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Expand access to reproductive care

BY DI EDITORIAL BOARD | NOVEMBER 28, 2012 6:30 AM

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A study to be published in the December edition of the American Journal of Public Health has found that the use of telemedicine abortions in Iowa has not increased the state's abortion rate, despite expanding access to such procedures in much of rural Iowa.

Telemedicine abortions — a unique type of procedure during which a doctor consults with a patient via videoconference and administers pregnancy-terminating drugs via remote-control — have been available in Iowa since 2008. The procedure was introduced to ensure that women living in rural Iowa, far from clinics that perform in-person abortion services, could receive adequate medical treatment. Since then, the study found, the abortion rate in Iowa has fallen and that the proportion of medical (non-surgical) abortions has risen from 46 percent to 54 percent.

The availability of telemedicine has decreased the likelihood of second-trimester abortion and improved access to abortion services for women living more than 50 miles from a clinic offering in-person abortion services.

These findings point to an important theme emerging in the research surrounding abortion rates: as access to reproductive health care increases, abortion rates fall. Arguments against expanding access to important reproductive health services are usually characterized by a fear that such measures will serve to increase the number of abortions performed. There is simply no empirical reason to believe that.

The Daily Iowan Editorial Board applauds the state of Iowa for introducing telemedicine to the rural reaches of the state; we believe that responsibly expanding access to reproductive health care is the best way to bring down abortion rates and ensure that women who do choose to have abortions receive high-quality care.

In Iowa and nationwide, abortion rates are falling. The Centers for Disease Control and Prevention last week released the abortion-surveillance data for 2009, which show a 5 percent drop-off in the number of abortions performed from the 2008 rate. Prior to that, abortion rates had been trending downward for more than nearly three decades. Between 2000 and 2009, the abortion rate fell by 7 percent.

One crucial contributor to falling abortion rates is increased access to and use of contraception. As top-line rates have fallen, abortion has become more concentrated among poor women, who have increasingly limited access to contraception and accounted for more than 40 percent of the nation's abortions in 2008, according to a study published in the journal Obstetrics and Gynecology.

"The economic recession that was occurring in 2008 may have made it harder for poor women to access contraceptive services, resulting in more unintended pregnancies," wrote Rachel K. Jones and Megan Kavanaugh, the study's coauthors.

The study also noted that poor women are the group most likely to be hurt by policies that limit access to health care, which could explain why abortion rates remain stubbornly high among this group.

Access to contraception does indeed make a world of difference. A study released in the fall by researchers at Washington University in St. Louis found that provision of free contraception dramatically lowers abortion rates. For three years between 2008 and 2010, approximately 9,000 females aged 14 to 45 were given free contraception. The abortion rate among the experiment group was about 6 per 1,000; nationwide, the average was 19.6 per 1,000.

Improving reproductive health care has a track record of reducing abortion rates; moral suasion and shuttering clinics do not. The state of Iowa and the nation as a whole should continue to expand access to reproductive care; ultimately, it is everyone's best interest.


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