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Telemedicine Abortions Upheld In Iowa

Sarah Boden / Iowa Public Radio
Planned Parenthood Rosenfield Center Manager Fiona Tubmen-Scovack (left) and Dr. Jill Meadows demonstrate telemed technology.

The Iowa Supreme Court saystelemedicine abortions in Iowa are allowable. In 2013 the Iowa Board of Medicine created rules that effectively banned abortions performed by video conference, but the state’s high court says these rules create an undue burden for women seeking to terminate a pregnancy. 

During a telemed abortion, a doctor oversees a patient taking the abortion-inducing medicine mifepristone through a two-way video conference. After taking the first pill, a woman goes home where she takes a second medication, misoprostol, and completes the abortion.

Aside from a single clinic in Rochester, MN, Iowa is the only state to provide abortion through a statewide telemedicine network. Planned Parenthood of the Heartland started providing the service in 2008.

The Iowa Board of Medicine determined that abortions performed by telemedicine were unsafe, since a doctor was not physically present during the procedure.  The board created standards of practice requiring a doctor to perform a physical examination prior to abortion, as well as a follow-up appointment.

Planned Parenthood, which is the state's sole provider of telemed abortions, argued the 2013 rules create an “undue burden” for women. The women's health organization say the rules are medically unnecessary and hold abortion to a higher standard than other telemedicine services.

The Iowa Supreme Court agrees.

"It is difficult to avoid the conclusion that the Board’s medical concerns about telemedicine are selectively limited to abortion," writes Justice David Wiggins, in the unanimous opinion. "The Board appears to hold abortion to a different medical standard than other procedures."

The American College of Obstetricians and Gynecologists, which submitted an amicus brief in favor of telemed abortions, says the service is particularly beneficial to women in rural communities, whose reproductive health needs can be underserved.

“This is especially true in a state like Iowa, where many women would have to travel hundreds of miles in order to each an abortion clinic,” writes ACOG’s president, Dr. Mark S. DeFrancesco. “Before the telemedine abortion program was implemented in Iowa, 91 percent of counties in the state lacked a known abortion provider.”

Accordingto the Guttmacher Institute, a pro-abortion research organization, many states restrict abortion access through regulation. Various states mandate waiting periods, pre-abortion counseling and parental notification, permit hospital-only abortions or ban insurers from providing abortion coverage.

“This is a major victory for the women of Iowa, and reproductive rights,” says Suzanna de Baca, Planned Parenthood of the Heartland's president.

Planned Parenthood of the Heartland provides women’s health and reproductive services in Iowa, Arkansas, Nebraska and eastern Oklahoma. Due to bans on the use of telemed abortion in the other three states, the organization has no plans to expand the service outside Iowa.

Telemed abortions first came to the attention of the Iowa Board of Medicine 2010, when anti-abortion advocacy group Iowa Right to Life filed a petition saying the practice was unsafe. At that time the board declined to act.

IRTL again petitioned the board in 2013, urging it to create the new standard of care. The 2013 board was appointed by Republican Gov. Terry Branstad, while the 2010 board held appointees nominated by Democratic Gov. Chet Culver.

“If people think that Iowa Right to Life as an organization are going to put up the white flag and surrender to this you know, they don’t know us,” says Jennifer Bowen, IRTL executive director. “We are just as committed to the fight today, as we were yesterday, as we were five years ago.”

“I could not speculate on how the board will react to the application, or how the board will apply that opinion, other than the board has historically respected the decisions of the court,” says Iowa Board of Medicine Executive Director Mark Bowden. The board next meets on July 9 and 10, where it will discuss the ruling.

It’s unlikely the board could successfully appeal to the U.S. Supreme Court. Earlier this year the nation’s high court declined to hear an appeal from North Carolina, after the United States Court of Appeals for the Fourth Circuit struck down a law that requires women to have an ultrasound prior to an abortion.

“The Supreme Court did that even though there’s a lot of controversy among the circuits and in state courts about whether or not procedures like an ultrasound constitute an undue burden,” says Drake University Law School’s Renee Cramer. “This Supreme Court also has a tendency to let state court rulings stand and it’s a pretty well established norm of judicial respect to allow state courts [to] interpret their constitutions and constitutional provisions rather than have the federal court step in.”