What's illegal? To learn, to practice, or both? Recommendations for the midwifery field to respond to the post-Dobbs abortion crisis.

Abstract

Purpose: Since before the ruling of the Dobbs v. Jackson Supreme Court decision there has been a shortage of abortion providers that has contributed to the lack of abortion access across the U.S. Midwives are uniquely positioned to provide abortion care due to their community-based training and practice, their professional scope of practice, and their reproductive health expertise. The purpose of this commentary is to analyse current advanced practice clinician (APC) abortion scope of practice policies and state level abortion restrictions to make recommendations to increase APC abortion training.

Materials and methods: Online state policy data on abortion restrictions and APC abortion scope of practice were compiled to describe the current U.S. landscape. An online survey (n = 197) of U.S. midwives collected responses on whether abortion training was a part of their midwifery curriculum, and the type of training received.

Results: Medication and procedural abortion care is included in the legal scope of practice of advanced practice clinicians, including midwives, in 22 states. Nine states where abortion is legal do not allow midwives to provide abortions. Although the American College of Nurse Midwives supports abortion and midwives providing abortion, the curricula at their accredited programs are limited. 65.5% of survey respondents indicated they didn't receive any abortion training in their midwifery program.

Conclusions: Ensuring communities have their health care needs met is our collective responsibility. We believe that innovative solutions including implementing institutional policies that intentionally integrate clinical abortion training into the curriculum of accredited programs and midwifery practice is part of the solution.