26 June 2022
In light of Friday's release of the Supreme Court's ruling in the case of Dobbs v. Jackson Women's Health Organization, which overturned the Court's prior rulings in the landmark Roe v. Wade case and the Planned Parenthood of Southeastern PA v. Casey case and turned any and all decisions regarding access to abortion care over to the states, we wanted to provide information on current Washington State law relative to abortion access, the scope of naturopathic physicians in providing abortion care, and the efforts of the WANP to protect patient access to this essential healthcare service.
Abortion has been legal in Washington State for more than 50 years. It was legal prior to Roe v. Wade and it remains legal here despite the Dobbs ruling by the federal court. Over the past five decades, the Washington State legislature has routinely and frequently improved and strengthened access to abortion care in our state, including the most recent HB 1851, signed into law on March 17, 2022.
Current Naturopathic Scope of Practice relevant to abortion care
Understandably, we have started receiving questions about whether abortion care is within the scope of practice of naturopathic physicians licensed in Washington State. Currently, Washington State statute grants authority to terminate a pregnancy to "a physician, physician assistant, advanced registered nurse practitioner, or other health care provider acting within the provider's scope of practice" (HB 1851).
So... Is abortion care within current naturopathic scope of practice? Here is what we know:
The most commonly utilized medications in achieving medical abortion - mifepristone and misoprostol - are within naturopathic prescriptive authority in Washington State.However, mifepristone (branded as Mifeprex or Korlym and often referred to as "the abortion pill") is regulated under the U.S. Food and Drug Administration's Risk Evaluation and Mitigation Strategy (REMS) system and therefore requires specific steps by a provider prior to being allowed to prescribe or dispense. (Learn more about these requirements here.) Because of this classification, mifepristone can be difficult to locate in general pharmacies at this time. Misoprostol (brand name Cytotec) can be used on its own to induce abortion, and it tends to be more readily available.
In Clinic/Mechanical/Surgical abortion*
This is where things get grey. Despite being routinely referred to as "surgical", vacuum aspiration (also known as a "suction abortion" or "aspiration abortion") and dilation and evacuation (D&E) are both relatively minor office procedures that can be performed in an office setting (as opposed to a surgical suite). Current Washington State law does not clarify whether these procedures are considered "surgery" (which would not be in naturopathic scope of practice) or "minor office procedures" (which may be in naturopathic scope of practice). Because current statute is unclear, the WANP is working on securing an interpretation of current state law on this matter and will keep our community apprised as we learn more.
*No healthcare provider should prescribe any medication or perform any procedure without adequate training and awareness of potential adverse effects or consequences, even if such medication or medical procedure is technically within the provider's scope of practice.
Current Efforts by the WANP to preserve and protect access to reproductive options
The WANP sprang into action after the leak of the Dobbs decision nearly 2 months ago. We began reviewing state law, communicating with the Department of Health, and engaging our contract lobbyist on this issue. Efforts had already been underway by the Washington State legislature to establish our state as a "sanctuary state" for gender-affirming healthcare in response to recent laws limiting or criminalizing this care being passed in some states. When it looked likely that the Supreme Court was going to overturn Roe, the legislature begin working to add abortion care to this "sanctuary state" effort. Leaders in the reproductive choice realm predict that the demand for abortionservices in Washington will increase by more than 250% due to states to our east likely criminalizing abortion immediately or very soon. This need will likely be far greater east of the Cascades, where there are fewer clinics and providers to provide these services.
The WANP is working hard to ensure that naturopathic physicians are not left out of this conversation. We are contacting the Department of Health (through our regulatory board) and the Attorney General's Office to obtain interpretation and clarification of current statute related to in office abortion, and working with our lobbyist and legislators to strengthen language in our 2023 scope expansion bill to ensure that naturopathic physicians who want to provide abortion services (with adequate training, of course) are legally able to do so.
Continuing Education efforts
We are aware that there are many in our community who are interested in pursuing additional training to achieve competency in providing abortion care, and we intend to provide such opportunities over this next year. Watch our continuing education offerings, conferences, and seminars to find out when we are offering courses not only on abortionservices but also on manual contraception options (e.g. placing IUDs and contraceptive implants).
We cannot emphasize enough that the ONLY way we are able to provide this advocacy on behalf of our profession is through the financial support of our members. If you are a current member, we thank you from the bottom of our hearts. If you are not a current member, we hope you will join us so we can continue to fight for inclusion in this and so many other key conversations. Finally, if you have any extra funds, please consider contributing to our Political Action Campaign (PAC) Fund so that we can continue to donate to legislators who support our efforts.
In health and with great respect and appreciation for all that you do for our larger community,
~Angela Ross, ND - WANP Executive Director
Anyone who follows the Washington State Department of Health on social media has learned or been reminded in the last few days of aspects of state law that are important for us as healthcare providers to know and keep in mind when treating or counseling our patients on issues of reproductive health. Below are a list of reminders, courtesy of our state Department of Health:
- Everyone in Washington State has the legal right to choose an abortion.
- Everyone in Washington State has the legal right to decide to have a child.
- No one can make reproductive choices for someone else in Washington State, even if the person is a minor.
- In Washington State, abortion care is considered private business between a patient and their healthcare provider. A person does not need to notify or have permission from anyone - not a spouse or partner, not a parent or guardian, not anyone - to obtain an abortion.
- Washington State law provides an extra layer of privacy protection for health care services, including abortion. If you are using health insurance that is paid for by someone else, tell your insurance company to communicate only with you. The Washington State Office of the Insurance Commissioner has more information at insurance.wa.gov/health-
- Washington State Sexual and Reproductive Health partner clinics provide sexual and reproductive health services on a sliding fee scale.
- The Northwest Abortion Access Fund and the National Abortion Federationmaintain current lists of abortion providers in Washington State.
- The Department of Health's Sexual and Reproductive Health Programcollaborates with other organizations and state agencies to increase access and decrease barriers to sexual and reproductive health information and services.