1.3% (n = 152) resulted in a complication: 1.8% for NP-, CNM-, and PA-performed aspirations and 0.9% for physician-performed aspirations. The unadjusted risk difference for total complications between NP–CNM–PA and physician groups was 0.87 (95% confidence interval [CI] = 0.45, 1.29) and 0.83 (95% CI = 0.33, 1.33) in a propensity score– matched sample. Conclusions. Abortion complications were clinically equivalent between newly trained NPs, CNMs, and PAs and physicians, supporting the adoption of policies to allow these providers to perform early aspirations to expand access to abortion care. (Am J Public Health. 2013;103:454–461. doi:10.2105/AJPH.2012. 301159) RESEARCH AND PRACTICE 454 | Research and Practice | Peer Reviewed | Weitz et al. American Journal of Public Health | March 2013, Vol 103, No. 3 METHODS In 2005, study investigators applied to the California Office of Statewide Health Planning and Development (OSHPD) for a waiver of legal statutes that limit the completion of surgical abortion to physicians.26---28 Following a public meeting, hearing, and extensive input from stakeholders, the State of California granted approval for Health Workforce Pilot Project No. 171 in March 2007, followed by approval of 4 subsequent extensions. The study received institutional review board approvals from the University of California, San Francisco; Ethical and Independent Review Services; and Kaiser Permanente of Northern California (KPNC). In this prospective, observational cohort study, NPs, CNMs, and PAs from 5 partner organizations (4 Planned Parenthood affiliates and KPNC) were trained to competence in the provision of aspiration abortion (a minimum of 40 procedures over 6 clinical days, with competence assessed by an authorized physician trainer). To be qualified for training, NPs, CNMs, and PAs had to have a California professional license, basic life support certification, and 12 months or more of clinical experience, including 3 months or more experience in medication abortion provision. Physicians employed by the facility served as the comparison group. A total of 28 NPs, 5 CNMs, and 7 PAs (n = 40) and 96 physicians (with training in either family medicine or obstetrics and gynecology) completed procedures during the study period. Physicians had a mean of 14 years of experience providing abortions compared with a mean of 1.5 years among NPs, CNMs, and PAs. This analysis did not include procedures performed by NPs, CNMs, and PAs during their training phase. Patients were enrolled at 22 clinical facilities between August 2007 and August 2011. Patients were eligible for the study if they were aged 16 years or older (18 years at Planned Parenthood affiliates), were seeking a first-trimester aspiration abortion (facilities self-defined this as £ 12 or £ 14 weeks’ gestation by ultrasound), and could speak English or Spanish. Patients were excluded if they requested general anesthesia or did not meet the health-related criteria (unexplained historical, physical, or laboratory findings or known or suspected cervical or uterine abnormalities). Study Procedures Eligible patients reviewed a consent form with a facility staff member. If a patient agreed to participate, she was asked whether she was willing to have her abortion done by an NP, CNM, or PA; if so, the aspiration was performed by the NP, CNM, or PA on duty. Patients in this group were routed to a physician if clinical flow necessitated reorganizing patients. Patients were also routed to a physician if they were unwilling to have their abortions performed by an NP, CNM, or PA or arrived for care when only a physician was present. Each patient received $5 and a follow-up survey about medical problems after the abortion to capture any delayed postprocedure complications. If patients did not return the survey, clinic staff made at least 3 attempts to administer the survey by phone. If the patient experienced postabortion problems, she was asked a defined set of questions to obtain medical details. Additionally, staff conducted patient chart abstractions 2 to 4 weeks after abortion to ensure delayed complications were The state allows non-physicians to perform medication and aspiration abortions The state allows non-physicians to perform medication abortions only The state specifically prohibits NPs, CNMs, and PAs from performing abortions The state has a general physician-only law for abortion The state has no specific law regarding who can perform abortions, but other potentially legal barriers exist for non-physicians Note. CNM = certified nurse midwife; NP = nurse practitioner; PA = physician assistant. FIGURE 1—Landscape of health professional regulation of abortion provision in the United States. RESEARCH AND PRACTICE March 2013, Vol 103, No. 3 | American Journal of Public Health Weitz et al. | Peer Reviewed | Research and Practice | 455 captured. For all outcomes other than an uncomplicated recovery, an incident report was generated and reviewed by the site medical director, study investigators, and the study’s Data and Clinical Safety Monitoring Committee. Additional monitoring of outcomes and study procedures included annual Office of Statewide Health Planning and Development---sponsored site visits; quarterly reviews of participant recruitment, patient experience, and clinical outcomes; and routine communication