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Committed to access to safe abortion for all women ...

Organizational Report 2008 - 2010


We work toward a different vision for abortion care ... Guided by the belief that women should be able to access the care they need no matter where they live. Guided by the reality that many health care providers are committed, but do not have the support, to meet the full range of women’s reproductive health needs. Guided by the conviction that a strong system of abortion care is one that is diverse and integrated. Guided by the knowledge that safe access to abortion makes a significant contribution to women’s health and autonomy.

Recognized as one of the top highhigh-impact reproductive health nonprofits for 2010.


We refuse to accept that any woman should be denied access to abortion, even if her community is too hostile, the services have never before been put in place, or the needs seem too overwhelming.

Major contributions from 2008 to 2010 include … New recognition of rural women’s abortion needs with release of AAP’s 2009 report, Abortion Access and Opportunity in Rural Communities: A Survey of Clinicians, and 6 presentations to colleagues at reproductive and public health forums.



Recruitment of over 70 partner organizations in “least access” states working on improving access to reproductive health including abortion. 

346 clinicians trained to manage early pregnancy loss in AAP’s miscarriage management trainings, developing more accessible, patient-centered care for women experiencing early pregnancy loss and a stronger system of back-up for early elective abortion.



Training and placement of only provider living and working in rural mountain project state.* 

*Specific state not used by request.


“Expanding access to safe abortion is the work we have to do. And this is AAP’s moment to do it.” The past three years have brought reminders that abortion must be approached with openness, compassion and, often, with bravery. As AAP’s work has expanded into more hostile and persistently underserved places - conservative Southern and Midwestern states, rural communities across the U.S. – we have grappled with the challenges of engaging people around the issue of abortion. Many of out programs now work explicitly in communities where there is a history of entrenched opposition to abortion, a culture of pervasive stigma and silence, and a troubled history with and subsequent distrust of “outsiders”, particularly concerning public health. As an organization, we are honing our ability to partner with these communities by approaching them with the same commitment, openness, and compassion we extend to women seeking abortion – and by honoring the bravery that our organizers, organizational partners, and women themselves exercise regularly. Our collective work is needed. Gains we experienced in 2008-2010 such as the expanded availability of early, medication abortion are offset by losses, some of which have come at a heavy cost. We lost Dr. Tiller. With health care reform and the persistence of the Hyde Amendment, we lost the opportunity to provide crucial supports for poor women. Independent clinics have closed or are facing the threat of closure, leaving women in those communities with diminished choices and drawing down on the diverse types of providers - private practices, clinics, hospitals - that a strong system of care needs. Expanding access to safe abortion care is the work we have to do. And this is AAP’s moment to do it. We have more resources than ever. We have a team of successful organizers and collaborative partners who bring innovation, experience and credibility. New, on-the-ground alliances are being formed where there are resources, interest and support. Capacity is being built in difficult places. We have established a significant presence for abortion-related work in some of the most politically and culturally hostile environments. As we take this moment to look back, we are awed and appreciative of the work of many, and poised to build on our shared successes and face the challenges ahead.

from the Board President and the Executive Director


BOARD of DIRECTORS

Our deepest gratitude to outgoing members Karen Edlund and

Stanley Henshaw for their years of leadership and service .

“The leadership demonstrates tremendous vision.”

Current as of January 2011 Janet Singer, CNM Susan Dickler, MPA, MSW Karen Edlund, RN Stanley Henshaw, PhD Lisa M. Stone, JD Joseph Speidel, MD, MPH Melanie Zurek, EdM

Emeritus Wyndi Anderson Traci Baird, MPH Sacheen Carr-Ellis, MD Marlene Gerber Fried, PhD Robert Kushen, Esq Lisa Levine, MPH Maureen Paul, MD Ruth Pottee, MD Mala Rafik, JD Susan Trotz Jean Wassell Judy Weiss, PhD Susan Yanow, LICSW


Focused. Responsive. Collaborative. Since 1992, the Abortion Access Project has been a leading innovator in identifying and filling gaps in access to safe abortion care — partnering with local health care providers, organizations and advocates to meet the reproductive health care needs of women. Through customized local support and the resources of our national office, AAP leverages community expertise to create on-the-ground opportunities to increase

access to safe abortion

for all women.

“I believe the Abortion Access Project is unparalleled in having shown a generation the way to leverage local lessons learned and strategystrategy-building and how to build linkages through collaborative work."


AAP in numbers ‌ Working in 12 states Collaborating with over 90 state and national organizations Assisting 494 trainees

“AAP is entrepreneurial and nimble."


Focused Only 1 in every 600 doctors across the country is trained in and practicing abortion care, and most choose to practice in urban settings. Efforts to introduce abortion into rural areas face unique challenges. In 2009, AAP

For most women living in rural America, accessing abortion care can be a near impossibility.

responded to a dire situation in one of our Rural Abortion Provider Initiative project states. This state was facing the retirement of its only physician offering abortion services – a doctor who had been flying in from a neighboring state once a month for years.

