In 2008, Iowa started a pilot program of a delivery system that gave access to a safe medical procedure for thousands of women. Furthermore, since access to the procedure has been increased, the number performed has decreased in the same time period. In response, Iowa’s Board of Medicine voted to ban use of the practice last month.
What was their reasoning? It just didn’t feel right.
Telemedicine has been in existence in some form for approximately 40 years. As defined by the American Telemed Association, telemedicine refers to “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” The form of electronic communication has evolved from a simple phone conversation to current technologies of closed circuit video conferencing and computer networking.
Telemedicine allows for consultations between medical professionals as well as with patients. It provides convenient access to experts, delivery of vital medical information, and for patient follow up. It is used by the military to treat soldiers with traumatic injuries and allows patients in China to have access to expert medical teams in the United States.
Why does the Iowa medial board feel that rural women in Iowa shouldn’t have access to this incredible advance in medical technology? The answer: abortion.
For the past five years, doctors have been using a video conference system to consult with women in clinics across Iowa for chemically induced abortions. Women are examined in the clinic by trained staff, which includes administering all necessary tests and sonograms. The doctor then consults with the woman in-depth via video and reviews the results of the tests and procedures performed in the clinic. If the doctor determines the woman qualifies (the medication can only be used during the first nine weeks of pregnancy), he enters a code from where he is at, which opens a drawer in the exam room that contains the bottle of RU-486 pills. The woman then retrieves the bottle and takes the first pill while the doctor watches. She then takes the remaining two doses at home, where she will experience what amounts to an induced miscarriage. She follows up with an in-person visit at the clinic in 12-14 days, also speaking with the doctor again via video conference if necessary.
This has increased access for women who would otherwise have had to travel long distances to have the medication provided. In five years, there has not been one complaint from a patient about the process.
Iowa was the first state in the nation to use the video conference system. Since then, only a handful of states allow the practice. In the same time period, eleven states have banned the practice all together. It should be noted that in all these states, telemedicine is allowed for other medical procedures. They have only outlawed it for abortion.
During the Iowa medical board hearing, opponents of using the system expressed concerned about the safety of women. Planned Parenthood presented the results of a 2011 study published in Obstetrics and Gynecology which compared women taking RU-486 via telemedicine consultation to those who had face to face visits with a physician. The study found identical complication rates (1.3%) regardless of consultation method. In fact, women who used the telemed method had a higher successful abortion rate (99%) than those who saw a physician (97%).
Since approval by the FDA in 2000, more than 1.5 million women have used RU-486.
In Iowa, access to the service did not make abortion more common. 3000 women in Iowa have had a chemically induced abortion after video conference consultations without complaint. The number of abortions decreased, however, by 30 percent during the same time period. Planned Parenthood and other agencies in Iowa were part of a five year program that dispensed free birth control to women, focusing on long-term methods such as IUDs. Planned Parenthood implanted more than 3,400 long-term contraceptives per year during the program. The number of abortions dropped from 6,649 in 2007 to 4,648 in 2012.
If using the video conferencing system was both safe and effective, and fewer abortions are being performed overall, why the sudden desire on the part of the medical board to ban the practice? The answer: anti-choice Republicans.
Planned Parenthood had been safely using the video conferencing system for two years when the medical board reviewed the practice for state licensed physicians in 2010 after complaints from anti-choice groups. They let the practice continue. In 2011 and 2013, the legislature made attempts to ban the practice, but was unable to pass a law. Finally, Republican Governor Terry Branstad replaced all ten members of the board with known anti-choice members. The new board held their first hearing on the use of telemedicine for medicine induced abortions in June of this year.
The new guidelines require that a physician performs all examinations and consultations in person; be present when providing “abortion inducing” drugs; and physically meet with the patient for the follow up appointment. This will make it more difficult for women in rural areas as they will have to travel — twice — to the few areas where a doctor is available. This could also increase the costs for these women, including the possibility of requiring a surgical abortion if there is a delay in making arrangements.
While the procedure is still technically legal, the risk of fines or other disciplinary action by the board essentially bans the practice. The new rules are set to go in effect in November. Planned Parenthood is considering challenging the new rules in court.