Montana Voices: State law unconstitutionally limits abortion access
If you are like a lot of Montanans, your primary healthcare provider is an advanced practice clinician, not a doctor. But under Montana law that same clinician may not be able to provide an abortion, a safe and common medical procedure.
The ACLU of Montana and the Center for Reproductive Rights are challenging this outdated and unconstitutional law, which puts advanced practice registered nurses (APRNs) — like our plaintiff Helen Weems — at risk of criminal prosecution for safely providing abortion care to their patients.
APRNs have a clear track record in other states of providing early abortions as safely and competently as doctors and physician assistants (PAs), and medical research uniformly confirms this. This same evidence shows that PAs can safely provide abortions, and in Montana PAs are already legally allowed to do so. In a state as large and sparsely populated as Montana, it’s common sense to expand access to abortion by also allowing APRNs to provide this much-needed healthcare service.
Abortion is basic healthcare. About one in four women in the United States will have an abortion by age 45. Access to abortion is important to allow people to plan for and ensure a better future for themselves and their families.
About 60 percent of women who have abortions already have at least one child, and most plan to have children in the future. The three most common reasons patients give for having abortions are concern for or responsibility to others; inability to afford to raise a child; or the need to work, attend school, or care for dependents.
Abortion is not only a common but also a safe procedure, with a very low risk of complications. Abortion is much safer than carrying a pregnancy to term. Major complications from abortion occur in less than one quarter of 1 percent of cases. The risk of death associated with childbirth is about 14 times higher than that associated with abortion.
Although abortion is basic healthcare, it can be hard to obtain abortion services in Montana. Montana is the fourth-largest state in the nation, and most of it is rural. Out of 56 Montana counties, 93 percent do not have an abortion provider, and 55 percent of Montana women live in those counties.
Some Montanans have to travel more than 180 miles to reach an abortion clinic. Patients in some areas of rural Montana may be able to obtain medication abortions (an abortion involving pills alone) locally, but they still face long travel distances if they need a different method of abortion or an abortion after 10 weeks of pregnancy, or if follow-up care is indicated.
Allowing APRNs — which include certified nurse practitioners and certified nurse midwives — to provide abortions would increase access to safe abortion care in Montana. Advanced practice clinicians (APCs) are often Montanans’ primary healthcare providers, especially in underserved areas. Yet currently, the only APCs who can legally provide abortions in Montana are physician assistants.
The evidence is crystal clear that APRNs can safely perform abortions in the first trimester, when nearly 90 percent of abortions in the United States take place. Leading medical and public health authorities (including the FDA) agree on this point. APRNs already provide procedures comparable to or riskier than early abortion, such as endometrial biopsies or dilation and curettage for management of miscarriage. Allowing these qualified healthcare providers to perform abortions would integrate abortion into primary care and expand access across Montana.
Allowing APRNs to provide abortions is not just good public policy, it’s constitutionally required. Two decades ago, the Montana Supreme Court ruled that Montana could not prohibit physician assistants from providing abortions. The resulting change in the law has expanded abortion access in Montana without compromising safety. Indeed, women are safer when they can access abortion without unnecessary delays.
The Supreme Court’s reasoning applies equally to APRNs, who are no less qualified to provide safe abortion care. Our lawsuit aims to correct this nonsensical and harmful disparity in Montana’s abortion law, so that APRNs can provide this essential healthcare service and help ease the considerable burdens Montanans face accessing abortion in our state.
Caitlin Borgmann is the executive director of the ACLU of Montana and an expert in reproductive rights law.