"We often focus on the clinical aspects of expanding abortion," notes Nancy A. Foss, AAP's Northern New England Field Consultant, "but grassroots community organizing is an important part of efforts to increase the number of abortion providers." This August, Nancy applied her organizing skills to her work on the Rural Abortion Provider Initiative, AAP's unique project to expand rural women's access to abortion. After surveying rural clinicians in Washington County, located at Maine's eastern coastline border with Canada, Nancy spent three days meeting with clinicians and public health allies in the region.

Stringing together visits with rural family planning clinics, private healthcare providers, and rural hospital basedpractices, Nancy went door-to-door providing abortion referral lists and other resources, making face-to-face connections with frontline staff and clinicians. "I wanted to know more about what clinicians in the region need, and have a dialogue with them around issues related to abortion care," explains Nancy.

"The more stops I made, the more confidence I had that rural healthcare providers were interested in abortion care, and that they welcomed the resources and support.   And not just clinicians - everyone in the office benefits from knowing more. I learned that often the women answering the office phones were handling abortion referrals far more frequently than the clinicians they worked with." In lieu of community-based abortion providers, improving referrals can make a significant improvement in women's access to abortion.

38.5% of pregnancies in Maine are unintended, well above the Healthy People 2010 goal set at 30%. Access to prenatal care in Washington County is lower than the state and national average, suggesting women have difficulty receiving healthcare services while pregnant.  More recently, Washington County's high levels of cervical cancer were highlighted in a national report. "I was concerned that the recent statistics about cervical cancer would leave providers without the time to think about abortion, but the healthcare workers I spoke with understand abortion is part of the spectrum of reproductive health services," relays Nancy.  "This view lays the foundation for AAP's efforts to integrate early abortion where women are already receiving care."

"I also used the trip as an opportunity to camp overnight at one of Maine's most beautiful coastal state parks, which added to the grassroots romance of the trip."  But beyond the romance, there is the solid strategy. Site visits are an important part of needs assessment and the cultivation of relationships and support. Face-to-face organizing is critical to building momentum around abortion training in the underserved communities of rural Maine. "It is so clear what a difference being physically there, walking through the office door and starting a conversation, makes in terms of moving ahead." And the work is moving ahead, with a new local partner hosting an AAP-organized training on medication abortion in early November. "Energizing existing networks of clinicians can make a huge difference in the impact of our work. All they need sometimes is a catalyst - like me knocking on their door."