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Editorial: Abortion rate falling despite increased access

BY DI EDITORIAL BOARD | AUGUST 30, 2013 5:00 AM

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Iowa’s long debate over the fate of telemedicine abortion appears to be nearing its conclusion.

The Iowa Board of Medicine is now considering banning doctors from administering abortions using a videoconference system. Several board members raised concerns about the practice at a public hearing on Wednesday, approximately two months after responding to a petition that called for new state regulations on Planned Parenthood’s controversial system of remotely providing pregnancy-terminating pills.

Board members voted 8-2 on June 28 to initiate the state’s rulemaking process. The vote did not prohibit telemedicine abortions but instead allowed for a public comment period along with a final vote by the board that just took place.

The key issue at this point is apparently the safety of the procedure.

Opponents argue that “webcam abortions” — as critics call it — expose women to potentially dangerous drugs without having a physician readily available to help patients who may experience complications.

Currently, Planned Parenthood of the Heartland is the main organization that provides abortion-inducing drugs via videoconference. The patient takes the drug with a Planned Parenthood staff member present and while in video contact with a doctor. The patient then receives a second drug and instruction on how to take it within 24 to 48 hours. A follow-up visit is scheduled within two weeks.

Proponents, on the other hand, say the practice offers women access to safe medication and that those opposing it simply want to make it harder to get an abortion in Iowa.

It is currently unclear whether telemedicine chemical abortions are as safe as chemical or surgical abortions performed in the presence of a physician.

Regardless of what the board decides, what is certain is that since the introduction of telemedicine abortions in 2008, abortion rates have fallen by 30 percent. According to state data, numbers have dropped from 6,649 in 2007 to 4,648 in 2012.

It is more or less unclear why exactly this dramatic drop took place, but the statistics do seem to indicate that increasing access does not lead to an increase in the number of abortions, as many opponents of increasing access to abortion tend to argue. The supposed link between supply of abortion services and the demand for those services appears to be very weak.

Increasing abortion services does not increase the demand for abortions and, correspondingly, reducing the number of abortion providers will not magically reduce the demand for abortions. Thus, a potential decision to shutter Planned Parenthood’s remote clinics would be a step backward in ensuring equal access to health care among all populations.

In 2008, there were only 11 abortion providers in the entire state of Iowa. Those 11 providers represented a 22 percent increase from 2005, when there were nine. Ninety-one percent of Iowa counties had no abortion provider, and more than half of Iowa women lived in these counties.

Planned Parenthood of the Heartland, as a result of its pioneering telemedicine, provided these women with the ability to obtain an abortion and delivered pills to patients in 15 clinics around Iowa following video consultation with a physician. The organization has dispensed the pills at least 3,000 times since 2010. In fact, there were 1,020 abortions performed by telemedicine in Iowa in fiscal 2010.

Women, particularly those in rural Iowa who had much easier access to abortions after the introduction of a telemedicine system, would find that access limited again.

The Iowa Board of Medicine should act to keep telemedicine abortions available across the state.


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