June 9, 2010 — The success of an Iowa-based program that uses telemedicine to increase rural women's access to medical abortion services has led other U.S. providers to consider replicating the effort, the New York Times reports. However, some antiabortion-rights advocates argue that it "tests the already complicated bounds of telemedicine," according to the Times.
Since June 2008, Planned Parenthood of the Heartland has used videoconferencing and an automated dispensing system to allow physicians to provide women with abortion medication at 16 Iowa clinics, resulting in 1,500 medical abortions.
The telemedicine process "feels not unlike any ordinary doctor's office visit," except that the doctor appears before the patient on a computer screen, the Times reports. Prior to the start of videoconferencing, the patient meets in person with a nurse. The nurse takes a medical history and performs a blood test, an exam and ultrasound; provides counseling on the procedure; and discusses plans for follow-up care and exams. The results of the consultation are shared via computer with the doctor, who then conferences with the patient over a private network. The patient is accompanied by the nurse at all times, and there have been no reports of serious complications from patients who have used the program.
A common regimen for providing medical abortion involves the administration of the drug mifepristone followed one or two days later by the drug misoprostol. Since FDA approved mifepristone for early pregnancy termination in 2000, more than one million women have ended pregnancies through medical abortion. Although the total number of abortions has declined in recent years, a growing proportion of women are opting for medical abortions rather than the surgical procedure.
Some abortion-rights advocates have long considered medical abortion a way to increase access to abortion services for women in rural and remote areas, where surgical abortion providers are scarce. However, few doctors offer mifepristone to women seeking abortions, according to Jill June, CEO of Planned Parenthood of the Heartland. June said she came up with the idea for the telemedicine program after considering the lack of providers and watching a TV show about doctors performing complicated surgeries via a robotic device. She said, "If they can do some of these complicated surgeries from miles and miles away from an operating room, why can't I hand someone a pill across the state?"
Abortion-rights opponents argue that the program puts women's safety at risk because they do not meet in person with a doctor, the Times reports. Troy Newman, president of the antiabortion-rights group Operation Rescue, said the program is "a prescription for disaster," adding that it "remov[es] the doctor-patient relationship from this process." Operation Rescue this spring filed a complaint with the Iowa Board of Medicine arguing that teleconferencing does not meet the state's law requiring licensed physicians to perform abortions.
Abortion-rights leaders counter that the program has proven safe and effective and that patients are comfortable with the process. Vanessa Cullins, vice president for medical affairs at the Planned Parenthood Federation of America, said that the program's critics "are not really protesting the new technology," adding, "They are protesting abortion in general" (Davey, New York Times, 6/8).