Planned Parenthood Telemedicine Program Update

Over the past few months, we’ve been following the news reports about Planned Parenthood of the Heartland’s telemedicine program, which allows women to access medication abortion through a live video consult with a doctor.

The program involves a Des Moines physician evaluating a patient via the video service and using a remote control to unlock mifepristone, the medical abortion pill. The patient takes the first dose under the doctor’s supervision, and then takes the remaining dosage in the privacy of their home. This service has allows women in rural areas, who would otherwise not have access to abortion, to safely terminate their pregnancies. So far, sixteen Iowa clinics are able to provide this service.

In October 2010, anti-abortion activists spoke out against the program, claiming it violates an Iowa law that requires all abortions to be performed by a physician. The discrepancy prompted the Iowa Board of Medicine to review the program, and a decision was reached earlier this month. In a letter to Cheryl Sullenger of Operation Rescue, the main organization behind the protest, the Iowa Board of Medicine held that the telemedicine program is not in violation of Iowa law and no doctors will be sanctioned for participating in the program.

This is good news for the women of Iowa, who greatly benefit from the service. Approximately 2,000 women have utilized the telemedicine program since it began in 2008, a statistic that shows the necessity for rural women to gain access to reproductive health options.

Guttmacher Report Shows Greater and Safer Abortion Availability

The Guttmacher Institute has released a new report about abortion in the United States. According to the report:

The abortion rate in the U.S., which has declined steadily since a 1981 peak of more than 29 abortions per 1,000 women, stalled between 2005 and 2008, at slightly less than 20 abortions per 1,000 women.

The report is made entirely of statistical data and offers no explanation for the decline of the abortion rate. Some have attributed the decline of the economy to the plateau of abortions obtained by women in the U.S.

The report also discusses the use of the abortion pill, mifepristone, and the availability of abortions. One positive effect of the legalization of mifepristone, which we wrote about in September, is its potential to increase abortion access for women in areas where surgical abortions are not an option. The theory is to make the right of choice available to every woman.  The report notes that “about 17 percent of all 2008 abortions, and more than a quarter of those performed before nine weeks of gestation, were medical abortions.”

This increase in medical abortions is shows not only greater access to the procedure, but also a safer option for women:

Rachel Jones, lead author of the Guttmacher report, sees the increase in medication abortions as good news, because such abortions occur early in pregnancy, when abortion is safest.

These statistics are good news for women’s health advocates, yet there is still a lot of ground to cover. Despite the fact that medication abortions are becoming more available, the study also found that “87 percent of U.S. counties had no abortion provider, and 35 percent of women of reproductive age lived in those counties.”

It is still disheartening that so many women do not effectively have the right to choose because of a lack of access. We’re glad that the Guttmacher Institute continues to shed a light on all the progress, and the work still left to be done.

This Week Marks Ten Years of Women Accessing Medication Abortion in the U.S.

On September 28, 2000, the FDA approved the drug mifepristone, in combination with misoprostol, for usage in a medical abortion pill. Formerly known as RU-486 and now marketed as Mifeprex, the drug offers women an alternative to surgical abortion.

According to a Guttmacher Insititute report (PDF), nearly half of pregnancies among American women are unintended, with 40 percent of these pregnancies resulting in abortion. Although the number of abortions performed in United States has decreased in the past decade, the number of medical abortions using the pill has grown. In 2007, an estimated 21% of all abortions performed prior to nine weeks’ gestation used medication abortion.

As Jodi Jacobson writes:

The earlier in an unintended pregnancy an abortion occurs, the safer and less costly it is. Medication abortion is only appropriate for unintended and untenable pregnancies up to nine weeks.  Availability of medication abortion has meant that an increasing share of abortions are early, and an increasing share of early abortions are done before six weeks or before nine weeks.

Besides the critical importance of safety and cost-effectiveness, medical abortion also provides an alternative to having an abortion performed in an operating room. For many women, being able to have the abortion experience in the privacy of their own home is more comfortable.

