Blog

News, updates, and opinions from reproductive health nurses.

Part I: Nurses Working Collectively to Integrate SRH into Practice, Education, Research, and Professional Advocacy

April, 27 2017

Author: Diana Taylor

Nurses in the U.S. have a legacy of activism that arises from our professional imperative to promote public policy that advance social justice and health equity. The national Nursing Code of Ethics states that nurses should act individually and collectively through political and professional actions for social change and justice. In addition, professional nursing organizations represent nurses as advocates for health care policy and legislation related to access to quality, equitable and affordable healthcare, and against the violation of patient and human rights.

The History: Early Activism by Public Health Nurses

Since Nurse Lillian Wald founded the first neighborhood health clinics as well as the New York Board of Health (1890) to care for poor families and improve public health, nurses individually and collectively have played a major role in helping people and vulnerable populations gain access to sexual and reproductive health (SRH) care. Legal and political barriers to SRH care, especially control of fertility and prevention of unintended pregnancy, were first challenged by Margaret Sanger, nurse and founder of what later became Planned Parenthood, who was jailed for distributing birth control information in 1918. This early activism spurred nursing organizations to begin advocating for birth control as both a means of disease prevention and a women’s rights issue. Although individual nurses and midwives have always helped women terminate pregnancies prior to 1973 Supreme Court decision (Roe v Wade), organized nursing did not take a clear prochoice position until [ANA 1989].

Since the 1960s and 1970s, nurse activists, clinicians and scholars have been at the forefront of raising awareness that sexual and reproductive health is more than maternal health. In the face of high national maternal and infant mortality rates, physician shortages and little attention to sexual health, nurses established nurse and midwife-led birth centers and feminist health centers. Public health nurses were trained through Planned Parenthood to provide contraceptive methods (including IUD insertions), treat sexually transmitted infections and promote sexual health. Nurses also became deeply involved in many policy shaping efforts aimed at transforming women’s health services, health professional education, and other initiatives striving to improve SRH. In the 1980s, cuts in funding for healthcare, family planning, and abortion services negatively impacted the efforts of these women’s health/SRH scholars and practitioner-activists.

It is important to point out that historically nursing has mirrored the political spectrum in the U.S. Contraception, abortion and other SRH services have long been controversial, and while individual nurses may not hold a single position on these topics, professional nursing organizations are unified in their opposition to political interference in evidence-based SRH care, nursing education and research.[1]

Revitalizing Nurses’ Role in Sexual and Reproductive Health: The ROE Consortium

With the mounting politicization of women’s health care and SRH services, in this blog we highlight a few of the next generation of nursing activists and organizations, that are continuing efforts to integrate sexual and reproductive health services into public health and primary care. We begin with two nurses who founded and built the Reproductive Options Education (ROE) Consortium for Nursing (ROE) in 1997 that revitalized nurses and organized nursing for capacity building in SRH and abortion care.

Katherine Simmonds RN, MPH, WHNP, PhD(c) (ROE founder and director 1997-2007) and Joyce Cappiello PhD, FNP (ROE director since 2008) of the Reproductive Options Education (ROE) Consortium for Nursing. The ROE Consortium was a project of the Abortion Access Project now known as Provide, Inc.

Kathy, with a background in community organizing and public health, first brought attention to the absence of abortion content in nursing education and the essential role of nurses in abortion care. She is the founder and first director of the Reproductive Options Education (ROE) Consortium for Nursing, an initiative to bring training and curricula on reproductive options to nurse educators in New England and across the United States. Kathy and the ROE Consortium ignited new efforts by nursing educators, clinicians and policy makers to integrate SRH and unintended pregnancy prevention, especially abortion care into primary care and public health. Under Kathy’s leadership, the ROE Consortium activated nursing educators and practitioners to participate in a new abortion provider initiative.

“For many people, nurses provide a critical bridge to the health care system. However, because of inadequate education, professional barriers, or unexamined attitudes and beliefs, nurses are often unprepared, unable or – in some cases – unwilling to provide sexual and reproductive health care, including to abortion. My goal is to support and equip nurses at all levels of practice to provide comprehensive, quality sexual and reproductive health care to the individuals and populations they care for. An equally important goal is to integrate reproductive justice strategies, other “standpoints” and “Intersectionality,” into frameworks for nursing education and practice in SRH.”

Joyce expanded the advisory board and activities of ROE under its parent organization, Provide (formerly the Abortion Access Project)[2] resulting in collaborations with nurse educators, and nursing and midwifery organizations. As director of ROE (2008-2016), Joyce spearheaded the development of essential competencies in unintended pregnancy and prevention care (UPPC) for pre-licensure nursing education. Building on this foundation, she developed curricular modules to align with the competencies. These web-accessible modules are designed to help nursing faculty easily integrate UPPC content into existing nursing courses.

