Pro-Choicers Have a Problem
Iowa’s fight over telemed abortions underscores the increasing scarcity of providers.

Telemedicine terminal in Des Moines, Iowa.


Betsy Woodruff

Up until November, you’ll be able to get an abortion in Iowa via a Skype-like connection during the early stages of pregnancy. Then new standards recently approved by the Iowa Board of Medicine, which require that a physician meet a pregnant woman in person before prescribing pills to cause an abortion, will kick in.

When Iowa banned webcam abortions, it helped augment one of the biggest problems for the pro-choice movement. While we have the most pro-choice president (and, arguably, the most pro-choice Senate) in history, and while groups like EMILY’s List helped propel a significant number of pro-choice candidates into Congress last November, there’s a problem for the pro-choice movement that no number of votes can fix: It’s getting increasingly difficult to actually find someone to give you an abortion.


That’s why telemedicine abortions (often called telemed or webcam abortions) are so important to pro-choice advocates. The procedure itself could be out of The Jetsons: A pregnant woman has a teleconference from a local clinic with a remote physician, who types a command into a computer that opens a drawer in front of the woman containing pills. The woman takes one pill in the office and takes the second dose at home within a few days to expel the fetus.

Greg Hoversten, chairman of the Iowa board, defended its decision by explaining the process further: “The woman essentially goes home and labors and delivers a fetus,” he said. “It’s very bloody. It’s painful. There’s cramping, pelvic cramping.”

Supporters of the ban argue that it’s motivated by medical concerns, not pro-life politics. Mark Bowden, the board’s executive director, says it adopted the rule in good faith and doesn’t expect a court challenge. Telemed abortions present problems from a medical-standards perspective, he says; for example, most states have strict requirements about the necessity of having a physical examination before a doctor can write a prescription.

“You can’t call up a doctor and say, ‘You don’t know me, but I don’t feel well and I think I need these drugs, will you write my prescription?’” Bowden told me.

And Republican state representative Dawn Pettengill praised the board’s decision.

“I’m kind of proud of them, really, because they are looking at it more from what the actual practice is, and ignoring the too-political side,” she says. “They’re just looking at it from a stand of what’s best for the woman. And it’s not really a rule that says abortion’s good or bad; it’s a rule that says the way that it’s being done now is not safe.”

She still expects a court challenge.

“I can’t foresee what’s going to happen there,” she tells me. “Probably.”

Given the increasing scarcity of abortion providers, it’s hard to imagine abortion advocates in the Midwest not mounting a legal challenge. The Guttmacher Institute (originally part of Planned Parenthood) reports that as of 2008, eleven states had five abortion providers or fewer. Eighty-seven percent of American counties had no abortion provider, and 35 percent of American women live in those counties. The number of abortion providers peaked in 1982 and steadily decreased until 2005, a 37 percent drop.

Susan Hill, president of the National Women’s Health Foundation, told the Washington Post that the decrease in providers has many pro-choice advocates concerned. “We need young doctors, and we need them badly,” she said. “The situation is pretty grave, pretty dire.”

It’s not all bad news for abortion doctors, though. Pat Richards wrote on (a website that helps users find nearby abortion providers) that fewer providers means less competition for practitioners.

“I can say from the experience that there are a number of doctors or clinic owners who at times were not thrilled if another doctor moved into their neighborhood,” she wrote. “After all, this is — YES I’LL SAY IT — a profit making venture so who in their right minds would want someone to move in who will take away some of your business?”

At least one of the conventional explanations for the shrinking number of abortion providers is exaggerated — attacks targeted at abortion clinics don’t seem to deter medical students from entering the field. In a paper published in Perspectives on Sexual and Reproductive Health, a periodical put out by Guttmacher, researchers found that “several physicians mentioned the threat of violence as an obstacle to providing abortions, but few considered this the greatest deterrent.” The paper’s authors concluded that many medical practices choose not to provide abortions because of the “stigma and ideological contention” that surround it. But there’s probably more to the decrease than just that.


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