Just days after state law in Maryland changed last summer to allow nurses in Maryland to perform abortions, Nicole Devlin began her training.
She shadowed a doctor during procedures, watching, learning and then performing the abortions over and over for 10 weeks. On her own for months now, she estimates she’s performed hundreds of abortions.
The nurse practitioner at Planned Parenthood in Baltimore is one of the first to join the provider ranks in Maryland, if not the first.
“The second I could be trained I said put me in, coach,” said Devlin, 35, who has worked in the women’s health clinic for nearly six years. “Of the skills I could learn, I find abortion care incredibly important.”
Training more nurses like Devlin is now a step closer with a formal training program officially in the works, though it’s still likely months or more away.
The state moved with urgency to expand its base of providers ahead of the Supreme Court decision overturning the Roe v. Wade precedent guaranteeing a right to an abortion.
Abortions are now banned in more than a dozen states and restricted in more, while Maryland has far more lenient laws.
Maryland joined at least 18 other states in allowing so-called advanced practice clinicians to offer abortions and the General Assembly allotted $3.5 million for training. Then-Gov. Larry Hogan, a Republican, vetoed the Abortion Care Access Act, but it was overridden by a two-thirds majority in the legislature.
Hogan withheld the funding in opposition to the expansion to non-physician abortion providers, citing potential harm to those who were pregnant.
Supporters including Devlin say the surgical procedure most commonly used is simple and takes no more than 5 to 7 minutes from inserting a speculum to using suction to empty the uterus.
The Maryland chapter of the American College of Obstetrics and Gynecologists strongly supported the inclusion of nurses in the legislation to include nurses. Nurses were already permitted to prescribe medication abortions, which are used in about half of all abortions.
Gov. Wes Moore, a Democrat, released the money as one of his first acts last week at the urging of advocates and providers. But a formal training program will take time to get running.
The Maryland Department of Health must identify a nonprofit group to oversee administration, tap providers for training and settle on a curriculum.
In the meantime, that has left providers with many more less experienced nurses to train while tending to a high volume of patients — something Planned Parenthood said would be difficult. Devlin had been on the job providing pelvic exams, inserting IUDs and working in the abortion recovery room for nearly five years, and was deemed competent to perform abortions — there’s no formal certification — after 10 weeks of training.
“The next one will be harder,” said Dr. Kyle Bukowski, chief medical officer of Planned Parenthood of Maryland, of the next round of nurses they’ll train.
Still, he said he’s “excited the process is starting now,” after the delay.
“We knew there would be a bit of an administrative process,” Bukowski said. “So when Hogan refused to release the funds after legislation was passed last year, we knew it would delay things even more, maybe another year.”
He said the funding could be used to hire another physician to work more slowly, at the speed needed by trainees. He also said nursing schools could provide a deeper background in abortion care so they are ready for clinical training.
The Johns Hopkins School of Nursing, for one, already has some workshops planned for students and nurses to learn about abortion training, school officials said.
Montgomery County Del. Ariana Kelly, who was the lead sponsor of the Abortion Care Access Act, is grateful the funds have finally been released. But she knows the delay has had a direct and substantial impact.
“Over the last six months, as we’ve been experiencing this delay, I have heard from a number of clinicians who are interested in getting the training, particularly in rural and underserved areas of the state,” Kelly, a Democrat, said.
Priya Hay-Chattopadhyay of the Baltimore Abortion Fund said the organization’s client volume has increased since the Dobbs decision, and they have needed to grow rapidly to address the demand.
“In 2022, we distributed about $780,000 in abortion funding and practical support funds, which was almost three times our 2021 total,” Hay-Chattopadhyay said. Calls to the organization’s hotline, too, increased over this period by 33%, she added.
While Maryland has become a safe haven of sorts for those seeking abortion care, Hay-Chattopadhyay said the group’s data about those who seek their services shows the state still has a long way to go. Nearly two-thirds of the fund’s clients are from Maryland.
Consistent financial support from the state, she said, would be a game-changer, “We have to make difficult decisions every day about who is going to get funding and how much and who isn’t.”
State health officials say goals include not only boosting the abortion workforce but ensuring the training is done in underserved areas and increasing access to services.
About two-thirds of Maryland counties didn’t have an abortion provider, according to 2017 data from The Guttmacher Institute, an abortion rights research organization. Access is least available in Western Maryland and on the Eastern Shore, but telehealth and medication abortions have been more available since the pandemic began.
The bill states that the Maryland Department of Health must “contract with a coordinating organization” to administer the clinical training program. In practice, this means selecting a nonprofit with experience in the abortion field to oversee the clinical training aspect of the program, which will be done in at least two community-based sites, such as a Planned Parenthood clinic.
Department officials said “a process for distribution of the funds is being finalized.” They wouldn’t comment further on the potential organization overseeing training, details about a curriculum, the number of providers that may receive training, or a timeline on the rollout.
But the need for the training is higher than ever, Bukowski said, “There already is a huge demand to get trained. We get tons of requests from other states and providers in practice in Maryland, and now, with the new legislation for advanced practice clinicians, we’re getting requests from them.”
Bukowski said he expects the organization overseeing the program to handle administrative aspects, such as checking licenses.
“Since the Dobbs decision,” Kelly said, “state legislative leaders in pro-choice states have been meeting and discussing what we can do. And clinical training is one of the top priorities.”
The implications of the legislation — and the rollout of the program — are national, Kelly said. Maryland’s approach to abortion care is serving as a model for other states.
Hay-Chattopadhyay agrees, but said that shouldn’t overshadow the importance of the program — and possible future legislation that would further protect abortion — in the state.
“There are still needs of Marylanders that are not being met,” Hay-Chattopadhyay said, “and now Maryland is also effectively responsible for providing abortion care to patients along the whole East Coast.”
“There’s a lot of demand from our peers; states across the country who are looking at developing similar programs and following our lead,” Kelly said. “But in order to follow our lead, we gotta get the program up and running.”