The Iowa Board of Medicine’s Ban on Telemedicine Abortions in Iowa: Increasing Safety or Decreasing Access? 
By: Hannah Fordyce
Student Writer for The Journal of Gender, Race & Justice, Volume 18

Medicine Bottle
The 2010 U.S. census Bureau found that 35.98% of Iowans lived in rural areas. As of 2008, there were 11 abortion providers in Iowa- in 9 of Iowa’s 99 counties. In 2008, Planned Parenthood of the Heartland (PPH) launched a telemedicine abortion program in Iowa, the first of its kind, to increase the number of PPH clinics that perform abortions. With the launch of this new program,
PPH was able to offer abortion services in 15 of its clinics.

Planned Parenthood of the Heartland uses telemedicine to perform medical, as opposed to surgical abortions. Medical abortions entail taking two different medications, and is a non-invasive, outpatient procedure. PPH’s telemedicine abortion program operates in the following way: PPH nurses or certified medical assistants (CMAs) examine the patient, conduct an ultrasound, and draw blood for blood tests. The physician reviews the results of those exams. The patient is connected with the physician through a real-time two-way video conferencing system. The physician is given information about the exams and can visit with the patient. After determining that the patient is a good candidate for a medical abortion, the physician can release a drawer, allowing the patient to access the medication. The physician and the PPH nurse or CMA watch the patient take the pill. Regardless of whether a physician is physically present or not, the patient is given another medication to take at home 24-28 hours after the first pill, and comes to a follow-up visit two weeks later.

The Iowa Board of Medicine passed Rule 653: Standards of Practice- Physicians who prescribe or administer abortion-inducing drugs on August 30, 2013. This rule requires a physical examination of the patient by the physician, requires the physician to be physically present when the drug is provided, and requires the physician to make a follow up appointment at the same facility where the drug was provided.

The effect of this rule on Planned Parenthood of the Heartland would be to shut down telemedicine abortions. Why is this problematic? PPH’s Brief in Support of Motion to Stay to the Iowa Supreme Court highlights a few major concerns.  First, women are guaranteed access to abortions under constitutional rights established by Roe v. Wade. There are very few abortion clinics in Iowa, and most are located in larger metropolitan areas, this presents access problems. For example, without PPH’s telemedicine abortion program, a woman living in Rock Rapids, Iowa would have to travel to Des Moines—twice—to have access to abortion services. The trip would be over 1,800 miles and would take a total driving time of more than 16 hours. This trip would be an inconvenience to most women, but especially limits access to women living in poverty, women with children, or women with unaccommodating employment. Second, while this rule was created in the name of increasing safety, telemedicine abortions offer a comparable amount of physician care as medical abortions with a physician physically present do. Safety to women is increased when the availability to abortions is increased. The earlier a woman gets an abortion, the safer the process is for her. Additionally, medical abortions are far safer than surgical abortions. Putting obstacles in the way of women receiving an abortion could mean that women have to wait longer to get an abortion and that they may have to have a surgical rather than medical abortion because of that delay.

Planned Parenthood of the Heartland is seeking judicial review of the Iowa Board of Medicine’s Rule 653. An administrative agency can grant a stay pending judicial review, but the Iowa Board of Medicine declined to do so. PPH sought a stay in the Iowa District Court for Polk County, and was granted a stay pending judicial review. The same Polk County District Court ruled on the merits and affirmed the Iowa Board of Medicine’s rule. Planned Parenthood of the Heartland sought another stay from the Iowa Supreme Court, and was recently granted the stay on September 16, 2014. PPH has an appeal pending before the Iowa Supreme Court, so this will be a case to watch for in the coming months.