AAP identified and recruited a clinician, Dr. Howard*, to participate in a medication abortion training. After the training, our state-based field organizer and partners followed up with the support and information she needed. AAP was there to counsel her when she began working in the state’s one abortion clinic. And, AAP was there several months later when she asked for additional surgical training.

Now, inspired, trained and supported, Dr. Howard has become the only abortion provider working and living in her state offering more regular and reliable access for women. *Pseudonym


“I feel like the AAP organizer is right there if I need something… or if any staff member needs something… she is a good place to go. I feel like I have an open phone line for access to her.” – Nurse Practitioner

Responsive AAP’s work with Advanced Practice Clinicians acts on the belief that more providers mean better access for women and that APCs are an important part of making this a reality. In fall of 2009, AAP released Providing Abortion Care: A Professional Toolkit for Nurse-Midwives, Nurse Practitioners, and Physician Assistants, a comprehensive resource on professional scope of practice as it pertains to abortion care for APCs. A collaborative effort of AAP, the National Abortion Federation and the Advancing New Standards in Reproductive Health (ANSIRH) program at the University of California San Francisco, the Toolkit is available at www.apctoolkit.org. In 2009, the Toolkit has spurred new state-specific APC work in Oregon and West Virginia, a continuation of the collaboration between AAP, ANSIRH, and NAF.


Collaborative This year alone, legislation has been introduced or passed that seriously limits the ability to provide accessible abortion care in at least 13 states, including AAP’s Least Access States Initiative project states. The Least Access States Initiative (LASI) is actively developing and enhancing new support for abortion services in the three LASI project states*. Since beginning work in these states, AAP’s organizers have formed collaborative relationships with over 70 state-level organizations to improve information on and referrals for abortion. With a strategic focus on collaboration with social service providers, AAP’s work in LASI states will reach a broad spectrum of women.

“Through the partner we’ve worked with, the community is strengthening its understanding and approach to reproductive and sexual health issues. It is exciting and truly humbling to be a part of a process where women are courageous enough to challenge themselves, their beliefs, and at times, their families. This is how movements are built, and how change happens .” – LASI State Director


Because of this Initiative, a total of four residency programs have now incorporated management of early pregnancy loss into their family medicine residency programs, providing a permanent learning opportunity for hundreds of residents.

To date, AAP has trained 346 family medicine residents and support staff members in just under two years.

Catalytic Because of its political and clinical connections to elective abortion care, outpatient uterine evacuation management of early miscarriage has not been taught to the majority of physicians. Decades of research on uterine evacuation, generated through experience with elective abortion, has been excluded from clinical instruction on miscarriage management because of stigma associated with elective abortion. Given that approximately 12 to 24 percent of pregnancies end in miscarriage before the first 20 weeks of gestation, this omission affects many women's ability to receive timely and appropriate care from their primary care providers. This gap in the health care delivery system also affects abortion care: it limits the system's ability to respond to both self-induced and incomplete abortion. In 2009, AAP launched its Miscarriage Management Training Initiative to address this gap.


2008

Drexel University Nursing Education Institute National Abortion Federation, Annual Meeting National Abortion Federation, Annual Meeting National Abortion Federation, Annual Meeting

2009

Training and Access Working Group Abortion Care Network American Public Health Association

Presentations

American Public Health Association American Public Health Association Drexel University Nursing Education Institute National Abortion Federation National Abortion Federation, Annual Meeting National Abortion Federation, Annual Meeting National Abortion Federation, Preconference National Abortion Federation, Social Science Meeting

2010

Society for Applied Anthropology Abortion Care Network Abortion Care Network American Public Health Association Eastern Sociological Society National Abortion Federation, Preconference National Abortion Federation, Annual Meeting National Abortion Federation, Preconference National Abortion Federation, Annual Meeting National Abortion Federation, Risk Management Nurse Practitioners in Women’s Health

Using a Standardized Patient to Teach Reproductive Content The Role of Nurses in Abortion Care Self-Induced Abortion using Misoprostol Alone: Legal, Medical and Policy Implications Reproductive Health Training Needs of Illinois Family Medicine Residents* *A submission led by partner organization, the Midwest Access Project Training Rural Abortion Providers, Colorado Expanding the Abortion Training Community to Include Independent Providers Linking Scope of Practice with Public Health Goals: Advanced Practice Clinicians and Abortion Care State differences in abortion access: A new tool to understand access to care and capacity for change Understanding clinician perspectives on abortion care in rural communities: A quantitative and qualitative approach Teaching Reproductive Content in the Classroom Advanced Practice Clinicians Take Their Seat at the Table: Applying a Professional Scope of Practice Model to Periabortion Care Attitudes and Experiences of Clinicians Practicing in Rural Communities Women's Experience with Viewing the Ultrasound Image during Gestational Dating Unpacking the Advanced Practice Clinician Toolkit: Focusing on Clinical Training 50 State Access/Opportunity Analysis Abortion and Stigma "Telemedicine" through the Lenses of Providers, Advocates and Women Self-Induced abortion: What providers need to know about legal, clinical and social contexts Abortion Provision, Occupational Stigma, and Abortion Access Disparities and Delivery: the interaction between abortion care services and economic barriers APC training models for abortion care Occupational Stigma and Abortion Provision The Politics of Scope of Practice Women's Experience with Decision-making with Medication Abortion: A Qualitative Grounded Theory Study Telemedicine and Underserved Communities Women’s Experience with Decision-making with Medication Abortion A Qualitative Grounded Theory Study