However, approval of mifepristone has not increased general access to abortion services as much as many reproductive health workers initially hoped. In 2009, Dr. Lawrence Finer of the Guttmacher Institute said:

Instead, almost a decade later, we find that women in areas that already had access to abortion now have the choice between a medication or a surgical abortion. But for most women who were not easily able to access an abortion provider before mifepristone became available, services remain difficult to obtain.

Jezebel points out one possible solution to this problem – a telemedicine program run by Planned Parenthood of the Heartland in Iowa. Women who participate in the program are able to obtain an ultrasound at any of 16 clinics, have an examination by a nurse, and talk to a doctor over a secure Internet connection. If the doctor sees no complications upon reviewing a patient’s medical records, they can unlock a box containing the pill and subsequently prescribe it. So far, almost 2,000 women have gained access to abortion services through this program.

Additionally, as author Irin Carmon states in the same post, this method makes it more difficult for anti-abortion activists to interfere with the process, increasing the safety and comfort of patients and physicians.

Ten years after its FDA approval, mifepristone has yet to substantially extend its reach beyond areas where access to abortion already existed. However, within a decade, it has become a significant part of reproductive health in the United States, and research data suggests its continued growth as an option for safely terminating unwanted pregnancy.

Misoprostol: A Catalyst for Revolution?

An optimistic op-ed published by Nicholas Kristof this weekend in the New York Times hypothesized that the medication misoprotol will revolutionize abortion access around the world, especially in developing countries, where five-sixths of abortions occur and “up to 70,000 women die a year from complications.”  Kristof claims that the drug, due to its use for other medical reasons, including treating stomach ulcers and stopping postpartum hemorrhages,will be very difficult for governments to ban.

In medical abortion procedures, misoprostol is most often paired with mifepristone (formerly known as RU-486) to end a pregnancy. This combination has a 95% success rate in aborting early pregnancies, and researchers are finding that using only misoprostol has an 80-85% percent success rate, which, as one doctor noted, is still better than the unsafe alternatives that women often try to end their unwanted pregnancies.  And while mifepristone is banned in many countries worldwide (on the African continent, only South Africa and Tunisia have approved it), misoprostol is commonly found throughout the world and can be purchased over the Internet from Indian pharmaceutical companies that mass-produce both mifepristone and misoprostol.  Kristof’s confidence in the pill’s growing influence is apparent:

[L]ast year the World Health Organization expanded [misoprostol’s] uses as an “essential medicine” to include treatment of miscarriages and incomplete abortions.

Brazil and some other countries have tried to tighten access to misoprostol because of its use for abortion. But curbing access to misoprostol would mean that more women would die of hemorrhages.

As word spreads among women worldwide about what a few pills can do, it’s hard to see how politicians can stop this gynecological revolution.

Kristof’s belief in governments’ inability to ban distribution of misoprostol because of its other uses is optimistic. While we wholeheartedly support greater access to abortion worldwide, we need only look at how funding for stem cell research has been effectively banned for the past decade because of anti-choice crusaders bent on stalling medical breakthroughs because of their opposition to abortion rights.

And Kristof’s belief that law enforcement would ignore the drug’s use to end pregnancies where abortion is illegal isn’t completely supported by women’s experiences. Women’s Health News covered a New York Times magazine article in 2006 which reported that in El Salvador, a country with a total abortion ban even in cases of rape, incest or life endangerment, women who were clandestinely using misoprostol for medical abortion have been subjected to police investigations in which forced pelvic/vaginal examinations took place.  In cases of “failed illegal abortions where the doctors have to perform a hysterectomy… the uterus is sent to the Forensic Institute, where the government’s doctors analyze it and retain custody of her uterus as evidence against her.”

Is misoprostol a pill that will revolutionize abortion?  Our hopes lie with Kristof’s optimistic idea of a quiet revolution in abortion access, but the reality might not live up to it.