STOKING FIRE: Expanding Options Through Telemedicine

Eleanor J. Bader

More than 1500 women have successfully used Planned Parenthood of the Heartland’s telemedicine program for medical abortions, and that makes anti-choice leaders nervous.

The scene sounds like something from a science fiction playbook:

“An abortionist in another town pushes a button on a computer screen and out pops the abortion pill. A licensed physician never examines the woman.”

A warning, written by members of Operation Rescue, follows: If anti-abortionists don’t act, Planned Parenthood will bring “push-button abortions” to a town or city near you.

Be afraid, the notice on OR’s website suggests, be very afraid. Oh, but not so afraid that you think all is lost, for OR is fighting Planned Parenthood of the Heartland’s utilization of telemedicine to expand abortion availability in Iowa and has filed a complaint with the state Board of Medicine to get it stopped.

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Russell Bardin, Chief Investigator of Iowa’s medical oversight agency, wrote complainant Cheryl Sullenger a letter in April, assuring her “that this matter will be investigated as soon as possible.”  And Sullenger? She is none other than OR’s second in command. Her anti-choice creds include two years in prison—1988 to 1990—for attempting to bomb San Diego’s Alvarado Medical Clinic in 1987. After moving to Wichita post-incarceration, she assumed a perch alongside OR head Troy Newman and proceeded to harass Dr. George Tiller, his staff and patients. Worse, immediately after Tiller’s murder, police found a slip of paper with Sullenger’s name and number in the getaway car used by assassin Scott Roeder.

For its part, Planned Parenthood of the Heartland became involved in providing medical abortions in the 1990s as part of the original FDA trial of the drugs. At that point a two-drug combo, called RU 486, allowed women to abort without surgery during the first seven–now extended to nine–weeks of pregnancy. The FDA approved the pills in December 2003; the Alan Guttmacher Institute estimates that 20 percent of women having early abortions now use them.

Planned Parenthood of the Heartland began Iowa’s telemedicine program in June 2008. According to Regional Director Todd Buchacker:

“We wanted to expand medical services to rural areas so women wouldn’t need to travel so far for care. Planned Parenthood of the Heartland runs 24 clinics throughout Iowa and Nebraska; 18 provide abortion services.”

“Iowa is unique,” he continues. “Its medical code is written in a way to allow telemedicine.  In fact, psychiatric care has relied on telemedicine consultations for about 15 years.”

Buchacker, an RN, describes Planned Parenthood’s telemedicine program and—big shocker—it’s nothing like the description on OR’s website. A patient comes into the Center, he begins, sees a nurse, and takes a pregnancy test. If the test is positive, she is given a sonogram and the image is either read on-site or is electronically sent to an off-site physician. In-person counseling with a trained staffer comes next. If the woman wants to terminate, she is told about both surgical and medical abortion. She is then shown an eight-minute video about medical abortion that describes the process and includes data about possible side effects, from severe cramping, to infection, to incomplete fetal expulsion. She is also told—by the counselor—about post-abortion follow-up and the availability of a 24-hour-a-day hotline should  complications or questions arise. If the woman opts for a medical abortion she ultimately goes into a room where she speaks, via teleconference, with a physician.

“By this point,” Buchacker adds, “the woman has already been counseled and the doctor has looked at the ultrasound and reviewed her medical history. The doctor is now there to answer any additional questions she might have. Once she says that she wants the medication, the doctor initiates the abortion by opening a drawer that is hooked up to a secure Internet connection. This gives her access to the first pill, mifeprex, which she takes in front of the doctor and the staffer who is in the room with her. The woman is then told to take the second drug, misoprostol, between 24 and 28 hours later, at home.”

To date, more than 1500 women have used Planned Parenthood of the Heartland’s telemedicine program for medical abortions; while it’s currently the only state to offer this service, Dr. Vanessa Cullins, Vice President for Medical Affairs at the Planned Parenthood Federation of America, says that PPFA is open to using telemedicine in other locales.

“There is the potential for telemedicine practices to expand,” she wrote in an email. “But there are many factors that each affiliate would have to consider, including the needs of the local population and state and local laws.”

Still, Cullins continues, “we’re encouraged by the response this service has received in Iowa. An independent researcher surveyed 200 patients who used the telemedicine system and 200 who were given the abortion pills in person from a physician. Ninety-four percent of women who received their pills through telemedicine were ‘very satisfied’ with their experience.”

What’s more, less than 0.5 percent of women using medication experience serious complications.  And, since the pills are widely and successfully used in other parts of the world—80 percent of early abortions in France and 43 percent in England are terminated with mifeprex and misoprostol—the potential expansion of medical abortion throughout the U.S. is undoubtedly causing OR a great deal of angst.

