{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T16:58:42Z","timestamp":1775667522813,"version":"3.50.1"},"reference-count":27,"publisher":"Guttmacher Institute","issue":"1","license":[{"start":{"date-parts":[[2018,2,14]],"date-time":"2018-02-14T00:00:00Z","timestamp":1518566400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Perspect Sexual Reproductive"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>CONTEXT<\/jats:title><jats:p>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\u2010midwives (CNMs) and physician assistants (PAs) to provide first\u2010trimester aspiration abortions; little is known about organizations\u2019 experiences in implementing this policy change.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>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\u2019 experiences were analyzed thematically, and facilitators of and barriers to implementation were identified.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>California's expansion of the abortion\u2010providing 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.<\/jats:p><\/jats:sec>","DOI":"10.1363\/psrh.12051","type":"journal-article","created":{"date-parts":[[2018,2,14]],"date-time":"2018-02-14T15:52:24Z","timestamp":1518623544000},"page":"33-39","source":"Crossref","is-referenced-by-count":12,"title":["Expanding the Abortion Provider Workforce: A Qualitative Study of Organizations Implementing a New California Policy"],"prefix":"10.1363","volume":"50","author":[{"given":"Molly Frances","family":"Battistelli","sequence":"first","affiliation":[{"name":"Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California  San Francisco"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Magnusson","sequence":"additional","affiliation":[{"name":"Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California  San Francisco"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. Antonia","family":"Biggs","sequence":"additional","affiliation":[{"name":"Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California  San Francisco"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lori","family":"Freedman","sequence":"additional","affiliation":[{"name":"Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California  San Francisco"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"259","published-online":{"date-parts":[[2018,2,14]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"Improving Abortion Access by Expanding Those Who Provide Care","author":"Barry D","year":"2015"},{"key":"e_1_2_6_3_1","unstructured":"California Assembly Bill No. 154 2013."},{"key":"e_1_2_6_4_1","unstructured":"AuerbachDIet al. Nurse Practitioners and Sexual and Reproductive Health Services: An Analysis of Supply and Demand Santa Monica CA:RAND 2012 https:\/\/www.arhp.org\/uploadimages\/RandHealthReport.pdf."},{"key":"e_1_2_6_5_1","unstructured":"California Senate Bill No. 1301 2002."},{"key":"e_1_2_6_6_1","unstructured":"California Office of Statewide Health Planning and Development(OSHPD) Health Workforce Pilot Projects Program 2017 https:\/\/www.oshpd.ca.gov\/HWDD\/HWPP.html."},{"key":"e_1_2_6_7_1","volume-title":"Health Workforce Pilot Projects Program Application #171: Demonstrating the Role of Advanced Practice Clinicians in Expanding Early Pregnancy Care","author":"Advancing New Standards in Reproductive Health","year":"2005"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2012.301159"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732313514483"},{"issue":"3","key":"e_1_2_6_10_1","article-title":"Designing and conducting research to make real social change in abortion care","volume":"42","author":"Weitz T","year":"2014","journal-title":"American Sociological Association Footnotes"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.2.226"},{"key":"e_1_2_6_12_1","volume-title":"TEACH Early Abortion Training Workbook","author":"Goodman S","year":"2016"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2014.302212"},{"key":"e_1_2_6_14_1","volume-title":"TEACH Early Abortion Training Workbook","author":"Goodman S","year":"2016"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/1062860613484295"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1363\/psrh.12015"},{"key":"e_1_2_6_17_1","volume-title":"Policy Trends in the States: 2016","author":"Nash E"},{"issue":"4","key":"e_1_2_6_18_1","first-page":"719","article-title":"Clinicians who provide abortions: the thinning ranks","volume":"80","author":"Grimes DA","year":"1992","journal-title":"Obstetrics & Gynecology"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1049-3867(05)80250-6"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.2307\/j.ctv17vf79f"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1363\/4214610"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.17226\/12956"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.outlook.2015.08.005"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2013.0072"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1363\/46e0414"},{"key":"e_1_2_6_26_1","unstructured":"ACCESS Women's Health Justice All* Above All and Ibis Reproductive Health Research brief: barriers to abortion care in California\u2014highlighting challenges of Medi\u2010Cal coverage 2016 https:\/\/ibisreproductivehealth.org\/publications\/research\u2010brief\u2010barriers\u2010abortion\u2010care\u2010california\u2010highlighting\u2010challenges\u2010medi\u2010cal."},{"key":"e_1_2_6_27_1","unstructured":"American Association of Nurse Practitioners State practice environment 2017 https:\/\/www.aanp.org\/legislation\u2010regulation\/state\u2010legislation\/state\u2010practice\u2010environment."},{"key":"e_1_2_6_28_1","volume-title":"Qualitative Research Design: An Interactive Approach","author":"Maxwell JA","year":"2012"}],"container-title":["Perspectives on Sexual and Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1363%2Fpsrh.12051","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1363\/psrh.12051","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,25]],"date-time":"2023-09-25T05:38:39Z","timestamp":1695620319000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1363\/psrh.12051"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,14]]},"references-count":27,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,3]]}},"alternative-id":["10.1363\/psrh.12051"],"URL":"https:\/\/doi.org\/10.1363\/psrh.12051","archive":["Portico"],"relation":{},"ISSN":["1538-6341","1931-2393"],"issn-type":[{"value":"1538-6341","type":"print"},{"value":"1931-2393","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,2,14]]}}}