AUGUSTA — Medical professionals testified Wednesday on both sides of a controversial Mills administration proposal to allow physician assistants and advanced practice registered nurses to provide abortion services.
Supporters argue the bill is particularly important to rural or lower-income Maine women who have to travel long distances or take time off for appointments at hospitals or offices where they can obtain a surgical or medical abortion. The bill seeks to add Maine to the roughly half-dozen states – including New Hampshire and Vermont – that treat abortions like other procedures that non-physicians are allowed to handle.
“No matter where she lives, a woman has the right to safely make her own health decisions, control her own future and get care from her provider of choice,” said House Speaker Sara Gideon, D-Freeport, who sponsored the bill for Democratic Gov. Janet Mills. “If we increase the number of providers in Maine, as we seek to do in this bill, then we are making real gains towards equitable access to health care for all women who need an abortion.”
But opponents warned that the Mills administration proposal will merely increase the number of abortions in Maine while potentially putting women at greater risk from abortion-related medical complications.
“This is not women’s health care,” said Kristina Terry, a registered nurse from Benton. “This is a push to lower the standards of women’s health care that is driven by a desire for greater access (to abortions). It is a massive degradation of the safety standards and puts lives at risk and the future reproductive health of Maine women.”
Current law allows only physicians to perform a surgical abortion or to prescribe the medications that lead to a drug-induced “medical abortion.” That law was passed in 1979 in order to prevent dangerous “back-alley abortions” and at a time when the professions of physician assistant and nurse practitioner were less developed in Maine than today.
The number of abortions performed in Maine fluctuates from year to year, but the national trend has been downward in recent decades. The Maine Center for Disease Control and Prevention reported 1,959 surgical and medical abortions in 2017, up slightly from 1,836 two years earlier but substantially lower than the 2,311 procedures reported for 2010.
Lawmakers also are considering several other abortion-related bills. The same committee voted last month along party lines to advance a bill that would require the state Medicaid program, MaineCare, as well as private insurers to pay for abortion services.
There are three health centers in Maine – in Portland, Augusta and Bangor – that perform surgical or “aspiration” abortions.
Physician assistants and advanced practice registered nurses – including nurse practitioners and certified nurse midwifes – are medical professionals who provide care under the supervision of a physician who may or may not be on-site. They can write prescriptions, offer treatments and perform some surgical procedures, depending on their level of certification.
In 1979 the state passed a law prohibiting anyone other than physicians from performing abortions as a way to prevent “back-alley abortions,” as Gideon put it, that can put the health of the woman at serious risk. But bill supporters contend medical technology has developed since then, as has the training for physician assistants and nurse practitioners.
The World Health Organization and the American College of Obstetricians and Gynecologists as well as state organizations such as the Maine Medical Association have endorsed allowing physician assistants and advanced practice registered nurses to provide abortion services as long as they’ve received training.
Stephanie Small, a nurse practitioner who works in family planning, pointed out that she can prescribe medications, manage pregnancy miscarriages, place intrauterine contraceptive devices and perform endometrial biopsies. Small said all of those activities are similar to the procedures required for an in-office abortion, but she must refer clients to abortion clinics elsewhere because of what she described as Maine’s “outdated law.”
“Maine’s nurse practitioner ban is no longer helping keep patients safe,” Small told members of the Legislature’s Health Coverage, Insurance and Financial Services. “Instead, it is causing unnecessary harm by keeping them away from qualified heath care providers.”
Bethany Beausang, a senior policy adviser to Mills, said such professionals are licensed by their respective boards and work closely with physicians in health clinics. But requiring women to make appointments at Maine’s few abortion clinics can actually delay care, potentially heightening the risk of complications from an abortion.
The bill from Mills – Maine’s first female governor – likely has good chances in the Democratic-controlled Legislature. But Wednesday’s hearing as well as recent policy debates in states around the country underscore how abortion remains an emotional and divisive political issue more than 45 years after the U.S. Supreme Court’s landmark Roe v. Wade case legalizing abortion.
Maine’s bill, L.D. 1261, drew strong opposition from anti-abortion organizations such as the Maine Right to Life Committee, the Rosetta Foundation and the Roman Catholic Diocese of Portland. Many of those arguments were rooted in religious or moral opposition, and sought to draw a moral distinction between abortions and other medical procedures, such as child births, routinely performed by non-physicians.
“The delivery of a child is different than the ending of a child’s life,” said Suzanne Lafreniere, representing the Roman Catholic Diocese of Portland.
Several active or retired medical professionals also testified against the bill.
Dr. Danae Kershner, a family practice physician in Aroostook County, said the many nurse practitioners and physician assistants with whom she works “provide excellent care” but rely heavily on physicians.
Kershner said surgical abortions carry risks of hemorrhage, infections, perforations of the uterus or other complications that could threaten the woman’s life or cause infertility. Additionally, the prescription drugs used in medical abortions “are not benign” and carry their own risks, she told lawmakers.
As a result, Kershner said, the proposed change will increase the number of complications and deaths tied to abortion.
“We are asking midlevel providers to perform abortions with little to no physician oversight or plans for managing the complications that most certainly will develop at some point,” Kershner said. “This risk would not be acceptable for any other procedure.”
The committee will hold a work session on the bill on a future date.
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