Hawaii nurses are now allowed to perform abortions in the first trimester of pregnancy after Gov. David Ige signed a bill into law Monday.

Hawaii joins 12 other states that allow abortions to be performed by advanced practice registered nurses. The other states are California, Colorado, Illinois, Maine, Massachusetts, Montana, New Hampshire, New York, Oregon, Vermont, Virginia and Washington.

Advanced practice nurses can now terminate early pregnancies in Hawaii by medication or aspiration — a medical procedure that uses suction to perform an abortion.

Advanced practice nurses can perform abortions if they have prescriptive authority and a valid unencumbered license.

Although Hawaii legalized abortions in the 1970s, access to clinical services remained limited, often requiring pregnant women to travel.

Ige said the law, now known as Act 3, “is especially important given the COVID-19 pandemic, which has imposed restrictions on travel to and from the neighbor islands and Oahu.”

Dr. Reni Soon, chairwoman of the Hawaii Section of American College of Obstetricians and Gynecologists, said during a news conference of Ige’s bill signing that there were neighbor island residents who could not fly to Oahu and that she had to travel to Maui twice a month to perform abortions.

“Folks from Kauai, Lanai and Molokai have to fly to access this basic health care,” Soon said. “Last spring, when travel restrictions due to the coronavirus pandemic went into effect, we couldn’t fly for a few months. So there was no access to abortion care on Maui for several months.”

Laura Reichardt, director of the Hawaii State Center for Nursing, said the number of advanced practice nurses has “more than doubled since 2005” in the state.

At the beginning of the legislative session, the Hawaii Life Alliance opposed the new law, citing concerns about abortions performed by nurses and worries about the safety of minors.

“We strongly oppose any measure that would allow anyone other than what current law permits, that licensed doctors and osteopathic physicians only provide abortions in an approved clinical setting,” Executive Director Janet Hochberg said in an email. “This is a surgical procedure performed on minor teens as young as 14 years old that under current law does not require a parent to be involved or even notified.”

Soon clarified Monday that abortions are not a surgical procedure.

“It’s an office procedure,” Soon said. “APRNs do very similar procedures in the office already. This is definitely within their scope of care.”