A Pioneering Effort to Increase Rural Women's Access to Safe Abortion in Iowa

For the past two years, Planned Parenthood of the Heartland has been using video-conferencing and a remote-controlled drawer to dispense abortion pills to women seeking early abortions in Iowa clinics. Operation Rescue is taking aim at the practice, charging that because these medication abortions are not “performed by a physician,” they violate Iowa law.

This claim doesn’t stand up. True, medication abortion straddles the line between procedure and prescription: while the physician only acts insofar as giving a woman two pills, the more significant part of the procedure is the counseling that precedes it. But this is exactly the point: the medication abortion “procedure” requires the counsel and knowledge of a health care provider—and these days, we do not have to be physically present to share knowledge and expertise. The digital age has removed countless barriers to information, particularly geographic barriers. Why shouldn’t digital technology also remove barriers to health care?

People living in rural areas have to work harder to gain access to health care, and this is particularly true of reproductive health services. Women in rural areas are disproportionately affected by the obstructionist anti-choice laws that may seem like “no big deal” to those of us in more fortunate circumstances. A waiting period means two long trips, perhaps in a borrowed car, and two days off from work, or two days hiring babysitters. A teenage girl seeking a judicial bypass to a parental notification law may also have a very long journey ahead of her (and she’ll have to find someone other than her parents to drive). Even barring complications, getting to a reproductive health clinic is no small feat for many women living in rural counties. These clinics tend to be few and far between, with small staffs and thus, most likely, limited hours. And many rural clinics that offer reproductive health care do not provide abortion services. In 1998, the Guttmacher Institute studied women’s health clinics in Washington State and found that of the 31 clinics in the rural areas of the state, only one offered abortion services to those in need.

If the right to have a legal, safe abortion begins to seem, to some women, like a theoretical one, then we have a big problem. Planned Parenthood of the Heartland deserves a medal for seeking to address the geographic (and often economic) disparity in abortion access in a smart and safe way. Telemedicine is already practiced in other ways in this country: a doctor may call in a prescription after only talking to a patient on the phone if a diagnosis is not necessary. And in some states, nurse practitioners, trained in counseling, can dispense the abortion pill. Planned Parenthood’s use of telemedicine acknowledges a key tenet of reproductive choice: that the most substantive and often difficult part of an abortion happens before a woman visits a clinic. We are lucky to be living in a time and place where the abortion procedure, whether surgical or by medication, is uncomplicated and very low-risk. The complicated part is the choice, and for that, a woman doesn’t need a doctor.