When July arrives and nurses are permitted by state law to perform abortion procedures, the first will be trained and ready.
That’s a pledge from Dr. Kyle Bukowski, chief medical officer of Planned Parenthood of Maryland.
“July 1 will be a game changer,” he said. “Our biggest focus, once we get initial providers ready, is to think about how we can further expand access.”
It will, Bukowski and others acknowledge, be a big lift to stand up a new workforce of nurse practitioners, midwives and physician assistants who are equipped to perform abortions for Marylanders and for women who can’t access the procedure where they live.
The providers say they feel a sense of urgency since a draft of a U.S. Supreme Court order that would overturn Roe v. Wade was leaked Monday. If the 50-year-old precedent is reversed, an estimated 26 states are expected to ban or restrict the procedure.
The planning has begun across Maryland in about 20 reproductive health care clinics and in schools of nursing that expect to offer training. The result could be significantly more providers available, as well as enhanced services to aid women who need to travel to the state, and expanded fundraising to pay for their visits and associated costs, such as lodging and child care.
Also in the works are more telehealth services, in which providers can prescribe medication abortions. Expanded telehealth gained authorization during the coronavirus pandemic and quickly became popular. More than half of abortions nationwide now begin with pills, according to the Guttmacher Institute, an abortion-rights research group.
Providers and legal experts say all the details and legal barriers will have to be worked out along the way, and as they arise.
Bukowski said the initial push by advocates to expand access in Maryland came in December, after the Supreme Court held arguments over a Mississippi law challenging Roe v. Wade. Providers turned to the state General Assembly, and by April, Democratic lawmakers had passed a law allowing nonphysicians to perform early abortions, as well as requiring insurance coverage for the procedure, and overrode Republican Gov. Larry Hogan’s veto.
The law directs the state to designate a nonprofit organization to set up training programs in at least two community-based sites and allocates $3.5 million in the next fiscal year, more than a year away. Hogan has since said he will not release the funding early because he believes “non-licensed physicians should not be performing these medical procedures,” according to his spokesman, Mike Ricci, referring to licensed nurses and physician assistants.
Anti-abortion organizations also have decried the use of taxpayer dollars to expand the number of abortion providers in the state rather than for things like prenatal care.
Planned Parenthood said it will do its training in-house for now, tapping doctors as instructors.
Johns Hopkins School of Nursing plans to incorporate training for abortion procedures into its curriculum for nurse practitioners. That could be a seminar or workshop or other instruction, followed by some practice, said Erin Wright, an assistant professor working on the effort.
Wright plans to get the training herself, if possible, but said some nurses won’t because they, like a significant portion of the country, oppose abortion on religious or moral grounds.
Wright delivers babies as a nurse midwife at Johns Hopkins Bayview Medical Center. The East Baltimore hospital is among a small number in the state, and in states so far south in the country, that perform late second-trimester abortions in some circumstances, which she said normally means the fetus is abnormal or not expected survive long after birth.
Maryland law allows abortions after fetal viability, about 24 weeks into a pregnancy, only if the patient’s life or health is endangered or there is a fetal anomaly.
Generally, Wright said, the training for early, nonsurgical abortions for nonphysicians would be fairly simple, especially for those already on the job at a clinic. There will not be any official certification, but nurses will have to show competency. After some instruction, the nurses will watch doctors perform the procedures and then they will be watched as they do them. After some paperwork attesting to the training, the facility will permit them to do the work.
“It could literally be an on-the-job situation, like training for IUD insertion, which is how physicians learn such things, as well,” Wright said.
Still, she said there is not enough time for doctors to train nurses while working.
Hopkins also has no timeline to add its training, and Wright wasn’t sure it would be available to nurses already practicing.
Carafem, which operates a clinic in Chevy Chase, has not started training nonphysicians yet. That’s because doctors are working to meet demand for abortions from Marylanders and people traveling from such states as Alabama, Texas and West Virginia, said Melissa Grant, the clinic’s chief operations officer.
“Some people are choosing to fly from Texas into communities where they can be seen relatively quickly,” said Grant, also a co-founder of carafem, which operates in several states. “And Maryland’s laws are such that there’s no waiting period, so people can come in and have an abortion done all in one visit.”
Grant said state funding for an off-site training program would be useful because otherwise it would mean one-on-one training in house over time and that could impact the clinic’s ability to see patients.
Carafem also is bolstering its telehealth capabilities to relieve the burden on its clinics. Doctors and nurses in Maryland already can prescribe medication abortions this way, and an expansion could benefit out-of-state travelers and women in more rural Western Maryland and the Eastern Shore, where clinic access remains limited.
“We’ve seen over a 200% jump from first quarter of last year till first quarter of this year in clients wanting to receive abortion care through telemedicine,” Grant said.
Most women tapping telehealth abortion services are in Maryland. That’s because providers legally must be licensed in states where they provide care. Further, 19 states specifically ban the use of telehealth visits for abortions.
The Morning Sun
Lawyers are watching such legal steps in other states closely and expect more state-level restrictions on reproductive services if Roe is overturned. Some cases will be resolved in court.
“There will be a few immediate results, and some that come down the path weeks and months afterward,” said Leslie Meltzer Henry, a professor in the University of Maryland Francis King Carey School of Law and an expert in reproductive justice and constitutional law. “For 40 million people who live in those states who could become pregnant and are of reproductive age, they will face potentially unwanted pregnancies in states hostile to abortion rights.”
She spoke during a webinar Thursday, along with other law experts about the consequences of overturning Roe v. Wade. They said the states restricting abortions continue to propose and pass novel legislation aimed at preventing women from traveling out of state for reproductive services or gaining outside services. Some new laws already have landed in court, such as Texas’ law allowing citizens to sue anyone who performs or aids in an abortion.
Another target for legislation is the abortion pill, which the U.S. Food and Drug Administration made more readily available at pharmacies and through the mail, in addition to doctors’ offices, last year, said Robert Percival, another Maryland law professor and a former clerk for Supreme Court Justice Byron R. White, one of two dissenters in the Roe v. Wade decision.
“Will states that ban pills start searching postal shipments governed by the Postal Service under federal authority?” he asked. “This gives rise to a conflict between states and the feds. … There will be endless battles over federalism as the Biden administration tries to make abortion more available.”
Though Hogan opposed the move to allow nonphysicians to perform abortion, the lawyers said it’s clear which side of the divide Maryland will be on going forward.
“In Maryland, the state can’t intervene in the decision to have an abortion before the fetus is viable or any time it’s deemed necessary to save the woman’s life,” or there are fetal deformities, Henry said. “For Marylanders, this means we are in a very different place than most people in the country.”