While small-town clinics and patients from Maine to Alaska celebrate the benefits of telemedicine, a growing quarrel over telemedicine abortions in rural Iowa is drowning out all songs of praise.
The first of its kind in the United States, the program fuses two well-established medical practices, telemedicine and the abortion pill, and adds a modern complication to the long-disputed issue of abortion’s morality.
“They (critics) are not really protesting the new technology,” said Vanessa Cullins, vice president for medical affairs at Planned Parenthood Federation of America, according to The New York Times. “They are protesting abortion in general.”
Dubbed “webcam abortions” by opponents, telemedicine abortions utilize the drug mifepristone, also known as RU-486, to allow women non-surgical abortions within the first nine weeks of their pregnancies without ever meeting a doctor face-to-face, according to The New York Times.
After a nurse, who is with the patient throughout the procedure, completes an examination that includes blood tests, medical history, ultrasound and counseling, patients videoconference with a doctor, sometimes hundreds of miles away, via a secure Internet connection. Having looked over the patient’s medical records and confirmed that the abortion will pose no health risk, the doctor then remotely unlocks and opens a drawer in front of the patient that contains the mifepristone pill she will take at the clinic and a follow-up pill, misoprostol, she will take a few days later.
This remote consultation lies at the heart of arguments against the procedure, as opponents claim it fails to meet Iowa laws requiring that abortions be administered by a licensed physician or osteopath, according to the Quad-City Times in Davenport Iowa.
“They are claiming this amounts to an examination,” said Terry Branstad, former Iowa governor and former president of the Des Moines University osteopathic medical college, to the Quad-City Times, “but that’s not the way I would interpret an examination. An examination is when you really see the patient. But an issue as significant as a pregnancy and abortion and doing that over telemedicine without ever seeing the patient, I don’t think it’s right.”
Iowa’s current governor, Chet Culver, and supporters of the procedure disagree with Branstad.
“What Terry Branstad is proposing is to shut down all telemedicine,” said Culver to the Quad-City Times. “You can’t just very narrowly pick and choose who is allowed to use telemedicine. This shouldn’t be about ideology. This should be about health care and providing services, including family-planning services. He’s over-simplifying a very complex issue.”
Objections to the more than 1,500 abortions that have taken place at 16 rural Iowa clinics since the program’s inception in 2008 rely on speculative legal perspectives, as most Iowa telemedicine laws were created in 1996 and include no rules either for or against the use of telemedicine for abortion purposes, reports the Quad-City Times.
More time is needed to study the issue before making a decision as to the legality and safety of the procedures declared an Iowa Board of Medicine committee following dozens of objections from Iowa residents during an October 23 public comment session, which included the submission of a 3,900-signature petition from Iowa Right to Life Executive Director Jenifer Bowen.
“This is a prescription for disaster,” said Troy Newman, leader of Operation Rescue, an abortion-opposition group that protested telemedicine abortions in Cedar Rapids, Iowa, to The New York Times. “You are removing the doctor-patient relationship from this process. And think about it: With this scheme, one abortionist sitting in his pajamas at home could literally do thousands of abortions a week. This is about expanding their abortion base.”
The experimental Iowa program just may expand beyond state lines, as the percentage of pill-abortions has risen despite a declining number of over-all abortions by American women in recent years, reports The New York Times.
“There are many affiliates that are carefully considering this option, within the confines of their state laws,” said Cullins to the Associated Press.
While these considerations may depend largely on the outcome of the current Iowa debate, the framework for such a move has long been in place.
Though the prescription of mifepristone, also marketed as mifeprex, through telemedicine is new, neither the pill’s use in the United States nor the use of remote consultations is.
First allowed by France in 1988, the abortion pill was legalized by the Food and Drug Administration (FDA) in September of 2000. Since, almost 1.5 million women have taken advantage of the non-invasive and more private abortion technique, with only eight related deaths reportedly caused by the bloodstream infection Sepsis – a death rate of 1 per 168,000 that’s much less than that of death by childbirth, reports the Associated Press.
“I just don’t see any downsides,” said Dr. David Grimes, a North Carolina obstetrician and gynecologist and former head of the abortion surveillance branch of the Centers for Disease Control and Prevention, to the Associated Press. “For those women who don’t like the invasiveness of surgery, it gives them a very important option.”
Grimes also noted the safety the pill provides women by allowing them to complete their abortions in the privacy of their own home in a clinic that could potentially be targeted by protestors, according to the Associated Press.
Similar to the pill’s convenience, Iowa’s telemedicine abortions have been equally heralded for the access and ease they provide women whom would otherwise need to make hours-long drives, or lack access to an abortion completely.