Study: Telemedicine hasn't increased Iowa abortion rate

• Proponents say the system is safe and legal
• Opponents say women can suffer dangerous complications at home
• Growth in remote abortions reflects burgeoning demand for telemedicine, researchers say

DES MOINES, Iowa -- A remote-control abortion-pill distribution method pioneered in Iowa four years ago improved access to women living in rural areas and did not increase the number of abortions performed in the state, according to a study released Thursday by the American Journal of Public Health.

The study examined the number of abortions in the two years before and after Planned Parenthood of the Heartland introduced abortions by telemedicine, which allows a woman to visit a clinic and take a pill administered by a doctor after a video conference.

The results showed the rate of abortions declined in Iowa after the procedure was made available in June 2008. At the same time, Planned Parenthood reported a slight increase in abortions performed as more women opted for the new procedure, said Daniel Grossman, the study's co-author.

Proponents say the system is safe and legal, and provides access to abortions in rural areas where no other doctors offer them. Proponents also note the procedure is part of a larger trend of increased remote treatments in all medical fields. Opponents call the system unsafe because the doctors have little in-person oversight and because the women can suffer dangerous complications at home.

A key finding of the study was that remotely administered abortions provided more access to the procedure to women who would otherwise have trouble finding an abortion provider, Grossman said.

"I think the most important thing is that it showed how access was improved after telemedicine was introduced," said Grossman, vice president for research at Ibis Reproductive Health in Massachusetts. The organization works to improve access and choice for women's reproductive health services.

The study also found a slight decrease in the number of abortions performed during the second trimester of pregnancy, when risks of complication are higher, said Grossman, also a clinical professor in the obstetrics department at the University of California in San Francisco. He noted the decrease was small enough to require further study.

"In the reduction of second trimester abortions, it will be important to see how that continues to play out," he said. "We know that earlier abortions are safer than later abortions."

The issue erupted into controversy about four years ago, when Planned Parenthood of the Heartland debuted the first-in-the-nation system.

Opponents asked the Iowa Board of Medicine to rule that doctors using the system violated state law because they weren't present when abortions were performed. The board declined the request.

Troy Newman, president of Operation Rescue, said the decreased number of abortions is the result of efforts by organization like his national anti-abortion group to curb the procedure's use.

The decrease also reflects a national trend, he said. The rate of abortions nationwide declined between 2000 and 2008, according to the most recently available Census data.

Newman dismissed the significance of the decrease in abortions performed after the first trimester because he said all lives are worth saving, regardless of gestational age.

Newman also argued that the pills a woman takes for the procedure are dangerous and have resulted in at least 11 deaths, often because of infection. The U.S. Food and Drug Administration, however, has said there is no evidence either of the pills, Mifeprex and misoprostol, has caused fatal infections.

"This lowers the standard of care for women, when we should be increasing it," said Newman, who argued the possibility of complications from a procedure remotely administered by a doctor lowered quality of care.

Planned Parenthood of the Heartland officials said a prior survey of women who have used the procedure showed a high rate of satisfaction and low rate of complications. There were 1,021 abortions performed through telemedicine in Iowa during fiscal year 2012, which ended June 30, according to the group.

In the telemedicine or remote control abortion-pill distribution method, a patient is first examined by a nurse at the small-town clinic, then interviewed via computer for several minutes by a doctor. Once the doctor determines that the medication would be appropriate, he or she pushes a computer button that opens a drawer in front of the patient. The patient withdraws the pills from the drawer and takes the first dose while the doctor watches. She then takes the rest of the pills at home, where she aborts her pregnancy.

The study released Thursday illustrates the value of remotely administered abortions, which provide quality, timely care to women close to home, said Penny Dickey, a Planned Parenthood of the Heartland public affairs officer.

"The results of this study confirm that providing access to medication abortion using telemedicine does not increase the number of abortions, but allows a woman to end a pregnancy when and where it is best for her," Dickey said in a statement.

The growth in remote abortions in Iowa reflects a global burgeoning demand for telemedicine, from general medical care to virtual visits by specialists, said Grossman, the study's co-author

The global telemedicine market is expected to double from $11.6 billion in 2011 to about $27.3 billion in 2016, according to a report from BCC Research in Massachusetts.

"There's more and more use of telemedicine for different kinds of consultations," Grossman said. "This is really just another application of that."