Abortion capacity in Colorado could increase with clinicians in advanced practice, more telehealth
As abortion rights activists in Colorado brace for a potential influx of patients entering the state following the planned overturning of Roe v. Wade, they are strategizing on how to increase the number of qualified abortion providers to meet demand and not compromise the care of Colorado residents.
“I don’t see any state that has safe access to abortion that can meet that demand with the current workforce. We’re talking about an incredible number of people of childbearing age who will be living in states with no access to abortion,” said Dr. Kristina Tocce, OB-GYN and Vice President and Medical Director of Planned Parenthood of the Rocky Mountains. .
“Every state with secure access will be called upon to meet an unmet need.”
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A draft opinion leaked this month shows the U.S. Supreme Court is set to overturn landmark Roe v. Wade, leaving abortion policy to the initiative of the states. Since Colorado now has reproductive health care, including the right to abortion, enshrined in state law, the state could become an abortion care access island as states surrounding areas are trying to adopt restrictions.
Wyoming and Utah both have so-called trigger laws on the books that will effectively ban abortion if Roe v. Wade is canceled. Oklahoma’s governor recently signed a six-week ban into law, following the controversial Texas measure, SB 8, which went into effect last year.
The experience following the Texas ban could foreshadow what Colorado can expect as neighboring states strive to ban abortion.
“Our volume has increased dramatically in the first month or so since implementing SB 8. We’ve seen a huge spike in our requests from people, especially from Texas. That volume continues to hold up,” Amanda said. Carlson, director of the abortion fund for Cobalt, a nonprofit organization dedicated to abortion access in Colorado.
An increase in non-resident abortion patients, many of whom may be further along in their gestation period due to travel and logistical delays, could create strain on the network of abortion providers.
“We know that if we encounter a shortage of providers in Colorado, there will be impacts both for people who travel to Colorado and for people who live in Colorado and need abortion care. I think the biggest concern for us is that people will inevitably be pushed much later in their pregnancy before they can access the care they need. Typically, when a person cannot access abortion care when they want it and are pushed later in their pregnancy, it can significantly increase financial costs and emotional burdens,” said Gina Martínez Valentin, director of the Colorado Doula Project, in a statement. statement sent by email. The organization provides practical, logistical and financial support to patients.
In 2021, 13.6% of the 11,580 people who had abortions in Colorado were from out of state, with high numbers from Texas and Wyoming, according to Vital Statistics from the Department of Health. Colorado Public Health and Environment. This share has steadily increased since 2017, when the first public data became available.
“We’re going to need more staff,” Carlson said. “We are facing this national crisis where receiving states are inundated and understaffed.”
“Just because abortion is legal somewhere doesn’t mean it’s accessible,” she said.
A May 9 meeting hosted by Cobalt among abortion providers gave them the opportunity to connect and begin laying the groundwork to meet the anticipated need.
Experts say an out-of-state flow of patients in a post-Roe world will require coordination and innovative problem-solving.
“One of our main focuses is how private providers can relieve some of the overwhelm and stress of some of the larger organizations that attend to many second trimester abortions for patients who travel out of state” , said Dr. Sarah Peterson. , an OB-GYN that offers abortions in the Denver metro area.
The clinic where she works tries to block time, for example, for patients who call at the last minute and need timely care. They are also working on communication strategies with larger organizations to let them know they are available to share the load. Currently, Peterson said she sees between two and 10 abortion patients a month.
Advanced practice clinicians, an untapped group
One strategy to increase the pool of providers in Colorado is to recruit more advanced practice clinicians — professionals such as nurse practitioners, certified nurse midwives, and physician assistants — to begin practicing abortion care.
APCs already use skills and provide care that is extremely similar to what is needed during an abortion, such as endometrial biopsies, ultrasounds, and IUD insertion. Their scope of practice may also include miscarriage management.
“Essentially, miscarriage management and abortions are the same skill set. We are trained in this and have experience providing this care,” said Kate Coleman-Minahan, assistant professor at the College of Science. nurses from the University of Colorado and family nurse practitioner.
