USA- Advanced practice clinicians sue for the right to provide abortions in Maine


Maine is one of 41 states that restrict abortion access by allowing only doctors to perform abortions. It’s one of the most rural states in the nation, and women must sometimes travel the entire day to end a pregnancy, including in the rough winters when travel is dangerous. Half of women in the state live in counties where abortion is not available after ten weeks of pregnancy. The American College of Obstetricians and Gynecologists and the American Public Health Association consider laws barring advanced practice clinicians from performing early abortions medically unfounded, according to a joint statement from Planned Parenthood and the ACLU.

On 20 September 2017, the American Civil Liberties Union and and Planned Parenthood filed a lawsuit challenging the state of Maine’s physician-only law for abortion. They said: “We are thrilled to be going on the offence against this harmful and medically unjustified restriction. The evidence is crystal clear that advanced practice clinicians can safely and effectively provide first-trimester abortion care – all this law does is hurt patients.”

This is the first court challenge to physician-only provision of abortion care since the landmark Supreme Court decision in 2016 in Whole Woman’s Health v. Hellerstedt, which emphasised that US states cannot burden patient access to abortion without proof of a valid medical justification.

The plaintiffs in the case are three nurse-practitioners and one nurse-midwife and two reproductive health care providers in Maine: Maine Family Planning and Planned Parenthood of Northern New England. The preliminary statement opens:


  1. Maine law gives advanced practice registered nurses (“APRNs”) broad authority to provide a wide range of health care services, including the authority to prescribe medications and perform procedures whose complexity and risks are comparable to, or greater than, those of first-trimester abortion. Yet despite the proven safety of abortion care and the proven ability of APRNs to provide such care safely and effectively, the State of Maine prohibits, under threat of criminal prosecution, anyone other than a licensed physician from providing abortion services… The State does not single out any other health care service as beyond an APRN’s scope of practice—only abortion. This restriction, which imposes severe burdens on women seeking abortions, violates federal constitutional guarantees of privacy and equal protection.


  1. APRNs are a category of registered professional nurses with advanced education and training. Encompassed within the category of APRNs are certified nurse practitioners (“nurse practitioners”) and certified nurse-midwives (“nurse-midwives”). APRNs in Maine are authorized to provide “expanded professional health care,”… reflecting their advanced skills and knowledge, ranging from delivering babies, to inserting intrauterine contraceptive devices (“IUDs”), to performing endometrial biopsies (the removal of tissue from the uterine lining). The complexity of these health care services (among many others provided by APRNs) is equal to or greater than that of first-trimester abortion, and childbirth poses far greater risks. Indeed, APRNs in Maine, including those at Plaintiffs’ clinics, can and do care for a woman experiencing a miscarriage using techniques that are identical to early abortion care…


SOURCE: Case File , 20 September 2017 ; Rewire, by Nicole Knight, 20 September 2017  ; PHOTO