Context: California's Reproductive Health Privacy Act, which became law in January 2003, clarified that advanced practice clinicians could legally provide medical abortion. Little is known about the characteristics associated with nonphysician clinicians' interest in receiving medical abortion training or their perceptions of barriers to medical abortion provision.
Methods: In early 2003, a total of 1,176 licensed advanced practice clinicians in California-nurse practitioners, physician assistants and certified nurse-midwives-completed a mail-in survey assessing their personal characteristics, beliefs and clinical practices. Weighted univariate and bivariate analyses were conducted to describe the respondents, their interest in receiving medical abortion training and their perceptions of barriers to providing such care.
Results: One-quarter of respondents desired training in medical abortion. A higher proportion of nurse-midwives than of nurse practitioners or physician assistants desired training (42% vs. 24% and 23%, respectively). The proportion of respondents desiring training also was elevated among clinicians who have prochoice attitudes, those who are familiar with medical abortion and those who spend at least one-third of their time providing care to women of reproductive age. Lack of training opportunities, legal uncertainties and clinical facility constraints were the most frequently reported perceived barriers to provision of medical abortion.
Conclusions: Considerable proportions of advanced practice clinicians-especially of nurse-midwives-may be interested in receiving medical abortion training. Perceived barriers to providing medical abortion are amenable to change. Policies and programs are needed to ensure that interested, committed clinicians can overcome barriers to providing medical abortion for their patients.