During her time as ROE Director, Joyce was the first chair of the SRH Special Interest Group of the National Organization of Nurse Practitioner Faculties (NONPF SRH SIG) where she raised the issue of barriers to education and training in SRH care and led strategic solutions (2010). In 2012, Joyce also co-chaired a national initiative[3] to align practice, education and credentialing for SRH care for primary care and public health professionals.  As part of the project, Joyce spearheaded an interprofessional study of primary care providers that expanded the UPPC competencies to include broad sexual and reproductive health competencies across the lifespan that align with the WHO SRH definition.

Collective Action: The Advanced Practice Clinician Initiative

Provide, Inc. with their team of field consultants and with the ROE Consortium’s expertise in nursing, developed the Advanced Practice Clinician (APC) Initiative to focus on introducing and supporting advanced practice nurses (APRNs) and physician assistants (PAs) in the provision of abortion care.  Scope of practice of nurses is defined by each state in legislation or rules and regulations that govern practice. Decades ago, laws were passed in some states to mandate the safe provision of abortion care using language to contain abortion provision to licensed physicians.  Today, the language in these laws has been used to restrict the number of trained advanced practice nurses (CNMs and NPs) to provide abortions. This restriction falls heavily on nurse practitioners (NPs) and PAs, roles that were not developed at the time of passage of the physician-only laws. In a few states, the laws have been successfully challenged although the politics of abortion has precluded this elsewhere even when nursing scope of practice regulations support the APRN skills required in abortion care provision. The APC Initiative identified key states with potential for practice with the goal to establish APRN and PAs as qualified and accepted providers of abortion care. To support this goal, the ROE Consortium focused on expanding abortion content in graduate and undergraduate nursing education, developed clinical placements in abortion care for nursing students and facilitated numerous presentations and discussion of regulatory restrictions and scope of practice issues in nursing. Another Provide project, the Miscarriage Management Training Initiative (MM-TI) has taught family medicine physicians and support staff to integrate miscarriage management into the primary care setting. The successful research outcomes from the MM-TI project have encouraged APRNs to consider including office-based miscarriage management with medication or manual vacuum aspiration (MVA) with local anesthesia into their practice to offer women expanded choices for abortion care.

ROE Consortium Expands: The Next Generation of Collective Action

While representing the ROE Consortium within a variety of reproductive rights and justice groups, including the National Abortion Federation (NAF) Clinicians for Choice Advisory Committee, Kathy and Joyce engaged nursing colleagues from organized nursing and public health including the American Nurses Association/Academy of Nursing, Nurse Practitioners in Women’s Health, NONPF (Diana Taylor); the American College of Nurse-Midwives (Amy Levi, Margie Beal, Francine Likis); the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), APHA and reproductive justice networks (Monica McLemore).[4]

Under Kathy & Joyce’s leadership, the ROE Consortium board members went to work—individually and collectively within their respective organizations—to build nursing capacity in SRH care with an emphasis on gaps including unintended pregnancy prevention; nurses role in the SRH workforce; SRH and abortion care education and training; SRH care ethics; and SRH policy advocacy/activism.

In Part II, I will highlight the continued and collective work to build nursing capacity in SRH and abortion care through collaborations with organized nursing and beyond (2010 to present).

Thank you Kathy and Joyce for creating and expanding the ROE Consortium in Nursing. Your vision and activism continues the legacy of nurses’ engagement in SRH and abortion care.

[1] Sexual and reproductive health (SRH) care is sometimes thought of narrowly as maternal-child, family planning, or women’s health care. However, to produce optimal health outcomes, many experts believe SRH care should include the reproductive health of men and women throughout their lifespan with a special emphasis on adolescents and health equity. Under a definition accepted by the World Health Organization (WHO) and implemented in a number of national health systems, a minimum package of SRH care accessible to all would include preconception care, contraception, pregnancy and unplanned pregnancy care, women’s health/common gynecology care, genitourinary (GU) conditions of men, assessment of specialty gynecology/GU problems including infertility, sexual health promotion, and delivered within a system of public health and primary care services.

[2] Provide is a nonprofit that works in partnership with health and social service providers and agencies to build a health system that, in a climate of diminishing access, is equipped to respond to women’s health care needs around abortion. We envision a healthcare system that cares for the whole person, meets her needs with dignity and respect, and where workers are given the tools and support to offer the best care to their clients.

[3] The SRH Workforce Project (2013): Overview and recommendations from the SRH Workforce Summit (Nothnagle, Cappiello, Taylor); SRH Workforce Summit: now is the time to bring sexual and reproductive health to primary care (Cappiello, Nothnagle); The interprofessional sexual and reproductive health care team (Levi et al)

[4] The American Academy of Nursing (AAN Women’s Health Expert Panel), the American Nurses Association (ANA, RNAction.org), the American College of Nurse-Midwives (ACNM), the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN), the American Public Health Association (APHA sections—Public Health Nursing and Population & SRH), the National Organization of Nurse Practitioner Faculties (NONPF-SRH Special Interest Group), Nurse Practitioners in Women’s Health (NPWH), Clinicians for Choice (NAF-C4C), and Nursing Students for Choice (NSSRH).