Study shows that telemedicine expands abortion access in Iowa

A new study published in the American Journal of Public Health analyzes the use of telemedicine to remotely administer "medical" (chemical, RU486) abortions in Iowa. Planned Parenthood began performing these "webcam abortions" in 2008, and by 2010 they were offered at 11 different clinics across Iowa.

The study should be taken with a few grains of salt because the authors strongly favor abortion; one actually worked for Planned Parenthood in Iowa at the time of the study, and two more work for the abortion advocacy organization Ibis Reproductive Health. The research should not be dismissed for that reason -- it must be assessed on its merits -- but readers should know the ideological perspective the authors seek to advance.

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The study only analyzes the first two years after webcam abortions were introduced -- and they were "phased in" over 21 months, nearly the entire study period -- so the full effect may not yet be clear (a limitation acknowledged by the authors). But here is what the researchers write in their summary:

[T]he proportion of abortions in the [Planned Parenthood] clinics that were medical increased from 46% to 54%. After telemedicine was introduced, and with adjustment for other factors, clinic patients had increased odds of obtaining both medical abortion and abortion before 13 weeks' gestation. Although distance traveled to the clinic decreased only slightly, women living farther than 50 miles from the nearest clinic offering surgical abortion were more likely to obtain an abortion after telemedicine introduction.

The researchers also note that overall abortions in Iowa declined during this period (as they did in many states), but that is clearly despite the webcam introduction, not because of it. Planned Parenthood -- the group performing the webcam abortions -- saw an increase in abortions. And while abortions dropped in the heavily-populated Des Moines area (where abortion was already very accessible), "the data showed ... an increase in the number of abortions performed on women living in the western and eastern portions of the state" -- the places where webcam abortions were introduced. Indeed, "availability of abortion services certainly increased after telemedicine introduction, because the number of clinics providing abortion care increased."

While the number of surgical abortions decreased, the number of RU486 abortions increased. And "most of the increase in the number of medical abortions after telemedicine introduction occurred among women living more than 50 miles from one of the surgical abortion clinics, especially in more remote parts of Iowa, as well as in eastern Nebraska and northwest Illinois. In most cases, the increases occurred in areas surrounding telemedicine sites."

With regard to abortion clinics in general (not just Planned Parenthood clinics), "The proportion of medical abortions among all abortions increased significantly, from 33.4% to 45.3%." So almost half of abortions in Iowa from 2008 to 2010 were RU486 abortions. That is startling, and the percentage is probably higher now than it was over the whole two-year period.

The authors conclude that "telemedicine could improve access to medical abortion, especially for women living in remote areas, and reduce second-trimester abortion." The bottom line is that this study provides evidence that the use of telemedicine for abortion does precisely what one would expect: it increases the incidence of RU486 abortions, increases the percentage of overall abortions that use RU486, and increases the incidence of abortion among women in rural areas -- which increases the overall incidence of abortion relative to what it would otherwise be. None of that is good considering both the unborn children killed and the women who risk their health by this particular abortion method.

Policy analyst Jacqueline Harvey, Ph.D., notes:

While methodologically sound, the study reads more like market research than a treatise on public health, especially since there was no mention of any complications. Using the most conservative numbers in range on incomplete abortions requiring surgical follow-up to a mere 2%, this means that of the study's 9,758 patients, at least 195 women who could not make the trip to a see a physician in person faced this complication alone. While earlier abortions do pose less risk, the authors do not acknowledge the risks involved with unsupervised self-abortion. The authors herald tele-med abortions as increasing access to abortions for women in rural areas, but do not consider a potential danger for women who cannot be treated for complications over a webcam.

The study is especially relevant to us in Minnesota because Planned Parenthood is now offering webcam abortions at its Rochester facility. It could soon expand this practice as it did in Iowa.