Colorado is one of the few states that does not have a law restricting abortions to physicians, which means APCs can provide them largely without restriction. Maryland is the most recent state to allow APCs to include abortions in their practice.
However, the Colorado group is unaware of this opportunity.
In a 2020 survey by Coleman-Minahan and colleagues, 12% of APCs knew they could have an abortion in Colorado. Almost 45%, however, were interested or potentially interested in medical abortion education. About 25% were interested or potentially interested in training in suctioning or the abortion procedure.
“This suggests Colorado has the provider capacity to expand access to abortion,” Coleman-Minahan said. “We’re going to need it because we’ve already seen an influx of patients leaving their state to receive essential healthcare in Colorado.”
She envisions a future where CPAs who work in urgent care facilities or family medicine practices will be able to provide abortion care, expand the pool of providers and also the geographic footprint of locations where patients can access care.
There are specialized programs to train CPAs in abortion care, such as the Training in Early Abortion for Comprehensive Healthcare, or TEACH, program in California and the Reproductive Health Access Project. No specific certificate is required for an APC to start performing abortions, so they can also learn on the job.
“I think that’s definitely a strategy that should be used, especially given the current emerging scenario,” Peterson said. “Where do we have potential suppliers? How can we better equip them in terms of comfort level and skills? »
Planned Parenthood already employs APCs.
“Using all hands on deck is definitely a strategy, and using advanced practice clinicians is definitely part of that strategic plan,” Tocce said. “Absolutely, there is tremendous interest across the abortion provider community to raise in every way possible and really call to action everyone who can contribute, and that includes advanced practice clinicians.”
Telehealth Abortion Care
Another strategy to increase provider capacity is telehealth, the use and reliability of which has increased since the COVID-19 pandemic.
A growing number of national companies, such as Carafem, Hey Jane and Choice operate in Colorado and ship abortion pills after consulting with a supplier. Just the Pill plans to expand into Colorado and operate mobile clinics starting in June, as The New Yorker reports.
The Colorado Doula Project is preparing to educate people about these self-directed abortions, as they anticipate an increase in the number of pregnant women seeking this option, Martínez Valentín said.
“Even if abortion becomes legally unsafe, it’s important people know they will still have access to safe abortion methods,” she wrote, pointing to the companies that send people approved abortion drugs. by the FDA. “As an organization, we are preparing to be able to support clients locally and remotely who choose to self-manage their abortions.”
Telehealth for abortion care has its advantages: it is convenient, private, and can provide space in clinics for patients who need procedural abortions.
“Minimizing pressure on clinics that only have a limited number of appointment slots per day is definitely something we’re working on,” Carlson said.
The strategic use of telehealth for patients who can have abortions safely without needing to attend in person “will open up the availability of physical facilities for patients who truly need them for their medical care,” said Tocce.
Planned Parenthood of the Rocky Mountains uses telehealth appointments for many of its services, including abortion care, and offered it even before the COVID-19 pandemic. Like other medical providers, it has expanded telehealth offerings in recent years out of necessity.
“A silver lining of COVID is that we now have this really robust telehealth network. It’s really been such a benefit for patients seeking abortion care,” Tocce said. “We’ve used it a lot and we plan to increase that capacity.”
While telehealth can be convenient, it also comes with unique challenges for both patients and providers. Petersen said she is open to telehealth abortion care, but the “logistical work” to get it started at her workplace is complicated. This might be a better strategy for larger organizations like Planned Parenthood and online businesses that have already developed best practices.
Patients must also travel to a state where abortion is legal in order to access abortion care via telehealth. Depending on the situation, they might need to stay overnight and might need help from an organization like Cobalt or another abortion fund for hotel and transportation costs.
Even if people in the abortion ecosystem think about the need to increase capacity and manpower, it will take time. For now, abortion is still legal nationwide, until a final Supreme Court ruling is handed down this summer.
“Scaling isn’t something that happens overnight,” Coleman-Minahan said. “It’s not just providers who are trained and ready to wait to intervene. It’s an opportunity, but it’s not something that’s going to happen instantly.”