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Maine Won’t Let Nurse Practitioners Perform Early Abortions, and It’s Harming Our Patients — So I’m Suing

Nurse Writing
Nurse Writing
Julie Jenkins,
Maine Family Planning
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September 21, 2017

From the time I was in college, I knew two things: I wanted to be a nurse practitioner, and I wanted to be an abortion provider. As the stepdaughter of a Maine abortion provider, and then a patient advocate at a Maine abortion clinic, I’d seen firsthand the importance of high-quality, comprehensive reproductive health care. I saw the challenges and protestors, too, but that didn’t deter me—I couldn’t imagine a more fulfilling career.

Today, I’m proud to say that I am a practicing nurse practitioner and that I had the gratifying experience of providing safe, compassionate abortion care while living in California. And now that I’m back in Maine, I provide my patients at Maine Family Planning with a range of reproductive health services, including inserting intrauterine contraceptive devices (IUDs) and performing colposcopies, which involve very similar skills as first-trimester abortion care.

I was also one of the first two nurse practitioners trained to help provide medication abortion care through Maine Family Planning’s telemedicine program, and I’ve been safely doing so since 2015. I provide every element of patient care both before and after a physician authorizes the patient, via video conference, to swallow the first of two pills that together end an early pregnancy. (The patient takes the second set of pills at home.)

But even though I safely provided abortion care in California, regularly perform procedures in Maine that are comparable to first-trimester abortion, and provide all of the in-clinic care for patients receiving a telemedicine abortion, Maine law bans me from performing abortions because I’m a nurse practitioner. As a result, I’ve been forced to send away patients in desperate situations, even though I am trained, qualified, and more than willing to provide the care they need.

Fortunately, with the help of the ACLU, I’m fighting to change that.

Our lawsuit challenges a provision in Maine law that requires abortions to be performed solely by physicians and blocks qualified nurse practitioners and nurse-midwives from doing so, despite our rigorous training and extensive clinical experience. Abortion is the only healthcare service singled out in this way.

These harms are not hypotheticals.

Medical authorities and peer-reviewed studies agree that advanced practice clinicians are qualified to provide early abortion care. In fact, advanced practice clinicians have been safely providing abortion care in states across the country — from California to Montana to Illinois to New Hampshire — for years and, in some cases, decades.

But the problem isn’t just that this law is preventing me and my colleagues from providing services that are well within our scope of practice — it’s also harming our patients.

Maine is the most rural state in the country, and the physician-only law severely restricts where and when patients can obtain an abortion. Because of this restriction, women must needlessly travel for hours — and pay for transportation, child care, and time off work that many of my low-income patients cannot afford — rather than getting care from a trained and competent provider in their own communities.

There’s a saying in Maine, reflecting our expansive geography and abysmal public transportation: “You can’t get there from here.” For some patients who need abortion care, particularly in the middle of a snowy Maine winter, that is the sad truth.

Moreover, because of this restriction, abortion care is generally only available in any given location in Maine one or two days of the week. For a patient in a low-wage job with no paid time off, or with significant childcare obligations, this is a serious problem.

These harms are not hypotheticals.

Just last month, I received a call from a patient who needed an abortion and wanted to come into Maine Family Planning’s Presque Isle clinic for care. I was there that day and ready to assist with a telemedicine abortion, but we simply could not find a doctor who was available by video conference. So even though I am qualified to provide this care, and we had the medication on site, the patient’s abortion was delayed by 14 days. To make matters worse, she had to make a five-hour round-trip to Bangor to get care. The state simply has no justification for harming Maine women in this way.

I care about this issue dearly. Time and again, my life experiences have affirmed for me that women need to be able to make our own decisions about pregnancy and parenting — and have access to health care to see those decisions through. My own journey to parenthood was a difficult one that included multiple rounds of IVF, miscarriages, and more anxious and sleepless nights than I can count. That experience only strengthened my resolve that women should be able to control our reproductive destinies, no matter what we decide.

And whatever a woman decides — to become pregnant, to continue a pregnancy, or to seek an abortion, she should have access to quality care from a provider in her community. I’m fighting to make that a reality.

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