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Democratic states across the country are embarking on a pioneering effort to increase access to abortion by teaching people who are not doctors to offer and perform the procedure.
In Washington state, a first-of-its-kind pilot program called the Pharmacist Abortion Access Project announced this week that it trained 10 pharmacists to prescribe abortion pills; so far, they have prescribed abortions to 43 people.
With Roe v Wade gone and abortion now all but eliminated in a dozen or so states, the project is the latest attempt to expand access to the procedure in the parts of the country that still allow it. Connecticut and Delaware have in recent years passed legislation to permit physician assistants, midwives and some nurses to perform abortions, while Oregon, Maryland and Illinois are now devoting millions of state dollars to programs that train similar professions in the procedure.
“Even in Washington state, where abortion is legal, people are facing barriers to accessing abortion care – especially people who are struggling to make ends meet, who live in rural areas or don’t have easy access to reproductive health care,” said Beth Rivin, the Pharmacist Abortion Access Project’s managing director and president of Uplift International, which partnered with the online pharmacy Honeybee Health to dispense the abortion pills. “This expands abortion access by bringing a new profession into abortion provision.”
Of the states that still allow abortions, 14 say that only physicians may perform the procedure, according to a tally by the Guttmacher Institute, which tracks abortion restrictions. But in the years since the US supreme court overturned Roe in the 2022 decision Dobbs v Jackson Women’s Health Organization, physicians – already in short supply in the US – have struggled to get training in how to provide abortions.
Abortion rights supporters have long said that non-physicians should be permitted to provide abortions earlier on in pregnancy if they involve pills or simpler procedures. The American College of Obstetricians and Gynecologists, the preeminent membership organization for OB-GYNs in the US, supports allowing certified nurse-midwives, nurse practitioners and physician assistants to perform abortions, since studies have found no “significant difference” in the complication rates of medication abortions performed by doctors compared to other trained clinicians.
“Let’s free up providers who can do the complex cases to do complex cases,” said Kylea Laina Liese, assistant professor at the Department of Human Development Nursing Science at the University of Illinois. In 2024, the University of Illinois College of Nursing became one of three organizations to receive $2m from the state’s public health department to expand abortion training – money that Liese is now using to train the first cohort of physicians and non-physicians.
Midwives, nurse practitioners and physician assistants, Liese said, “are much more likely to represent the communities that they work in. That’s something that’s really missing in abortion care. Being able to have Bipoc communities get their reproductive and sexual health services from providers that look like them and that they trust – it lowers those burdens.” More than 60% of all practicing US physicians identify as white, while far smaller fractions identify as Black, Indigenous or people of color.
In addition to increasing access, advocates say, these programs can help destigmatize abortion by moving it out of the silo of specialized abortion providers and clinics. In Maryland, where the state health department has awarded more than $10m to the University of Maryland to train new abortion providers, the program is also looking to teach emergency room doctors and pediatricians – the kind of specialties that don’t typically offer abortion training.
“My dream for all primary care is: you see someone has a positive pregnancy test, you tell them they have a positive pregnancy test, and then you’re able to offer them any option that they choose,” said Jessica Lee, an associate professor of medicine at the University of Maryland School of Medicine who is helping run the program.
Don Downing, co-director of the Pharmacist Abortion Access Project and a professor emeritus of pharmacy at the University of Washington, was surprised by how many patients and pharmacists were interested in the project.
“I really thought, about two or three years ago, that we might have difficulty finding pharmacists who are willing to prescribe a medication abortion,” Downing said. “Well, it turns out the pharmacists were as upset as I was with the Dobbs decision, and we got our 10 pharmacists – we wanted to keep it small – in very quick order.”
Pharmacists’ ability to prescribe medication varies from state to state. In Washington state, the Pharmacist Abortion Access Project takes advantage of decades-old law, which authorizes pharmacists to prescribe drugs. Recent changes in the Food and Drug Administration’s regulation of the common abortion pill mifepristone also expanded the types of providers who can prescribe and dispense the drug to include certified non-physicians.
But those changes could prove to be short lived. Shortly after Roe fell, anti-abortion activists filed a lawsuit asking a court to roll back the FDA’s 2000 approval of mifepristone. That case ultimately reached the US supreme court last year, which unanimously ruled to preserve access to mifepristone – but did so on technical grounds, leaving the door open for further attacks on the drug. That lawsuit is now continuing in a lower court. Abortion pills now account for roughly two-thirds of all US abortions.
There is also the prospect of narrower rollbacks. The incoming Trump administration could reverse more recent changes to mifepristone’s regulation – including changes that have enabled pharmacists to prescribe the drug.
“It’s pretty frightening,” Downing said. “It’d be like saying pharmacists can’t provide flu shots anymore or Covid shots.”
If those rollbacks happen, Liese and Lee said that their states’ respective programs would focus on teaching providers how to offer surgical abortions as well as medication abortions that only use the drug misoprostol (which is safe but can lead to more complications).
Whatever happens, Rivin hopes that other blue states will try to replicate the Pharmacist Abortion Access Project. In New York – which already permits some non-doctors, such as physician assistants and nurse practitioners, to perform abortions – lawmakers introduced a bill that would effectively allow pharmacists to administer abortion pills. That bill stalled, but a similar measure has already been introduced this year. Legislators have also introduced a bill to create a state training program for abortion providers.
“Our model is definitely a model that those states might be interested in. It’s more important than ever in 2025 and for the next few years,” Rivin said. “So we’re encouraging leaders in those states to get in touch with us.”
