Abortion pills by video

A few months ago, we looked at stories about Angie Jackson, the woman who video taped herself having an abortion. Now we have stories coming out of Iowa about Planned Parenthood’s initiative to dispense an abortion drug after a video conference.

The story has been circulating on the local level and on some advocacy sites, but the New York Times is taking notice. The beginning of Monica Davey’s article seems fair, setting up the arguments from different sides.

Efforts to provide medical services by videoconference, a notion known as telemedicine, are expanding into all sorts of realms, but these clinics in Iowa are the first in the nation, and so far the only ones, experts say, to provide abortions this way.

Advocates say the idea offers an answer to an essential struggle that has long troubled those who favor abortion rights: How to make abortions available in far-flung, rural places and communities where abortion providers are unable or unwilling to travel. So far only Planned Parenthood clinics in Iowa use this method, but around the country, abortion providers have begun asking how they might replicate the concept.

For some, however, the program tests the already complicated bounds of telemedicine. Abortion opponents say they are alarmed, fearful for the safety of women who undergo abortions after consulting with doctors who have never actually been in the same room with them. Opponents filed a complaint this spring with the Iowa Board of Medicine, arguing that a doctor’s remote clicking of a mouse hardly meets the state’s law requiring licensed physicians to perform abortions, and more objections are coming.

If you read further, though, you’ll find the following talking heads.

–The head of Operation Rescue

–The vice president for medical affairs at Planned Parenthood Federation of America

–The president and chief executive of Planned Parenthood of the Heartland

–One of Planned Parenthood’s doctors

–The president of the National Abortion Federation

Three Planned Parenthood representatives? That feels, um, balanced? Couldn’t the reporter make an effort to contact at least one of the more prominent anti-abortion organizations in the country, such as the National Right to Life Committee or Care Net? What about the local chapters? And as Mollie pointed out last week, the Times hasn’t bothered mentioned public opinion regarding abortion.

The reporter tracks down some solid numbers about the number of clinics using the procedure and how many have abortions have been performed. However, I would have been interested in the details behind the supposed growing percentage of women opting for abortions by medication. Does anyone track those numbers?

We have a brief mention of the health risks involved but the article doesn’t mention the FDA warning against buying the drug over the Internet. Seems kind of relevant, doesn’t it? This is the brief health paragraph from the article.

Abortion providers say the pills are safe and mostly effective (successfully ending about 97 in 100 pregnancies, according to Planned Parenthood). In rare cases, such abortions have appeared related to sometimes fatal infections caused by a bacterium, though federal authorities have found no definitive link.

The FDA also recommends follow-up visits and medical screening to avoid complications. Does Planned Parenthood recommend or require this at all?

This section of the article feels almost whimsical:

Some people, including Jill June, president and chief executive of Planned Parenthood of the Heartland, have long seen the potential of abortion medication as making it feasible for women in remote places, far from surgical clinics and surgical abortion providers, to have access to abortions in their own local doctors’ offices. But that promise, Ms. June said, has largely gone unfulfilled (many doctors have not offered the pills), and that–as well as a television show she saw one night in which a doctor carried out elaborate surgery via a robotic device–led her to dream up Iowa’s program.

“If they can do some of these complicated surgeries from miles and miles away from an operating room, why can’t I hand someone a pill across the state?” Ms. June remembered thinking.

These paragraphs feel a bit like a waste when we could ask some pretty basic questions. How much does it cost for a patient to do this procedure instead of a surgical abortion? How late in the pregnancy can you have this procedure? Why is there no mention of the specific medications involved? Here’s what the Des Moines Register article reports:

The abortion process in question involves two medications, both of which cause women to miscarry. The first is Mifeprex, a brand name for a pill also known by its chemical name, RU-486. The second drug is misoprostol, which women take at home after taking Mifeprex in the clinic.

About 1,500 Iowa patients have used Planned Parenthood of the Heartland’s videoconferencing system to obtain abortion drugs in the past two years. The medication is available only to women in their first nine weeks of pregnancy.

The Register article also explains what is said in a presentation video, something that went unmentioned in the Times article. Perhaps the Times could have spent more time explaining some basic information instead of what led the Planned Parenthood director to “dream up” the idea.

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  • Annie

    Having had a near life-threatening reaction when given Misoprostol for a missed miscarriage, I find this policy reprehensible. Misoprostol is not approved by the FDA for this usage. I can’t believe any doctor would be okay with prescribing it over the phone for a woman in a rural area without easy access to emergency medical services in case of uterine hyperstimulation, which can lead to rupture.

  • Sarah Pulliam Bailey

    Thanks for weighing in. I’ve deleted a comment that didn’t focus on journalism. Were the elements in the Times article that were missing?

  • Annie

    I definitely think they should’ve mentioned something about the risks of the off-label use of Misoprostol, particularly in such an uncontrolled environment. Are these care providers so focused on accessibility that they fail to offer these patients fully informed consent?

  • http://www.priestsforlife.org Leslie Palma

    This is what Father Frank Pavone, national director of Priests for Life, had to say about Iowa Planned Parenthood’s reprehensible new policy. The op-ed was published online in the National Catholic Register on Sunday,June 6.


  • Martha

    At least the article does include some information that I wished to know:

    “Before the videoconference begins, a patient in a distant clinic meets (in person) with a nurse. There, blood tests, a medical history, an exam, an ultrasound and counseling on matters like what to expect from the procedure and plans for a follow-up exam are completed. The results are shared (by computer) with a doctor miles away, and the doctor and the patient (at all times accompanied by the nurse, who sits beside her) meet by videoconference over a private network.”

    Because RU-486 is contraindicated in cases such as “an intrauterine device (IUD), as well as with ectopic pregnancy, adrenal failure, hemorrhagic disorders, inherited porphyria, and anticoagulant or long-term corticosteroid therapy” and “women who are more than 35 years of age and who also smoke 10 or more cigarettes per day should be treated with caution because such patients were generally excluded from clinical trials of mifepristone” (source Wikipedia article).

    I do remember the early trials in France and the death of one Frenchwoman (that’s why the age and smoking history are so important). But yeah, the article is falling over itself to point out how convenient! safe! community service oriented! this idea is, and there’s not one scrap of coverage as to why, medically speaking, these kinds of prescribing by remote may be dicey.

    Nope, it’s just the usual suspects when it comes to the abortion foes angle.

  • Martha

    I imagine the ultrasound is to determine the stage of pregnancy; again, the article mentioned that these drugs are administered up to the ninth week of gestation, but neglected to mention that between seven to nine weeks is the limit for these drugs and abortions at later stages must be surgical ones.

  • http://www.ecben.net Will

    If the “notion known as telemedicine” is “expanding into all sorts of realms”, why does the story not mention any others? I needed to go no farther than Wikipedia, which in turn directed me to the American Telemedicine Association.

    Why doesn’t Monica Davey quote anyone who is critical of the effect on “the doctor-patient relationship” without reference to any particular view on abortion? Is she unable to find any such voice? When there are 1,930,000 search results on “telemedicine”?