Telemedicine increases access to abortion for rural women

Professor Lisa R. Pruitt in A Feminist Theory of the Rural, 2007 Utah L. Rev. 421, discusses the negative effects judicial decisions regarding abortion, including mandatory waiting periods, have on rural women. Many of these negative effects stem from the lack of abortion providers in rural communities. Rural women face many barriers to accessing abortion providers in distant metropolitan areas including limited or nonexistent transportation and burdensome distances that can entail hours or days of travel. With telemedicine, travel may no longer be a barrier for some rural women.

Telemedicine uses new technology like videoconferencing to provide rural communities greater access to medical services. More recently, clinics have utilized telemedicine for a controversial procedure- abortion. For the past four years, Planned Parenthood of the Heartland in Iowa has utilized telemedicine to increase access to abortions for rural women, and a new study of the program provides promising results.

Planned Parenthood of the Heartland was the first clinic to use telemedicine abortions. The procedure begins with the woman receiving an ultrasound to determine how far along she is in her pregnancy. Then a nurse inspects the patient before she has an interview with a doctor via a webcam. If the doctor decides that the procedure is appropriate, the doctor pushes a computer button that opens a small drawer in front of the patient, which contains a pill, usually the drug RU-486. The patient takes the first abortion pill while the doctor observes her via webcam. The patient then takes the rest of the pills at home.

A study the American Journal of Public Health published last week relayed the effects the new program has on abortions in Iowa. The study's lead author was Dr. Daniel Grossman, an assistant professor at the University of California, San Francisco and a senior associate with Ibis Reproductive Health, a research-based non-profit. The study tracked the number of abortions in Iowa for two years before the new telemedicine program began. According to USA Today, the results of the study showed that the rate of abortions declined in Iowa during the four-year period, while Planned Parenthood reported a slight increase in abortions. The study also found a slight decrease in the number of abortions in the second trimester, a time when the risk for complications is higher, but the decrease was so slight that it required further study. Finally, the study found that the telemedicine procedure provided more rural women access to abortion providers.

In another study that the journal of Obstetrics and Gynecology published in 2011, Grossman followed 578 women who came to the Iowa Planned Parenthood clinic to use the drug RU-486. According to an MSNBC report, the women were able to choose telemedicine or face-to-face consultations, with 223 women signing up for telemedicine consultations and 226 women for face-to-face consultations. Termination of the pregnancy was successful in 99% of the telemedicine patients as opposed to 97% of the face-to-face patients, and there was no significant difference between the two when it came to medical complications. In addition, 94% of the women who used telemedicine were "very satisfied" with the procedure. In addition, telemedicine patients were more likely to report satisfaction with their care than those receiving face-to-face care. Even so, 25% of the telemedicine patients said they would have preferred to have their doctor in the room.

While the procedure purports many benefits, it is not without its critics. Cheryl Sullenger, a senior policy adviser for Operation Rescue, an anti-abortion group, criticized the procedure because licensed physicians do not physically examine the women and the women undertake a multi-day abortion process at home without easy access to a physician. Troy Newman, the president of Operation Rescue, says the decreases in abortions are part of a nation-wide trend and are the result of efforts of organizations like his who fight to curb the number of abortions. He also argued the pill used in the procedure has caused infections, which the U.S. Food and Drug Administration says is not true.

In addition, Dr. Morris Wortman, a professor at the University of Rochester School of Medicine and director of the Center for Menstrual Disorders and Reproductive Choice, said that telemedicine depersonalizes an emotional procedure. He believes it would be more difficult for a physician to console a patient who is not in the room.

Some states, including Arizona, Kansas, North Dakota, Nebraska, and Tennessee, have passed laws limiting telemdicine abortions. If new legislation passes in Texas, it will require physicians to personally administer both of the abortion drugs and have a follow up visit with the patient within 14 days. These requirements are in addition to the current requirement of having a physician conduct a sonogram on the patient 24 hours in advance of the administration of the first pill. If the law passes, it will in effect eliminate telemedicine abortions in Texas.

Proponents of the procedure claim that it is perfectly safe and legal. In addition, they point out that it is just a part of a larger trend in the medical field toward telemedicine and remote care. Arthur Caplan, a medical ethicist, also says the opposition to the procedure has little to do with the safety of women and more to do with an anti-abortion agenda. He argues that people should not attack a procedure that provides greater services to rural women and that we should celebrate telemedicine for its ability to help solve the problem of a dearth of primary care physicians in rural areas.

While there are disadvantages to not having a doctor in the room during a very emotional procedure, telemedicine is one way to give women in rural areas an opportunity to exercise their right to an abortion. The procedure may not be ideal; however, unless there is a way to attract more physicians to rural areas it is a better option than having the semblance of an option.