Girl on laptop via Alessandro Valli
The field of telemedicine—the act of “visiting” a doctor remotely using internet video conferencing—is an exciting development that could change the lives of individuals living in remote areas or without access to reliable transportation. The internet democratizes reasonably-priced health care. You don't have to travel to see a doctor you like; you don't need to take up as much of a doctor's expensive office hours if you’re simply Skyping her with a question.
While it’s likely that telemedicine will expand preventative health care and improve doctors’ efficiency by evaluating whether a patient needs a “hands-on” appointment, it also has important implications for women seeking medical abortions.
The Iowa state government is conducting hearings to evaluate the currently legal practice of telemedical abortion. Members of the Iowa Medical Board who oppose the practice are facing off against members of Planned Parenthood.
Telemedical abortion has been legal in Iowa since 2008. To undergo the procedure, a woman must undergo an ultrasound by a trained professional in her hometown. She receives standard information about medical abortion and signs a consent form. At this point, a physician teleconferences in via a secure line to answer any questions the woman may have, review her medical history, and determine whether she is a candidate for a medical abortion. After this, the doctor enters a passcode at her location that unlocks a drawer in the woman’s clinic containing mifepristone and misoprostol, medications that produce a medical abortion—sometimes referred to as the “abortion pill.”
The women then returns home where she essentially experiences an induced miscarriage. Prior to telemedical abortions, there were six clinics offering abortion services in Iowa. Now nine additional clinics provide telemedical abortion services, usually in rural and underserved areas. There is a low rate of complications with the abortion pill, so Planned Parenthood and other advocates of telemedical prescriptions argue that this type of prescription is just as safe as prescriptions where women are physically seen in a clinic.
Despite the increase in clinics where women can access abortion services, the number of Iowan abortions has actually dropped 30 percent since 2007, from 6,649 that year to 4,648 in 2012. The drop may be attributed to greater emphasis on preventative measures, including a push towards implantation of long-acting birth control devices (IUDs).
Women are now more likely to utilize a medical abortion instead of a surgical abortion and are also getting abortions earlier in pregnancy—a positive shift, as abortions become riskier as a pregnancy progresses.
But whatever the data say—and the data suggest very positive things thus far—the pushback from the Iowan Medical Board doesn’t necessarily utilize numbers as a metric of success. Where women’s health care and abortion and contraceptive access is concerned, it’s obvious that science does not often prevail.
It was an epic undertaking to make Plan B (often mistakenly referred to as “the abortion pill,” although it does not cause abortions) available over the counter, despite years of FDA recommendations to do so. Plan B One Step has just been made available to women of all ages (it’s no longer kept behind the counter like other versions of emergency contraception) after more years mired in controversy. The list goes on—the insanity that was last year’s laser focus on women’s right to birth control access, sometimes referred to as “slut pills.”
The science behind women’s reproductive rights is only part of its deeply complicated history. Telemedicine itself is a new technology—I’d venture to say that most people haven’t yet had a telemedical consultation. Even as the practice has expanded access and better care for many patients, it's a concept that not everyone has fully grasped.
The problem is when legislators, who should be as objective as possible, are swayed by an emotional response, an issue that's forever fueled the abortion debate. In response to the practice of telemedical abortion, Iowan Medical Board Chairman Dr. Greg Hoversten said, "That really bothers me. Iowa women are the first ones to get this in this fashion. There's something wrong there. It doesn't seem right."
Telemedicine is already used in the military. Image via U.S. Army Materiel Command
It’s this feeling that technology in general—and tech that affects the practice of something as divisive as abortion especially—must confront. The creeping suspicion that as we plant our feet more firmly in the digital space, from finding love to telecommuting to getting an abortion, something ineffable is lost.
We often feel most human when surrounded by humans. Though a doctor’s examination prior to an abortion might not even involve her touching the woman, we still irrationally feel that they should sit there together, that the physical proximity of people somehow offers more legitimacy.
Despite protestations that safety is an issue, research suggests that telemedical abortions aren't any more dangerous than alternatives. In one study, 450 women given medical abortions in Iowa were surveyed following their procedures. There was no difference in outcome between those who went to a clinic and those who attended a video conference. I think the question over this technology has nothing to do with rates of complications.
Partly the pushback in Iowa is due to the age-old impulse to control women and their reproduction, but I think we’ve also got the added layer of squeamishness around how much of our lives, things that once seemed so personal, are conducted through the internet.
There’s the thought that telemedical abortions make the whole thing so easy, that women should pay somehow for wanting to terminate a pregnancy. What the numbers show is that access doesn’t encourage women to get more abortions, but it does make them relatively easier to obtain. For a woman far away from a city center, a telemedical abortion saves time, money, and stress. This should be seen as a positive effect, not a negative. And in time, I believe it will be.
For now it's an uphill battle, both to accept telemedicine generally and to accept its use in broadening abortion access. The Iowa Board hearing concluded yesterday and a ruling will be discussed tomorrow. My hope is that the Board will see this use of telemedicine as a shining example of technology at its best, a force that makes people's lives better, safer, and easier in measurable and intangible ways.