In 2025, more than 360,000 abortions — about a third of all U.S. abortions last year — were provided by advanced practice clinicians rather than physicians, according to new data released by the Guttmacher Institute, a think tank that researches and advocates for abortion access. 

Twenty-five states and the District of Columbia allow abortions to be provided by health providers who are advanced practice clinicians, a category that includes physician associates, advanced practice registered nurses, nurse practitioners, certified midwives and certified nurse midwives. 

The new findings show that abortions provided by advanced practice clinicians – which included both procedures and those by pill – accounted for nearly a third of all abortions nationwide last year, not counting self-managed abortions or those obtained outside the formal medical system. The organization says these types of providers fill a crucial access need at a time of OB-GYN shortages and more than a dozen state abortion bans. 

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“These data help to illustrate the critical role that (advanced-practice clinicians) play in providing abortions across the country, including in many underserved communities,” said Isaac Maddow-Zimet, Guttmacher data scientist and study lead, in a written statement. He added that such providers also provide counseling and follow-up care “even in states where they are not permitted to provide direct abortion services.” 

Whether advanced practice clinicians can provide abortions varies by state laws and regulations, with many states limiting the types they can provide to aspiration procedures in the first trimester or pills. Twenty-five states and the District of Columbia allow at least some nonphysician occupations to provide abortions. The states include: Alaska, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Rhode Island, Vermont, Virginia and Washington.

Arizona, Pennsylvania and Wisconsin could also consider allowing those providers to offer abortions after Democrats won trifectas in this month’s midterm elections and promised to expand abortion access. 

The American College of Obstetricians and Gynecologists recommends allowing advanced practice clinicians to provide abortions, saying in an issue brief that restricting abortion care provision to only physicians or board-certified OB-GYNs “are not based in science; improperly regulate medical practice; and impede patients’ access to quality, evidence-based health care.” 

In 2016, the U.S. Food and Drug Administration changed the guidelines around the abortion drug mifepristone, permitting advanced practice clinicians such as midwives to prescribe mifepristone.  

In the years since Roe v. Wade was overturned, several states, including Alaska, Michigan, North Carolina and Ohio, have struck down physician-only abortion laws.

An ongoing lawsuit brought by nurses and midwives in Arizona challenges laws barring them from providing abortion, saying they violate the state’s constitutional amendment enshrining abortion rights passed in 2024. 

After striking down many of Missouri’s abortion restrictions earlier this year, a judge upheld that state’s physician-only law, noting the difference in training for different types of abortions.

Stateline reporter Sofia Resnick can be reached at sresnick@stateline.org.

Nurses at St. Mary’s Hospital in Madison have filed official charges with the National Labor Relations Board against the hospital’s parent company, SSM Health, for allegedly violating federal law by refusing to negotiate a contract with the recently established nurses’ union. 

The hospital’s nurses voted by a landslide earlier this summer to establish a union — a result that SSM fought to prevent the NLRB from recognizing. The efforts of management to prevent the union recognition were rebuffed by federal officials. 

In a news release on Tuesday, the nurses argued that hospital administration is wasting time engaging in anti-union activities when instead negotiations on a labor contract should be getting underway. 

The nurses have complained that the hospital administration has reduced staffing to unsafe levels, putting patient safety at risk. Staffing levels at St. Mary’s are the lowest of Madison’s seven hospitals. 

“SSM should be investing in staffing, support and retention of nurses, not wasting time and resources fighting our union, which is our voice to speak up for our patients,” St. Mary’s nurse Hannah Joers said in a statement released by the union. “Our number one goal is to win a contract which better takes patients’ level of sickness into account for staffing, and makes sure that we keep nurses by the bedside. SSM executives in St. Louis are abusing our empathy, making us do more and more with less and less. We’ve had enough, and the time has come to transform the system so that our patients’ needs come first. We will never back down and we are 1,000% determined to win a strong contract to provide the highest quality patient care.”