For Abortion Pills, You Must 'See' Your Doctor

States enact laws banning webcam consultations to end pregnancies
Virtual doctor visits in the U.S. in 2012: 10 million Photograph by Alamy

Five years ago, doctors at the Whole Woman’s Health clinic in Austin, Tex., began prescribing abortion-inducing drugs to patients in McAllen, a town about 300 miles away on the Mexican border. The women consulted with the clinic’s physicians by telephone and videoconference, eliminating travel time and lowering costs for doctor and patient. Before this service was available, the clinic would pay doctors to drive to the town two to four days a week. Remote visits allowed the clinic to offer abortions six days a week.

That’s no longer possible. In the past two years, 10 states* have effectively outlawed what opponents call webcam abortions. Nine passed legislation requiring doctors who prescribe abortion drugs to be in the same room as patients. Texas says doctors must perform ultrasounds on all women seeking abortions and describe the results in person. Whole Woman’s Health no longer administers abortions from afar in Texas. “We still do it in our Maryland clinic and plan to start it up in our Minnesota clinic, but our five Texas sites are very limited now,” says Amy Hagstrom Miller, founder of the for-profit chain of seven clinics.

Telemedicine bans are the latest attempt by anti-abortion activists to curtail the widespread use of drugs that allow women to avoid undergoing surgery to end a pregnancy. Since 2000, when the U.S. Food and Drug Administration approved a pill to induce miscarriage, drugs have increasingly replaced surgical abortions. They accounted for 17 percent of nonhospital abortion procedures in 2008, the latest year for which data are available, according to the Guttmacher Institute, a reproductive health research group.

This year, Republican lawmakers in Iowa, Alabama, Indiana, Missouri, and Mississippi have introduced similar bills restricting the use of telemedicine in prescribing abortion drugs. All but one of the measures are based on model legislation written by Americans United for Life, an anti-abortion group in Washington that calls abortion drugs “the new profit-boosting frontier” for providers. Remote abortion services are about making money, says Charmaine Yoest, the group’s president. “It’s appalling that the self-described defenders of women’s health demonstrate over and over that they’re willing to put their economic interests ahead of actually protecting women.”

Miller says Yoest has it backward. Remote consultations didn’t increase the number of abortions her clinics offered, she says. But it did make them safer by enabling women seeking abortions to obtain them earlier in their pregnancies, which research shows reduces the risk of complications.

Since its introduction in the 1960s, telemedicine has revolutionized how people in rural and other underserved areas get all kinds of medical care, giving them access to cardiologists, neurologists, and other specialists. States have generally encouraged its use, aided by millions of dollars in public and private investment. In the U.S., 10 million people took advantage of virtual doctor visits last year, quadruple the number five years before, according to the American Telemedicine Association. Abortion is the only area where lawmakers have curbed its use or prevented it from expanding, says its president, Jon Linkous. In June, Republican Governor Rick Snyder of Michigan lauded a bill promoting telemedicine as an “incredible opportunity” to deliver care to those without easy access to a doctor. Six months later, he signed into law a ban on the same remote consultations for drug-induced abortions.

Yoest of Americans United for Life says states are seeking to outlaw telemedicine abortions out of concern for patients’ safety. Women up to nine weeks pregnant typically take a first dose of the abortion drug at a clinic, a second dose at home 48 hours later, and then follow up with a doctor after two weeks. Yoest argues it’s dangerous to take the drugs without that face-to-face supervision.

A 2011 study published in the journal Obstetrics & Gynecology shows otherwise. Researchers in Iowa—which has 16 clinics offering video doctor visits for abortions, more than all other states combined—compared the experiences of 449 patients, 226 whose doctors prescribed abortion drugs in person and 223 who were given the treatment after a teleconference. It found the complication rate, 1.3 percent, to be the same in both groups.
* Arizona, Kansas, Michigan, Nebraska, North Dakota, Oklahoma, South Dakota, Tennessee, Wisconsin, Texas


    The bottom line: In the U.S., 10 million people in underserved areas see doctors via telemedicine. Activists want to restrict its use for abortion services.

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