Restrictions on medication abortions hurt rural women

NPR's Jennifer Ludden reported today on the ways in which states are increasingly regulating medication abortion.  Needless to say, this has an enormous impact on women who must travel farthest to reach an abortion provider—especially if other regulations in a given state require multiple visits to the provider.  In short, rural women stand to benefit most from the availability of medication abortion, especially if the medicines can be dispensed remotely—with the physician not necessarily in the presence of the woman.

Ludden contrasts Ohio, where lawmakers are seeking to further restrict medication abortion, with Iowa, where—until 2013—the drugs were dispensed using telemedicine.  Penny Dickey, chief clinical officer of Planned Parenthood of the Heartland described the Iowa process, in use from 2008 until Iowa's Board of Medicine—newly populated by appointees by a Republican governor—ordered it stopped in 2013:

"The physician and the patient connect via a HIPAA-compliant video conferencing system,"  The doctor reviews the woman's ultrasound online and they talk about her medical history. Then ... the doctor clicks in his or her computer to open a locked drawer where the patient is sitting. 

"It will say, are you sure you want to do this?" she says. "And they'll click again, and the drawer will open." 

Inside are the two medications. The woman takes the mifepristone in view of the doctor. A clinic staffer sitting with her confirms instructions on taking the second drug at home.

When in use, the program led to earlier abortions, which are also less expensive and safer.  Planned Parenthood of the Heartland has sued the state over the ban; the case is now before the Iowa Supreme Court.  

Meanwhile, 16 states have proactively banned telemedicine for abortion, and more such bills are expected in other statehouses this year.

For this story, Ludden interviewed Dan Grossman, an obstetrician who is vice president of Ibis Reproductive Health, a nonprofit that promotes safe access to abortion.  He says "medication abortion is so safe and so easy, you can imagine not needing to visit a clinic at all.

Medical abortion has the potential to be a real disruptive technology and change the way women access and experience abortion. …  It would really be quite easy for women to actually use this on their own … and potentially access this medication directly from a pharmacy. It could almost be eligible for the kind of medication that could be available over the counter.

I discuss medication abortion, in particular in relation to a Texas law limiting its use, in this article.  The Iowa shift on medication abortion was the topic of this earlier post.  Iowa's initial decision to permit medication abortion remotely was the subject of this post.