California is starting a reproductive health corps to increase abortion access across the state

When Bethany Golden arrived at the Yale School of Nursing in 2000 for her master’s degree in nurse midwifery, she was eager to get started.

“The first thing I asked was, ‘when are we going to learn how to do abortions?’” she said. “I was shocked to hear, ‘well, you won't.’”

Twenty-three years later, Golden said nursing programs and medical schools across the country still don’t give students robust, clinical education on how to perform abortions. Instead, physicians, nurses, and other members of primary care teams must pursue additional education on their own or learn on the job. 

This approach has led to a dearth of providers, even in California, where 40% of counties don’t have a single abortion provider, according to the Guttmacher Institute.  

“For a procedure that we know that is very safe and effective, it's been treated as if it's sort of a specialty care,” Golden said.

Now, she's part of a team of providers in California who want to give the next generation what they didn’t have. The group’s aim is to develop a Reproductive Health Service Corps and Golden is helping to lead the charge at TEACH, Training in Early Abortion for Comprehensive Healthcare, one of six organizations chosen to build up their reproductive care training programs over the next four years.

The initiative began after a law passed in 2022 requiring the development of such a corps. From there, the state allocated $20 million to develop pathways, plus an additional $20 million to financially aid students who sign on to practice in underserved communities. 

The launching of the new effort coincides with an increased demand from out of state. Data collected from abortion providers since Roe v. Wade was overturned in June 2022 shows California is performing an average of 734 more abortions per month than it was in the months before the Dobbs decision.  

Catching up with the need

For the past decade, the number of health care professionals who are allowed to perform  abortions has grown as California has worked to expand access to the procedure. 

In 2013, nurse practitioners, certified nurse-midwives and physicians’ assistants got authorization to perform first trimester abortions under a physicians’ supervision. More recently, California passed laws allowing those professionals to perform the procedures on their own.

But a bottleneck has persisted when it comes to training people to undertake those procedures, even as more people come into California to get care. Golden said it’s crucial to get people to clinical opportunities, like those available for births. 

“There were never the same amount of clinical opportunities with abortion where you would come out of school feeling ready to practice,” she said.

In addition to TEACH, programs are also being developed at UC San Francisco’s Black Midwifery Fellowship, the Abortion Care Training Incubator for Outstanding Nurse Scholars and Primary Care Advanced Practice Nursing Specialties at the UCSF School of Nursing. 

California State University East Bay’s Department of Nursing and Nurses for Sexual & Reproductive Health will also be building up programs for new and existing nurses. 

Sarah Nathan is a faculty member at UCSF’s School of Nursing, which will start its fellowship program in Fall 2024. 

“People who are really interested in sexual reproductive healthcare have been asking for this for a long time,” she said. “They view it as part of regular primary care.”

Nathan said the program at UCSF will teach about 70 students over the course of four years — 50 nursing school students and 20 already-practicing nurse practitioners and nurse midwives. Nathan said a website with more information for prospective students will be launching in spring 2024. 

That website will also include information about signing up to serve in communities where abortion access is limited. People who do so can receive scholarships and student loan repayment. 

Ultimately, the consortium’s goal is to make it so that people seeking abortions don’t have to undergo hardship in order to get the procedure: they can work with a practitioner who they have a relationship with, who speaks their language or looks like them. 

“If we are able to offer that service as a normal part of reproductive health care in all the settings where people seek it, then they can stay in the community,” said Golden.