North Dakota this year banned abortion after a fetal heartbeat can be detected. North Carolina passed a law that allows health care workers to refuse to perform an abortion. Texas outlawed abortions after 20 weeks of pregnancy.

But the wave of abortion restrictions sweeping the nation seems to be breaking at the Sierra Nevada, as California now stands poised to increase abortion access by letting more medical professionals perform certain procedures.

"The line is being held in California," said Elizabeth Nash, state issues manager at the Guttmacher Institute, a reproductive-rights research group.

Abortion opponents and abortion rights advocates at a 2013 rally on the steps of the Kansas Statehouse. Kansas has been part of a wave in which states with
Abortion opponents and abortion rights advocates at a 2013 rally on the steps of the Kansas Statehouse. Kansas has been part of a wave in which states with Republican governors and GOP-controlled Legislatures enacted new restrictions on abortion providers. (AP Photo/Orlin Wagner) ( Orlin Wagner )

Gov. Jerry Brown soon will decide whether to sign AB154 by Assemblywoman Toni Atkins, D-San Diego, which would let nurse practitioners, certified nurse-midwives and physician assistants with special training perform the most common kind of first-trimester abortion. The Assembly passed the bill on a 50-25 vote in May, and the state Senate passed it Monday on a 25-11 vote, with most Democrats and no Republicans for it.

"Californians have always liked to think of ourselves differently," said Kathy Kneer, president and CEO of Planned Parenthood Affiliates of California, adding that she hopes the bill "truly does signal a turn of the tide against these state restrictions all across the country. Hopefully this will send a message to go in the opposite direction."

The Assembly must vote on some Senate amendments before the bill reaches the governor's desk, and Brown won't comment on bills that haven't reached his desk yet. Though he was raised Catholic and even spent time in a Jesuit seminary, he described himself in 2010 as "an uncompromising champion of a woman's right to choose."

Almost two dozen states have enacted more than 40 new provisions that restrict abortion access so far this year, according to the Guttmacher Institute. Perhaps most visible was Texas, where state Sen. Wendy Davis' much-publicized filibuster slowed but couldn't stop Texas' new law, which also requires abortion clinics to meet the same standards as hospital-style surgical centers.

Besides California, only New York and Washington have moved to expand abortion access in 2013 -- and in both those states, the bills fizzled out amid Republican opposition, Nash said.

The tea-party-fueled backlash to President Barack Obama's first years in office pushed state legislatures and some governor's offices to the right in 2010, Nash said, unleashing a flood of new abortion restrictions.

But liberal abortion rights in California date back to 1967, when Gov. Ronald Reagan signed one of the nation's first laws legalizing the procedure. More recently, the state's voters have repeatedly rejected ballot measures to require parental notification before a minor can have an abortion, and California is one of only 15 states in which low-income women can get publicly funded abortions.

The bill's supporters say there aren't enough doctors now providing abortions. Almost half of California's 58 counties have no accessible abortion provider, they say, so women must either travel or wait a long time to have the procedure.

Kneer argued that even in the state's red counties, people tend to prefer safe, accessible, early abortion to later-term, riskier abortions.

Sonja Cahoon, a certified nurse-midwife at Oakland's Highland Hospital as well as at her own Berkeley clinic, said it's not just an issue for the state's more rural areas, which might lack abortion providers but also are much less densely populated.

"Mid-level" medical professionals are capable of providing first-trimester abortions, she said. "Certainly training would be required, but it's not a surgical procedure."

Opponents argue that only doctors have the medical knowledge to ensure a safe abortion and that because the vast majority of abortions are an elective procedure and are not done to protect a woman's health, there can't be a "critical shortage" of doctors.

Having a constitutional right doesn't necessarily mean the right to exercise it anytime, anywhere, said Carol Hogan, spokeswoman for the California Catholic Conference. "We have a constitutional right to bear arms, but we're not demanding that there be gun stores in every city and county."

Arguments about access "are really a smokescreen," said Hogan, whose group consists of the state's archbishops and bishops. Most California women can get an initial assessment or even an abortion within a day or two, she said, adding that counties without any providers account for only a small fraction of the state's female population.

Hogan said the bill also would deem abortion by aspiration -- in which the uterus' contents are suctioned out -- as nonsurgical. Along with another bill to require that the state's building code hold abortion clinics to the same standard as primary-care clinics, it could clear the way for Planned Parenthood to grab primary-care clinic funding under Obamacare, she said.

But Kneer said it's hardly a moneymaker, as Medi-Cal reimbursements for abortion remain "abysmal" and Affordable Care Act money will be available only for primary care, not for abortions.

other states’ (aborTION rollbackS

California Gov. Jerry Brown soon will consider whether to sign a bill expanding abortion access, but many other states have enacted new abortion restrictions this year. Here are a few examples of the kinds of laws other states have passed in 2013:
Enacts or tightens clinic regulations: Alabama, Indiana, North Carolina, Texas, Virginia
Requires abortion provider to have hospital privileges: Alabama, North Dakota, Texas, Wisconsin
Bans abortion somewhere between six and 22 weeks after woman’s last period: Arkansas, North Dakota, Texas
Bans “telemedicine” that lets doctors remotely supervise administration of pregnancy-ending drug: Alabama, Indiana, Louisiana, Mississippi, Missouri, North Carolina, Texas
Restricts coverage of abortion in new state health-insurance exchanges: Arkansas, North Carolina, Pennsylvania, Virginia