What you should know about 'abortions via webcam'

 

Abortions carried out through a remote provider who delivers medicine through the mail are at the center of a contested piece of legislation in Kansas. (Photo: Getty Images)

Next week, lawmakers in Kansas will reconvene to discuss House Bill 2674, a hotly contested piece of legislation that calls on insurers to cover telemedicine abortions the way they cover in-person abortions. Telemedicine abortions — sometimes called “abortion via webcam” — are a way to terminate a pregnancy through a remote provider who delivers medicine either via the mail or at another clinic.

Since Kansas is one of 19 states that currently ban this type of abortion, the bill is only a hypothetical — and the bill is aimed at expanding telemedicine care in general, with abortion just one of the procedures named. But that hasn’t stopped opponents from speaking out.

Kansans for Life, the state’s anti-abortion organization, is vehemently opposed to the bill and is calling on lawmakers to, instead, add language that bans telemedicine abortions (which the state already does). “We are Kansans for Life, not Kansans for Life Sometimes,” Rep. Kevin Jones, a staunch Republican, said regarding the bill. “Telemedicine is an important endeavor, but not if it can be used to murder the future leaders of our state.”

Supporters, however, insist it’s a step in the right direction — an acknowledgment that telemedicine is a safe and effective way to get various types of medical care, including abortions. As HB 2674 hangs in the balance, here’s a roundup of what we know about telemedicine abortions.

Telemedicine abortions have been around for a decade.

The first state to offer telemedicine abortions was Iowa, a move inspired by a lack of health centers in rural areas, and a limited number of physicians to provide abortions overall. The state’s program was launched by Planned Parenthood of Greater Iowa in 2008. At the time, according to clinical health researcher Dr. Daniel Grossman, the state had 17 affiliate Planned Parenthood centers, but just two physicians who could provide abortions.

That program — and all of them since — involves a medication abortion.

Medical abortions, which are approved by the Food and Drug Administration, involve administering two types of medications. The first, mifepristone, acts as a hormone blocker, causing the uterus to shed its lining. The second, misoprostol, induces contractions that cause the equivalent of a miscarriage. For women who are eight weeks pregnant or less, the procedure is 98 percent effective. For those nine to 10 weeks pregnant, it’s 96 percent effective. 

The one thing that makes medication abortions difficult to do remotely is that FDA regulations require the first medicine, mifepristone, be administered directly by a doctor. 

To make this possible, Planned Parenthood created lockboxes with the medicine that can be opened remotely by doctors who are approved to carry out abortions.

The process underway in Iowa is one that has been mirrored in other parts of the country. When a patient gets confirmation of a pregnancy through a blood test and ultrasound, but does not live near an abortion provider, the clinic can send the confirmation to a clinic that does abortions. Once the doctor there is briefed on the information, the doctor can get on a video chat with a patient.  After discussing the risks, the doctor could then hit a key that would open a lockbox containing the two different medications. (The New York Times captured a picture of that here).

Planned Parenthood has since expanded that program to multiple states.

Just two years after the Iowa program began, Dr. Daniel Grossman — now the director of the research group Advancing New Standards in Reproductive Health (ANSIRH) — published a study showing that women found the process effective and were more satisfied overall. In response, Planned Parenthood worked to expand the program — first to Minnesota then to Alaska. Another organization, Maine Family Planning, helped get the program underway in Maine.

In 2016, a new version of telemedicine that relies on mail was introduced in five more states. 

To circumvent the need for mifepristone, the first pill in a medical abortion, to be administered by a clinician, a group of doctors launched an official study in 2016. (Since it’s a part of a study, it’s classified as an Investigational New Drug Application, or IND, and the typical regulations don’t necessarily apply.) The project was launched Gynuity Health Projects, an organization that works to ensure individuals in resource-poor environments gain access to health care. 

The organization’s program is taking place in five states: Hawaii, Maine, New York, Oregon, and Washington. Like the programs in Iowa and elsewhere, it also includes a video chat with a physician (who has been able to review an ultrasound), but instead of taking the medicine in a clinician’s office, patients are sent the medicine through the mail.

A recent major study of telemedicine abortions found them to be safe and effective.

Grossman, who has been on the frontlines of the telemedicine abortion movement from the start, conducted the largest study to date of this phenomenon last year. His research, published in the journal Obstetrics & Gynecology, looked at seven years of data involving 20,000 patients. The results were unequivocally positive. Not only were adverse effects as rare as in-person medicine abortions, but the satisfaction rate among the women who received telemedicine abortions was also higher.

“The likelihood of having a serious adverse effect is very low,” Grossman tells Yahoo Lifestyle. “So I think this model of reaching women directly in their homes and communities has the possibility of improving access to this safe and effective technology.”

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