As proposals to tighten abortion laws work their way through statehouses across the country, California lawmakers are set to consider legislation aimed at giving more women access to first-term pregnancy terminations.
The California bill, by Sen. Christine Kehoe, D-San Diego, would allow nurse practitioners, physicians assistants and certified nurse midwives to perform a procedure known as "aspiration" abortion, which employs a suction method to remove a fetus from a uterus.
The push, which would make the state the fifth to allow non-doctors to perform the procedure, comes as debate over abortion and reproductive health issues, including birth control coverage, heats up across the nation.
Legislation to require ultrasounds and a mandatory waiting period for most women seeking abortions was signed into law this week in Virginia, one of at least a half-dozen states where attempts to tighten abortion laws have made headlines this year.
Texas has also begun requiring sonograms. Oklahoma is considering defining the start of "personhood" at conception. Kansas lawmakers may ban the use of taxpayer money for abortion.
A record-setting 92 measures restricting abortion were enacted across the country in 2011, according to the Guttmacher Institute, a think tank that supports reproductive rights.
But California's debate is moving in the opposite direction.
The state has long been stalwart in favor of abortion rights. A survey released this week by the Public Policy Institute of California found 68 percent of adults believe the government should not restrict access to abortion.
"We are a Democratic state, we've got a very substantial bloc of independent voters who tend to be liberal on social issues. And then among Republicans we don't have as strong an orientation around religious social values as we've seen in other states," PPIC President and CEO Mark Baldassare said.
Kehoe's Senate Bill 1501 is likely to win passage in the Democratic-controlled Legislature. Gov. Jerry Brown has yet to take a position.
Supporters say the change in law would ensure women who want to terminate a pregnancy can get the procedure in a safe and timely manner, even if there isn't a doctor who provides abortions in their community.
"We want to make sure that we can remove as many barriers as possible for women for this safe medical procedure," said Planned Parenthood Affiliates of California President Kathy Kneer, whose organization is a co-sponsor of the bill.
Religious and conservatives groups, including the California Catholic Conference, have come out in opposition.
SaveCalifornia.com President Randy Thomasson said the change "will kill more human beings in the womb and out of the womb by lowering the standards on abortion."
"What do they want to do next, do antiseptic coat hangers?" he said. "It's the wrong direction for safety (and) it's the wrong direction for protecting people's lives."
State law has allowed providers covered by the bill to administer medication that causes an abortion since 2002. The abortion pill can be administered until nine weeks into a pregnancy, while the aspiration abortions can be performed at any time in the first trimester, which ends around the 12-week mark.
Supporters say those extra weeks can be crucial, particularly for women who live in rural or low-income communities and have limited access to doctors who perform abortions.
"The early access is a key part of the procedure being safe," Kehoe said. "If the woman has to travel to see a doctor weeks and weeks can go by before some women are able to make these arrangements."
Critics say the lack of doctors who perform the procedure is a reflection of a growing consensus that abortion is wrong, a sentiment they say is reflected in the legislation introduced in other states.
"If it was OK, the country would have accepted it," said National Right to Life President Carol Tobias. "There's always been an underlying uncomfortableness, and I think that's just coming more to the front now."
The legislation was modeled after a pilot program run out of the UC San Francisco Bixby Center for Global Reproductive Health that allows providers covered under the bill to perform the procedure as part of a study. The waiver for the program, which began in 2007, expires later this year. Supporters say its findings show the change is just as safe and often preferred by patients.
"They would tell us that they really appreciated being able to stay in the facilities where they were used to being seen and they really appreciated being able to see the clinicians that they knew," said Tracy Weitz, the UCSF associate professor who served as lead researcher.
Assemblywoman Linda Halderman, a surgeon who has tracked the project, said a review of the raw data left her with concerns about patient safety.
"To me, I think what we're doing here is not an issue of anything but patient safety at this point," said the Fresno Republican, who opposes abortion for religious reasons. "We cannot say that we are not endangering women through this experimental process."
Halderman, who specialized in breast cancer surgery, said she worries that providers covered in the bill will not have proper training or expertise to deal with potentially fatal complications such as perforation.
Weitz countered that "clinicians are trained to manage the kinds of complications that happen in first-trimester outpatient abortions."
She said an analysis of about 15,000 patients receiving treatment from physicians and clinicians at 22 sites found that serious complications are "incredibly rare."
Some leading players in the medical community are still on the sidelines.
The California Medical Association and the regional arm of the American Congress of Obstetricians and Gynecologists are not expected to take a position until late this month. The California lobbyist for the OBGYN association expressed concern that any change in policy would be "premature," because some findings from the UCSF study are still being analyzed.