For any professor or professional researcher, it can often take months or years to see the seeds of a research project bear fruit. For UC Hastings Professor Jennifer Dunn, the passage of California’s new law AB154, which went into effect January 1, 2014, marked the end of a nine-year “gestation period” of her work coming to fruition.
Nine years ago, when Professor Dunn was the Director of the Access through Primary Care Initiative at UCSF’s Advancing New Standards in Reproductive Health, she worked on a study that evaluated the safety and acceptability of nurse practitioners (NPs), certified nurse-midwives (CNMs) and physician assistants (PAs) in providing aspiration abortion. Even embarking on the study required a legal waiver so that UCSF could conduct the research. “I was responsible for working with the study sites and seeking and obtaining a legal waiver of California’s physician-only abortion restriction so that we could start the study,” Dunn explained.
The Principal Investigators on the study were Tracy Weitz, PhD, MPA (UCSF School of Medicine) and Diana Taylor, PhD, NP (UCSF School of Nursing). The 2013 study results demonstrated that NPs, PAs and CNMs could safely provide first trimester aspiration abortion.
Professor Dunn then used the findings from the study as the basis for a law review article, published in June 2013 in the UCLA Law Review, entitled “After the Choice: Challenging California’s Physician-Only Abortion Restriction.” The article argues that the physician-only restriction is an unconstitutional violation of the right to choose and disproportionately affected women in rural areas.
Based on the study and its findings, Assemblywoman Toni Atkins introduced AB154, which allows medical professionals other than physicians to perform abortions. The California legislature passed the bill in October 2013, making California the only state to pass a law increasing access to abortions in 2013 and implicitly validating Professor Dunn’s published work. The law went into effect on January 1, 2014.
“The project was started by an interdisciplinary group at UCSF – faculty and researchers from nursing, medicine and law,” Dunn noted. “It is an amazing example of what can be accomplished with cross-discipline collaboration.”
Abstract from Professor Dunn’s article “After the Choice: Challenging California’s Physician-Only Abortion Restriction”
Women in California have the right to abortion protected by statute and the state constitution. Yet for many women, the “right” to abortion is illusory. Most clinics and hospitals that provide abortions are concentrated in urban areas, leaving many counties without a single abortion provider. Practical barriers to access are compounded by California’s sheer size and geography, resulting in provider shortages and delays in care outside major urban areas.
This access problem is exacerbated by California’s physician-only abortion restriction, which prohibits qualified, licensed health professionals from providing aspiration abortion (commonly referred to as surgical abortion), the most common procedure for terminating a pregnancy in the first trimester. Numerous studies demonstrate that early aspiration abortions are as safe when performed by nurse practitioners (NPs), physician assistants (PAs), and certified nurse-midwives (CNMs) as when performed by physicians. Yet under California’s Business and Professions Code, only physicians can perform this procedure.
This Article challenges the constitutionality of California’s physician-only abortion restriction under the state constitution and argues that the state has no compelling interest in restricting trained and competent clinicians from providing aspiration abortions. Looking at a successful state constitutional challenge to a physician-only abortion restriction in Montana as a model, the Article argues that using California’s state constitution to challenge the physician-only abortion restriction could be an effective approach for improving access to abortion. Further, the strategy outlined in this Article could be used to challenge similar abortion restrictions in other states that have strong state protection for the right to privacy.
About Professor Jennifer Dunn
Professor Dunn teaches courses at the intersection of health sciences and law. Licensed in California and New York, Professor Dunn began her legal career at a plaintiffs' class action law firm where she litigated health care and civil rights cases in state and federal courts throughout the country.
Professor Dunn’s research, writing and advocacy focuses on women’s health and reproductive justice. She is a frequent guest lecturer at medical and health sciences conferences and grand rounds. Her recent article, After the Choice: Challenging California’s Physician-Only Abortion Restriction was published in the UCLA Law Review Discourse in June 2013. Her collaborative study with UCSF’s Schools of Nursing and Medicine, which looked at hospital bans on vaginal birth after cesarean (VBAC) and the impact on access in California, was published in BioMed Central Pregnancy and Childbirth in early 2013. Professor Dunn’s first book, Abortion in California: A Medical-Legal Handbook, was co-authored with UCSF faculty and serves as a resource for clinics and hospitals throughout California.
Professor Dunn served as the Acting Assistant Dean of the Graduate Division at UC Hastings in 2012-2013 and previously served as the Executive Director of the UCSF/UC Hastings Consortium on Law, Science & Health Policy. Before joining UC Hastings in 2009, she spent four years as the Director of UCSF’s Access through Primary Care Initiative and the Law & Policy Advisor for Advancing New Standards in Reproductive Health, a collaborative research group and “think tank” at the University of California, San Francisco. She has taught women’s health and reproductive justice at UC Hastings and UC Berkeley Law.