The Abortion Fight Unfolding In Iowa That Could Have Huge Implications For The Rest Of The Country


(Credit: AP/Manuel Balce Ceneta)

As all eyes have been trained on high-profile battles over abortion access in Texas and North Carolina, you probably haven’t heard much about Iowa lately. Health officials in the Hawkeye State have been quietly moving forward with an anti-choice initiative that’s largely flown under the radar. Iowa’s Board of Medicine is proposing rules that would ban so-called “telemedicine abortion” — an initiative that would ultimately threaten reproductive health care for the state’s low-income and rural communities, and could also spark a legal fight with implications for abortion access across the country.

What’s “telemedicine abortion”? Why are we fighting over this? What does this mean for the broader reproductive rights landscape? Here’s what you need to know:

“Telemedicine” is becoming a standard health practice. “Telemedicine” is a fancy term for the practice of using video technology to allow doctors to consult with patients remotely. Telemedicine procedures, which were first invented in the 1960s to treat astronauts, are becoming an increasingly standard practice in the medical community. Telemedicine is now used by about 10 million to 12 million Americans every year, and the federal government has adopted the practice to treat chronically ill veterans. In 2008, Planned Parenthood of the Heartland began using telemedicine to expand disadvantaged women’s access to abortion. Iowa was the first state to pioneer a telemedicine abortion program, hoping to help women in rural areas who don’t live near an abortion clinic and can’t afford to travel to the closest one.

Telemedicine abortions are very safe. The anti-choice community tends to decry telemedicine reproductive care as “webcam abortions,” drumming up fear about robot doctors operating on women. In fact, the procedure simply involves a doctor prescribing a pill over a video chat. Telemedicine abortion is only available for women who are having first-trimester, non-surgical, medicine-induced abortions. Several studies have confirmed that women feel satisfied with these procedures, and it makes no difference to them whether they’re speaking with a doctor in person or over the phone. Research has also shown that it’s very safe — which makes sense, because first-trimester abortions are incredibly safe.

Abortion opponents see telemedicine as yet another avenue to cut off access to abortion. Telemedicine abortion programs are not actually very common yet. (Planned Parenthood of the Heartland runs the largest one in Iowa, and there have been fledgling initiatives in Nebraska, Minnesota, and Texas.) But abortion opponents are preemptively attacking it anyway, hoping to cut off the possibility of expanding reproductive access to more women. Over the past several years, twelve states have rushed to enact bans on telemedical abortion services even if they’re not currently in place. Now, state laws often stipulate that women must be in the presence of a doctor when taking the abortion pill — even though that’s medically unnecessary — preventing telemedicine programs from even getting off the ground. Other states try to limit access to the abortion pill by forcing clinics to adhere to outdated methods of administering it.

Iowa’s Board of Medicine reviewed and approved the telemedicine program in 2010 — but since then, the Board has been stacked with abortion opponents. Iowa Gov. Terry Branstad, an ardent anti-choice Republican, has replaced all ten members of the Board since the last review of the telemedicine abortion program. Now, it’s filled with abortion opponents, including a Catholic priest. In June, those new members of the board voted to approve rules that would ban Iowa’s telemedicine services for abortion care. And this week, a legislative committee agreed to let the Board continue with implementing those rules. “This is a terrifying example of politics dictating health care,” Dr. Robert Shaw, the chairman of Planned Parenthood of the Heartland’s board of directors, said on Wednesday.

The nation’s biggest telemedicine program could be banned as early as October. The Board of Medicine will hold a public hearing about the matter at the end of this month. After that, the Board will review the proposed rule again — and, given the overwhelming support for it among the new board members, it will likely go ahead and approve it. The telemedicine ban could take effect this fall.

As states move to shut down abortion clinics, access to telemedicine is more important than ever. Around the country, state legislators are launching a coordinated attack on abortion clinics — a somewhat indirect method of limiting abortion access without banning the procedure altogether. The recent high-profile fight in Texas culminated in the GOP-led legislature approving sweeping new restrictions that will likely force 90 percent of the state’s clinics to close. As low-income women lose access to nearby clinics and may be forced to travel hundreds of miles to get to the nearest one — an expensive trip that many of them cannot afford — the ability to consult with a doctor remotely could significantly improve their ability to get the care they need. As the American Prospect points out, there are other legal challenges brewing about telemedicine in other states, too. If these programs are banned, and if courts allow those bans to stand, it could have implications far outside of Iowa. It could signal that this particular avenue is totally cut off to reproductive health advocates, and low-income and rural women will pay the price.