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Moves To Ban Telemedicine Abortion Could Limit Early Access to Abortion

May 20, 2015 — While efforts are underway to advance federal legislation (HR 36) that would ban abortion at 20 weeks of pregnancy, several states already have moved to ban abortion via telemedicine, a method that can help women access the procedure earlier in pregnancy, Kaiser Health News reports.

Background

Generally, according to KHN, a telemedicine abortion involves a woman and a physician meeting via a video connection while the woman is at the clinic. The physician will determine whether it is appropriate to prescribe the woman the two drugs used to induce a medication abortion. Medication abortion can be performed up to nine weeks of pregnancy.

Currently, telemedicine abortions are restricted in 16 states, where physicians are required to be physically present when administering medication abortions. Telemedicine abortions are permitted in Minnesota and Iowa, although the Iowa Supreme Court is currently weighing a rule from the state Board of Medicine that would require in-person medication abortion.

Benefits of Telemedicine Abortion

Supporters of telemedicine abortion have said the procedure increases the chances that a woman who is seeking an abortion can obtain the procedure earlier in pregnancy, when it is safer and less costly, KHN reports.

Further, they said it could help women seeking abortion care in areas with few providers. According to a report from the Guttmacher Institute, as of 2011, nearly 90% of counties in the U.S. do not have abortion clinics, and more than one-third of women of childbearing age resided in one of those counties.

Meanwhile, the overall abortion rate has decreased since 1981, but the rate of medication abortion -- provided in person or via telemedicine -- has increased from 17% in 2008 to nearly 25% as of 2011, according to KHN. Further, a recent study found that in Iowa, where Planned Parenthood of the Heartland provides telemedicine abortions at six locations, women who had abortion were 46% more likely to have the procedure in the first trimester of pregnancy once telemedicine abortion was introduced. The study, which compared the two-year periods before and after telemedicine abortion was offered, also found that the proportion of medication abortions at the PPH clinics increased from 46% to 54%.

Daniel Grossman, the study's lead author and vice president for research at Ibis Reproductive Health, said, "From a public health perspective, even though there was a relatively small decline in second trimester abortions, it's significant. Second trimester abortions have higher complications and are more expensive for women." According to Guttmacher, a first-trimester abortion cost about $500 in 2012, while abortion at 20 weeks had a median cost of $1,350.

Opponents Use Unfounded Safety Claims To Push Restrictions

According to KHN, abortion-rights opponents often try to restrict the procedure, claiming that it is unsafe, and are working to impose restrictions that require physicians to dispense medication abortion in person. However, supporters of abortion rights note that telemedicine abortion is safe and that requiring a physician's presence is not necessary.

For example, Penny Dickey, chief clinical officer at PPH, said patients receive exactly the same care whether the procedure is done with a physician in the room or via telemedicine.

Further, Grossman in a 2011 study found that medication abortions done in person and those done via telemedicine had nearly identical outcomes, with 99% of telemedicine patients and 97% of in-person patients having successful abortions. Grossman said, "Adverse events are no higher with telemedicine. We have looked at this and we have some data that shows it's just as safe as medication abortions provided in person" (Andrews, Kaiser Health News, 5/19).