisco

First published online:

| DOI: https://doi.org/10.1363/psrh.12051
Abstract / Summary

Access to abortion care in the United States varies according to multiple factors, including location, state regulation and provider availability. In 2013, California enacted a law that authorized nurse practitioners (NPs), certified nurse-midwives (CNMs) and physician assistants (PAs) to provide first-trimester aspiration abortions; little is known about organizations’ experiences in implementing this policy change.


Beginning 10 and 24 months after implementation of the new law, semistructured interviews were conducted with 20 administrators whose five organizations trained and employed NPs, CNMs and PAs as providers of aspiration abortions. Interview data on the organizations’ experiences were analyzed thematically, and facilitators of and barriers to implementation were identified.


Administrators were committed to the provision of aspiration abortions by NPs, CNMs and PAs, and nearly all identified improved access to care and complication management as clear benefits of the policy change. However, integration of the new providers was uneven and depended on a variety of circumstances. Organizational disincentives included financial and logistical costs incurred in trying to deploy and integrate the different types of providers. Some administrators found that increased costs were outweighed by improved patient care, whereas others did not. In general, having a strong administrative champion within the organization made a critical difference.


California's expansion of the abortion-providing workforce had a positive impact on patient care in the sampled organizations. However, various organizational obstacles must be addressed to more fully realize the benefits of having NPs, CNMs and PAs provide aspiration abortions.

Author's Affiliations

Molly Frances Battistelli is project director, Sara Magnusson is project coordinator, M. Antonia Biggs is social psychologist researcher and Lori Freedman is associate professor, all at Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco.


The views expressed in this publication do not necessarily reflect those of the Guttmacher Institute.