The Hawaii Legislature is considering a bill that would expand access to abortions by permitting advanced practice nurses to do the procedure in addition to physicians.
House Bill 576, which was passed by the House Consumer Protection Committee Wednesday, would authorize advanced nurse practitioners to perform aspiration abortions — a procedure that involves suction to terminate an early pregnancy.
If passed, Hawaii would join a dozen other states that permit certain licensed providers to perform early in-clinic abortions, including California, Colorado, Illinois, Maine, Montana, New Hampshire, New York, Oregon, Vermont, Virginia, Washington and Massachusetts.
Under Hawaii’s current statute, only physicians are allowed to perform aspiration abortions. Advanced practice nurses are allowed to assist patients with medication abortions, but not aspiration abortions.
The Hawaii Life Alliance, a local affiliate of the National Right To Life nonprofit organization, opposed the measure in testimony, citing concerns about patient safety and a lack of a structure to ensure parental permission for minors.
The current limit on the types of providers who can provide aspiration abortions has been a major obstacle for Hawaii women to access them, said Dr. Reni Soon, the chair of the Hawaii Section of the American College Of Obstetricians and Gynecologists.
Hawaii was the first state to codify a woman’s right to an abortion in 1970. But the number of free-standing clinics that offer abortion has dwindled since then to just three, including two on Oahu and one on Maui that offers abortions two days per month. Independent clinics, not hospitals or physician’s offices, provide the overwhelming majority of abortions in the country and have done so since abortions were legalized.
“There’s a big difference between having it legal and actually being able to access that care, and right now there is a significant proportion of our state residents who aren’t able to access that care,” Soon said.
Very few doctors on the Big Island do them, according to Soon, who is among the Oahu doctors who travel to neighbor island clinics. Women who live on Lanai, Molokai, Kauai or Niihau must travel by plane to obtain an abortion.
Limits on travel during the COVID-19 pandemic have made it more difficult for patients, Soon said.
“I have had patients concerned about quarantining and the requirements around that, and they wouldn’t be able to afford not leaving their house for two weeks when they come back home,” she said. “They never came over for that care.”
Janet Hochberg, the executive director of the Hawaii Life Alliance, testified in opposition to the bill, citing concerns about safety of the procedure if conducted by health care professionals other than physicians.
Limiting it to doctors and osteopathic surgeons “may put them at less risk for injury or serious complications,” she told Civil Beat by email.
An earlier draft of the bill had proposed adding physician assistants to the pool of providers able to perform aspiration abortions, but that provision was later eliminated.
The bill was introduced by Rep. Linda Ichiyama and four other House members. They note that the U.S. National Academies of Sciences, Engineering, and Medicine has found barring certain health care professionals from providing aspiration abortion care “confers no medical benefit and instead harms patients by limiting access to care.”
A six-year study conducted by the University of California, San Francisco found first trimester abortions had similarly safe outcomes whether performed by trained nurse practitioners, physician assistants, certified nurse midwives or doctors.
Dr. Allan Weiland, a retired obstetrician gynecologist who lives on Maui, said he is most concerned about patients who may resort to trying to terminate a pregnancy on their own.
Weiland, in his several decades as a doctor, found that wealthy women were able to access abortions, while poor women, women of color and rural women were not.
“The goal should be, every pregnancy should be a wanted pregnancy,” he said in an interview. “If there are some circumstances that make it difficult for that, then we should be able to provide people with a variety of services that meet their needs.”
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