Menus Subscribe Search

Follow us


sonogram

(PHOTO: STEVEN FRAME/SHUTTERSTOCK)

California Looks to Make Historic Expansion of Access to Abortion

• October 02, 2013 • 12:00 PM

(PHOTO: STEVEN FRAME/SHUTTERSTOCK)

A state law could soon be signed to allow non-doctors to perform some abortions.

When you read about abortion these days, the news is mostly about restrictions—new state laws, regulations, and court challenges that aim (depending on your point of view) either to make the procedure safer for women or to put providers out of business. But California is going in the opposite direction, with two bills that could lead to the one of the biggest expansions of access to abortion in the United States since the FDA approved mifepristone, a.k.a. the abortion pill, in 2000.

AB 154 would allow specially trained nurse practitioners, nurse midwives, and physician assistants to perform first-trimester abortions without a doctor’s supervision. AB 980 would hold abortion clinics to the same building standards as other primary care facilities, instead of the stricter rules that some cities and counties would like to impose. Both are aimed at making the procedure more widely available in rural, largely conservative parts of the state where incomes are low, teen pregnancies are rampant, and finding an abortion provider often means taking the day off from work or school, getting on a bus, and traveling for hours or days.

Reaction has been predictably split. Margaret Crosby, the ACLU‘s lead voice on reproductive issues in California, says one of the most significant things about the bills is that they “treat abortion like any other medical procedure. The fact that abortion is singled out for special consideration is a relic of the days when it was a felony,” she says. “It’s a reflection of where this country is politically rather than medically.”

That dismays Brian Johnston, director of the California Pro-Life Council, who sees what he calls the “minimization” and “casualization” of abortion as a terrible thing for women and girls. If the bills are signed, he says, “animals will have more dignity under the laws of California than human beings.”

California’s support for abortion rights goes back to at least 1967, when Governor Ronald Reagan signed a law legalizing the procedure, six years before Roe v Wade. The state is also one of only a handful to have the right to privacy written into its Constitution.

Both sides do agree on one thing: The central role played by researchers in persuading lawmakers to pass the bills could change the terms of the whole debate.

Indeed, AB 154 would have gone nowhere but for a recent study out of the University of California-San Francisco that ranks as one of the largest examinations of abortion complication rates ever conducted. After monitoring more than 11,000 procedures over five years, researchers found very little difference in the rate of complications between first-trimester vacuum aspirations performed by experienced doctors and those done by skilled non-physicians.

“Other states that are adding restrictions and barriers are doing so purely out of politics,” says Kathy Kneer, president and CEO of Planned Parenthood Affiliates of California. “It’s not based on any medical evidence. The California study gives people a way to push back. It’s like a factual slap in the face.”

But first, some back story.

California’s support for abortion rights goes back to at least 1967, when Governor Ronald Reagan signed a law legalizing the procedure, six years before Roe v Wade. The state is also one of only a handful to have the right to privacy written into its Constitution. Courts have cited that right many times over the years to reject attempts by abortion opponents to impose restrictions.

As a result, unlike the vast majority of other states, California pays for abortions for low-income women and lets teenage girls end their pregnancies without having to tell their parents first. It has about 500 providers scattered throughout the state. These providers accounted for 18 percent of all the abortions performed in the U.S. in 2008, the Guttmacher Institute says. California “does not have” an access problem, insists Carol Hogan, director of pastoral projects and communications for the California Catholic Conference.

But abortion advocates look at the same picture and see many glaring gaps. Some 52 percent of counties—mainly in conservative areas like the vast agricultural Central Valley—either don’t have any providers or lack accessible providers, defined as clinics that perform abortions routinely for a fee that women can afford. Medi-Cal (the state’s version of Medicaid) may pay for the procedure, but it does so at 1985 levels—as much of a disincentive for many doctors and hospitals as noisy protesters and bomb threats.

Plus, California is enormous. Kern County, for example, at the southern end of the Central Valley, has one abortion clinic to serve an area larger than New Jersey.

“Maybe there’s a clinic in their area but it only offers the [abortion] pill and that’s only good through the eighth week of pregnancy,” says Sierra Harris, associate director of ACCESS: Women’s Health Justice, a non-profit organization in Oakland that helps women make arrangements and sometimes pays for their trips. “They have to arrange childcare, transportation.” The more onerous the logistics, the longer it takes to obtain care, and many women miss the first-trimester cutoff that most clinics impose, making it even harder to find a provider. “The delays lead to more delays. It becomes a cycle,” Harris says.

Then there’s the chronic nationwide shortage of doctors trained to perform abortions. New Hampshire, Vermont, Oregon, and Montana have long permitted physician assistants and nurse practitioners to pick up the slack.

