Development. We are grateful for the work of the partner organization principal investigators: Mary Gatter, MD, Katharine Sheehan, MD, Dick Fischer, MD, Debbie Postlethwaite, NP, MPH, and Amanda Calhoun, MD. Additional gratitude is extended to two former University of California, San Francisco (UCSF)-based research managers, Deborah Karasek, MPH, and Kristin Nobel, MPH; UCSF-based project manager Patricia Anderson, MPH; former UCSFbased legal team Jennifer Dunn, JD, and Erin Schultz, JD; clinical education consultant Amy Levi, PhD, CNM; statistical consultant John Boscardin, PhD, through the UCSF Clinical and Translational Science Institute; health regulation consultant Barbara Safriet, JD; and the sitespecific research coordinators. Finally, Maureen Paul, MD, MPH, and Suzan Goodman, MD, MPH, were instrumental in the early design of this project. Human Participant Protection Study protocol and procedures received institutional review board approvals from the University of California, San Francisco; Ethical and Independent Review Services; and Kaiser Permanente of Northern California. References 1. Jones RK, Zolna MR, Henshaw SK, Finer LB. Abortion in the United States: incidence and access to services, 2005. Perspect Sex Reprod Health. 2008;40(1): 6---16. 2. Jones RK, Kooistra K. Abortion incidence and access to services in the United States, 2008. Perspect Sex Reprod Health. 2011;43(1):41---50. 3. Drey EA, Foster DG, Jackson RA, Lee SJ, Cardenas LH, Darney PD. Risk factors associated with presenting for abortion in the second trimester. Obstet Gynecol. 2006;107(1):128---135. 4. Bartlett LA, Berg CJ, Shulman HB, et al. Risk factors for legal induced abortion-related mortality in the United States. Obstet Gynecol. 2004;103(4): 729---737. 5. Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM. Regulation: Policy Considerations for the 21st Century. San Francisco, CA: Pew Health Professions Commission; 1995. 16. Roe v Wade, 410 U.S. 113, 149 (1973). 17. Connecticut v Menillo, 423 U.S. 9 (1975). 18. Mazurek v Armstrong, 520 U.S. 968 (1997). 19. Burke DM, ed. Defending Life 2010: Proven Strategies for a Pro-Life America: A State-by-State Legal Guide to Abortion, Bioethics, and the End of Life. Washington, DC: Americans United for Life; 2010. 20. Rough G. Planned Parenthood to end abortions at 7 Arizona sites. Arizona Republic. August 19, 2011. Available atarticles/2011/08/18/20110818arizona-plannedparenthood-ends-abortion-3-cities.html. Accessed December 21, 2012. 21. Freedman MA, Jillson DA, Coffin RR, Novick LF. Comparison of complication rates in first trimester abortions performed by physician assistants and physicians. Am J Public Health. 1986;76(5):550--- 554. 22. Goldman MB, Occhiuto JS, Peterson LE, Zapka JG, Palmer RH. Physician assistants as providers of surgically induced abortion services. Am J Public Health. 2004; 94(8):1352---1357. 23. Warriner IK, Meirik O, Hoffman M, et al. Rates of complication in first-trimester manual vacuum aspiration abortion done by doctors and mid-level providers in South Africa and Vietnam: a randomised controlled equivalence trial. Lancet. 2006;368 (9551):1965---1972. 24. Jejeebhoy SJ, Kalyanwala S, Zavier AJ, et al. Can nurses perform manual vacuum aspiration (MVA) as safely and effectively as physicians? Evidence from India. Contraception. 2011;84(6): 615---621. 25. Weitz TA, Foster A, Ellertson C, Grossman D, Stewart FH. “Medical” and “surgical” abortion: rethinking the modifiers. Contraception. 2004;69(1): 77---78. 26. Cal Code of Regulations §1399.5411. 27. Cal Code §75043. 28. Cal Business Professions Code §2253. 29. Chan IS. Proving non-inferiori Position Statement Midwives’ Provision of Abortion-Related Services Background Unsafe abortioni is one of the five major causes of maternal mortality. Global, regional and national agencies have set goals and guidance for reducing high maternal mortality in general and abortion-related maternal mortality and morbidity in particular. Governments agree that ‘[…] in circumstances where abortion is not against the law health systems should train and equip health providers to provide safe services [….]’. Reportsii indicate that globally, 94% of women live in countries where abortion is legally permitted for one or more indications. Evidence demonstrates that access to safe abortion-related services can almost eliminate maternal deaths due to unsafe abortion.iii Recent global guidance includes abortion care as an essential element of basic reproductive health services and a means of reducing maternal mortality and morbidityiv vvivii Realising that authorised and well-educated midwives can provide competent and safe abortion-related servicesviii ix x ximany governments have modified their laws and policies to empower midwives to provide comprehensive abortion services. In some parts of the world maternal mortality rates are at critical levels. Abortion related mortality can be 60 times higher in low versus high resource countriesxii . Position ICM affirms that a woman who seeks or requires abortion-related services is entitled to be provided with such services by midwives. In keeping with the above midwives should: · Consider such care to be within the role of the midwife as defined by the laws and policies of his/her country · Recognise the woman’s right to decide for herself and provide information,