SUMMARY POINTS

Skills

• It is valuable to identify and understand the life experiences that inform personal opinions in order to promote a non-judgmental climate for person-centered care.
• Patient-centered counseling uses a non-directive approach with active listening, open-ended questions, and accurate information about pregnancy options

Safety

• Abortion is safe and common; 30% of pregnancies end in abortion globally (WHO 2024); one in four U.S. pregnancy-capable people will have an abortion (Guttmacher 2025c).
• Procedural and medication abortion, including self-managed medication abortion, are incredibly safe when done in a timely way, at appropriate pregnancy durations, by those with the necessary skills (ACOG 2024, WHO 2024, NASEM 2018).
• Removing legal restrictions on abortion is associated with significant reductions in maternal morbidity and mortality globally. In fact, the only factors decreasing abortion safety are those decreasing access (NASEM 2018, Upadhyay 2015, White 2015).
• While restrictive laws seek to discourage abortion, individuals continue to have abortions even when it is illegal (Bearak 2020).
• Nearly half (45%) of all abortions worldwide are unsafe, and nearly all unsafe abortions (97%) occur in the Global South (WHO 2024). See Global Abortion Facts.

• People who have abortions are at no higher risk for mental health problems or post-traumatic stress disorder (PTSD) than those denied an abortion (Horvath 2017, Biggs 2016).
• People have been ending pregnancies on their own throughout history, often using herbs, either alone or with other methods, with the support of an herbalist or community healers (Chen 2023).
• The advent of abortion pills has transformed the safety and availability of abortion in the absence of a healthcare provider. Self-managed medication abortion is proven to be safe and effective (Conti 2019, Schmidt 2022).

Role

• Given how common pregnancy, abortion, and early pregnancy loss are, nearly all primary health care clinicians will treat people experiencing these issues.
• Reproductive health access and provider training may be limited by hospital mergers, religious and legal restrictions, licensure limitations on advanced practice clinicians, stigma, and lack of transparency for people seeking care and trainees (Sagar 2023, Thorne 2019, Uttley 2013).
• Advanced-practice clinicians provide first-trimester abortion care with similar safety, effectiveness, and patient acceptability as physicians in locations where abortion care is not limited to physicians (NASEM 2018, Sjöström 2017). Physician-only laws stem from the marginalization of midwives and other advanced-practice clinicians, not from evidence of lack of safety.
• If you do not provide abortion services directly, it is important to know how to refer and manage rare follow-up needs within the context of your practice setting.