Abortion advocates have been trying for years to revamp the California statutes. A turning point came in 2002, when lawmakers enacted a new law that enshrined Roe. The law also gave the go-ahead for non-physicians to perform “medical” (pill) abortions.

Yet even pro-choice lawmakers remained reluctant to let non-doctors do “surgical” (vacuum aspiration) abortions—as of 2008, about 83 percent of first-trimester procedures in the U.S., Guttmacher says. They wanted proof that patients would not be harmed (and assurances that the medical establishment wouldn’t be hurt, either).

But the same political forces that have made it difficult to build new clinics and train doctors have also made it nearly impossible for researchers to study abortion the way they do other medical procedures.

Enter Tracy Weitz, an associate professor in the ob/gyn department at UCSF. A social scientist by training, she heads the Advancing New Standards in Reproductive Health project at the school’s Bixby Center for Global Reproductive Health, one of the very few programs in the U.S. doing clinical research on abortion and contraception.

Weitz and her team discovered a little-known mechanism in California law that lets health care professionals conduct pilot projects—for example, studying whether dental hygienists can be trained to safely fill cavities. After a two-year approval process, the researchers quietly embarked on a study the likes of which has never been done in this country.

First, non-physicians around the state—nurse practitioners, certified midwives, and physician assistants who specialized in women’s health and were already doing procedures like inserting IUDs and taking Pap smears—received training in how to perform vacuum aspirations. After they could show they were competent, they were allowed to do first-trimester procedures at some 22 sites run by Planned Parenthood or Kaiser Permanente, the state’s largest HMO.

Eventually Weitz and her team gathered data comparing 5,675 abortions performed by non-physicians to 5,812 performed by doctors with years of experience. Given that the non-physicians were such novices, Weitz was expecting their complication rate to be as high as five or six percent. But problems like incomplete abortions and infections were so infrequent that the study had to be extended a year to capture more patients, she says. In the end, the complication rate was 0.9 percent for doctors and 1.8 percent for non-doctors—figures that Weitz calls “enormously, incredibly safe.”

She credits the same kinds of improvements in technology that have made many other medical procedures easier and safer since the 1970s. The instruments used in vacuum aspirations are less apt to puncture tissue, ultrasounds make it possible to tell the age of the fetus, and antibiotics given before the procedure reduce the risk of infection. Abortion opponents point out the non-physicians still had twice as many complications as the doctors, but Weitz dismisses this as “disingenuous,” given that some critics have been claiming complication rates of 10 percent or higher.

The UCSF study, published on the American Journal of Public Health‘s website, didn’t just sway Democrats to pass the non-physicians bill. AB 980, the bill dealing with building codes, also benefited from the fresh information. Governor Jerry Brown, apro-choice former Jesuit with a long history of supporting women’s issues, could sign the two bills any day, although his slowness is causing jitters in some camps and hope in others.(Also on his desk is a narrower abortion-related bill that would protect the privacy rights of young adults who receive insurance through their parents; in September, Brown signed a fourth bill buttressing the rights of foster kids to reproductive health information and services.)

No one seems to expect that the California bills will have any domino effect in conservative regions of the country. Even in California, Johnston says, there could be pushback in the form of court challenges or voter initiatives. Indeed, while a brand-new poll by the Public Policy Institute of California found that 61 percent of those surveyed don’t want the government to interfere with abortion access, that figure is 10 points lower than in 2000. (PDF here.)

But Kneer says the UCSF study could have a major impact in liberal states concerned about abortion access for low-income and rural women. “Places that have a progressive political environment now have a large study to back them up so they can also expand,” she says,

Meanwhile, Weitz predicts, the effects of any new law could also be felt in border states like Arizona that have more restrictive abortion rules. “I do think it’s likely that some women will come to California for services,” she says. “It happened in the 1970s. There’s no reason to think … that the same thing wouldn’t happen now.”


This post originally appeared on ProPublica, a Pacific Standard partner site.

Nina Martin
Nina Martin is ProPublica’s first reporter covering gender and sexuality. She joined the staff in September 2013 after spending much of the last decade at San Francisco magazine as articles editor (since 2007) and executive editor (2003-2005).

More From Nina Martin

A weekly roundup of the best of Pacific Standard and PSmag.com, delivered straight to your inbox.

Recent Posts

December 22 • 4:00 AM

Keep That E-Reader Out of Bed and You’ll Feel Better in the Morning

New research finds e-readers, like other light-emitting electronic devices, can disrupt normal sleep patterns.


December 20 • 10:28 AM

Flare-Ups

Are my emotions making me ill?


December 19 • 4:00 PM

How a Drug Policy Reform Organization Thinks of the Children

This valuable, newly updated resource for parents is based in the real world.


December 19 • 2:00 PM

Where Did the Ouija Board Come From?

It wasn’t just a toy.