Financial Overview Revenue

Expenses Grants, 86% $1,752,339

Individual Contributions, 8% $164,946

Interest, 5% $92,705

Program, 90% $3,746,506

Fundraising, 6% $250,855

Management, 4% $172,670

Program Service Fees, 1% $22,734

The information above reflects revenue and expenses from 2008, 2009, and 2010, combined. Figures from 2010 have not yet been confirmed by independent audit. Program expenditures were additionally supported by a $3.6 million grant that was received in 2007. Copies of the complete 2008 and 2009 audit reports are available from AAP upon request.


Program Expenses by Project

2008

2009

2010

100% 90% 80% 70% 60% 50% 40% 30% 20% 10%

0% 2008

Least Access States

2009

Rural

Abortion Education/Training

2010

Miscarriage Management

APC

Low Income

Public Awareness


Generous Support Many foundations and hundreds of individual donors are making generous investments in AAP’s work. We are grateful for their commitment to ensuring that women in the United States are able to access safe abortion, no matter where they live. We are proud to count the following individuals, foundations, and institutions among AAP’s supporters in 2008—2010: Randy Albelda Wyndi Anderson Ann Avery Traci Baird & Matthew Dalva Jerry Busch Professor & Mrs. M. Colyer Crum Barbara L. Cullen, Esq. Monica Dostal Karen Edlund Catherine England Ellen Paradise Fisher Marcus Gordon Marc Grella Jeanette Helfrich Elise Henricks & Anthony Dutzik Stanley Henshaw Lorinda Hohenbrink Lauren Kneisly Donald Kollisch & Patricia Glowa Gloria Kramer Robert Kushen Lisa & Kenneth B. Levine Brooke McConnell & Chris Hemstead

Judy Norsigian Jan Paradise Marsha Platt Dianne Reynolds Karen Rosen Kathy Rosenfield Ellen Ruell Helen Shin Janet Singer & Andrew Grad Jane Singer Judith Ellen Smith Joseph Speidel Lisa Stone Alice Stowell Debra Stulberg Deborah VanDerhei Lois Wessel NARAL Pro-Choice Wyoming Sherry Zitter Melanie Zurek

Many more anonymous donors. Our list reflects our commitment to not print a donor’s name without express permission to do so. If you do not see your name on this list and would like to be publicly acknowledged, please contact bm@abortionaccess.org.

Anonymous (2) Bixby Center for Global Reproductive Health, UCSF Brush Foundation Compton Foundation Danco Laboratories, LLC Dickler Family Foundation Educational Foundation of America General Service Foundation girls just wanna have funD of Horizons Foundation Richard and Rhoda Goldman Fund Ibis Reproductive Health Irving Harris Foundation John Merck Fund Moriah Fund Ms. Foundation for Women* New Directions Foundation New Prospect Foundation OMA Fund of the Ms. Foundation for Women The David and Lucile Packard Foundation Prentice Foundation Samuel Rubin Foundation Steven B. Achelis Foundation Tides Foundation Mary Wohlford Foundation *as fiscal agent for the Training and Access Working Group


Talented people … As of January 2011

AAP Staff

Field Organizers

Melanie Zurek, Executive Director Wyndi Anderson, Senior Director of Programs Maggie Baker, Office Manager Sera Bonds, Senior Director of the Least Access States Initiative Joyce Cappiello, Director of the ROE Consortium for Nursing Brooke McConnell, Development Officer Jenny O’Donnell, Deputy Director

Nancy Foss Kathleen Lane Deborah VanDerhei Anita Wilson LASI State Directors (3) LASI State Organizers (12) MMTI Organizers (2) MMTI Trainers (6)

“Their leadership is excellent. They also make good use of consultants, leveraging existing expertise in several different states, while maintaining a small staff and managing its expenses carefully. “

… deeply held commitment


Our Mission The Abortion Access Project is committed to access to safe abortion for all women in the U.S. We believe that by being clearly focused on abortion within the context of our broader values we will make a significant contribution to women’s health and autonomy. To this end, AAP: Looks for gaps in abortion access that no one else is addressing and seeks to create and support innovative responses to these gaps; Seeks to catalyze changes within health care and reproductive health activism that increase the participation of a wide range of health care providers in providing and connecting women to safe abortion care; and Works with local partners to achieve locally-driven, locally-relevant goals and connects this work to national organizations also interested in expanding access.


Abortion Access Project 2008-2010 Organizational Report