December 19 • 12:00 PM

Social Scientists Can Do More to Eradicate Racial Oppression

Using our knowledge of social systems, all social scientists—black or white, race scholar or not—have an opportunity to challenge white privilege.


December 19 • 10:17 AM

How Scientists Contribute to Bad Science Reporting

By not taking university press officers and research press releases seriously, scientists are often complicit in the media falsehoods they so often deride.


December 19 • 10:00 AM

Pentecostalism in West Africa: A Boon or Barrier to Disease?

How has Ghana stayed Ebola-free despite being at high risk for infection? A look at their American-style Pentecostalism, a religion that threatens to do more harm than good.


December 19 • 8:00 AM

Don’t Text and Drive—Especially If You’re Old

A new study shows that texting while driving becomes even more dangerous with age.


December 19 • 6:12 AM

All That ‘Call of Duty’ With Your Friends Has Not Made You a More Violent Person

But all that solo Call of Duty has.


December 19 • 4:00 AM

Food for Thought: WIC Works

New research finds participation in the federal WIC program, which subsidizes healthy foods for young children, is linked with stronger cognitive development and higher test scores.


December 18 • 4:00 PM

How I Navigated Life as a Newly Sober Mom

Saying “no” to my kids was harder than saying “no” to alcohol. But for their sake and mine, I had to learn to put myself first sometimes.


December 18 • 2:00 PM

Women in Apocalyptic Fiction Shaving Their Armpits

Because our interest in realism apparently only goes so far.


December 18 • 12:00 PM

The Paradox of Choice, 10 Years Later

Paul Hiebert talks to psychologist Barry Schwartz about how modern trends—social media, FOMO, customer review sites—fit in with arguments he made a decade ago in his highly influential book, The Paradox of Choice: Why More Is Less.


December 18 • 10:00 AM

What It’s Like to Spend a Few Hours in the Church of Scientology

Wrestling with thetans, attempting to unlock a memory bank, and a personality test seemingly aimed at people with depression. This is Scientology’s “dissemination drill” for potential new members.


December 18 • 8:00 AM

Gendering #BlackLivesMatter: A Feminist Perspective

Black men are stereotyped as violent, while black women are rendered invisible. Here’s why the gendering of black lives matters.


December 18 • 7:06 AM

Apparently You Can Bring Your Religion to Work

New research says offices that encourage talk of religion actually make for happier workplaces.


December 18 • 6:00 AM

The Very Weak and Complicated Links Between Mental Illness and Gun Violence

Vanderbilt University’s Jonathan Metzl and Kenneth MacLeish address our anxieties and correct our assumptions.


December 18 • 4:00 AM

Should Movies Be Rated RD for Reckless Driving?

A new study finds a link between watching films featuring reckless driving and engaging in similar behavior years later.


December 17 • 4:00 PM

How to Run a Drug Dealing Network in Prison

People tend not to hear about the prison drug dealing operations that succeed. Substance.com asks a veteran of the game to explain his system.


December 17 • 2:00 PM

Gender Segregation of Toys Is on the Rise

Charting the use of “toys for boys” and “toys for girls” in American English.


December 17 • 12:41 PM

Why the College Football Playoff Is Terrible But Better Than Before

The sample size is still embarrassingly small, but at least there’s less room for the availability cascade.


December 17 • 11:06 AM

Canadian Kids Have a Serious Smoking Problem

Bootleg cigarette sales could be leading Canadian teens to more serious drugs, a recent study finds.


December 17 • 10:37 AM

A Public Lynching in Sproul Plaza

When photographs of lynching victims showed up on a hallowed site of democracy in action, a provocation was issued—but to whom, by whom, and why?


December 17 • 8:00 AM

What Was the Job?

This was the year the job broke, the year we accepted a re-interpretation of its fundamental bargain and bought in to the push to get us to all work for ourselves rather than each other.


December 17 • 6:00 AM

White Kids Will Be Kids

Even the “good” kids—bound for college, upwardly mobile—sometimes break the law. The difference? They don’t have much to fear. A professor of race and social movements reflects on her teenage years and faces some uncomfortable realities.


Follow us


Don’t Text and Drive—Especially If You’re Old

A new study shows that texting while driving becomes even more dangerous with age.

Apparently You Can Bring Your Religion to Work

New research says offices that encourage talk of religion actually make for happier workplaces.

Canadian Kids Have a Serious Smoking Problem

Bootleg cigarette sales could be leading Canadian teens to more serious drugs, a recent study finds.

The Hidden Psychology of the Home Ref

That old myth of home field bias isn’t a myth at all; it’s a statistical fact.

The Big One

One in two United States senators and two in five House members who left office between 1998 and 2004 became lobbyists. November/December 2014

Copyright © 2014 by Pacific Standard and The Miller-McCune Center for Research, Media, and Public Policy. All Rights Reserved.