In their end-of-the-world-as-we-know-it projection, the landscape is teeming with dead fetuses. “If abortionists are allowed to dispense abortion drugs at the push of a button,” OR howls, “an abortionist sitting in an office miles away could kill hundreds of babies before lunch time.”

Let’s hope the Iowa Board of Medicine sees it differently.

News Politics

Clinton Campaign Announces Tim Kaine as Pick for Vice President

Ally Boguhn

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

The Clinton campaign announced Friday that Sen. Tim Kaine (R-VA) has been selected to join Hillary Clinton’s ticket as her vice presidential candidate.

“I’m thrilled to announce my running mate, @TimKaine, a man who’s devoted his life to fighting for others,” said Clinton in a tweet.

“.@TimKaine is a relentless optimist who believes no problem is unsolvable if you put in the work to solve it,” she added.

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

Kaine signed two letters this week calling for the regulations on banks to be eased, according to a Wednesday report published by the Huffington Post, thereby ”setting himself up as a figure willing to do battle with the progressive wing of the party.”

Charles Chamberlain, executive director of the progressive political action committee Democracy for America, told the New York Times that Kaine’s selection “could be disastrous for our efforts to defeat Donald Trump in the fall” given the senator’s apparent support of the Trans-Pacific Partnership (TPP). Just before Clinton’s campaign made the official announcement that Kaine had been selected, the senator praised the TPP during an interview with the Intercept, though he signaled he had ultimately not decided how he would vote on the matter.

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Kaine’s record on reproductive rights has also generated controversy as news began to circulate that he was being considered to join Clinton’s ticket. Though Kaine recently argued in favor of providing Planned Parenthood with access to funding to fight the Zika virus and signed on as a co-sponsor of the Women’s Health Protection Act—which would prohibit states and the federal government from enacting restrictions on abortion that aren’t applied to comparable medical services—he has also been vocal about his personal opposition to abortion.

In a June interview on NBC’s Meet the Press, Kaine told host Chuck Todd he was “personally” opposed to abortion. He went on, however, to affirm that he still believed “not just as a matter of politics, but even as a matter of morality, that matters about reproduction and intimacy and relationships and contraception are in the personal realm. They’re moral decisions for individuals to make for themselves. And the last thing we need is government intruding into those personal decisions.”

As Rewire has previously reported, though Kaine may have a 100 percent rating for his time in the Senate from Planned Parenthood Action Fund, the campaign website for his 2005 run for governor of Virginia promised he would “work in good faith to reduce abortions” by enforcing Virginia’s “restrictions on abortion and passing an enforceable ban on partial birth abortion that protects the life and health of the mother.”

As governor, Kaine did support some existing restrictions on abortion, including Virginia’s parental consent law and a so-called informed consent law. He also signed a 2009 measure that created “Choose Life” license plates in the state, and gave a percentage of the proceeds to a crisis pregnancy network.

Regardless of Clinton’s vice president pick, the “center of gravity in the Democratic Party has shifted in a bold, populist, progressive direction,” said Stephanie Taylor, co-founder of the Progressive Change Campaign Committee, in an emailed statement. “It’s now more important than ever that Hillary Clinton run an aggressive campaign on core economic ideas like expanding Social Security, debt-free college, Wall Street reform, and yes, stopping the TPP. It’s the best way to unite the Democratic Party, and stop Republicans from winning over swing voters on bread-and-butter issues.”

Analysis Abortion

Legislators Have Introduced 445 Provisions to Restrict Abortion So Far This Year

Elizabeth Nash & Rachel Benson Gold

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. Of these, 35 percent (445 provisions) sought to restrict access to abortion services. By midyear, 17 states had passed 46 new abortion restrictions.

Including these new restrictions, states have adopted 334 abortion restrictions since 2010, constituting 30 percent of all abortion restrictions enacted by states since the U.S. Supreme Court decision in Roe v. Wade in 1973. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

Mid year state restrictions


Signs of Progress

The first half of the year ended on a high note, with the U.S. Supreme Court handing down the most significant abortion decision in a generation. The Court’s ruling in Whole Woman’s Health v. Hellerstedt struck down abortion restrictions in Texas requiring abortion facilities in the state to convert to the equivalent of ambulatory surgical centers and mandating that abortion providers have admitting privileges at a local hospital; these two restrictions had greatly diminished access to services throughout the state (see Lessons from Texas: Widespread Consequences of Assaults on Abortion Access). Five other states (Michigan, Missouri, Pennsylvania, Tennessee, and Virginia) have similar facility requirements, and the Texas decision makes it less likely that these laws would be able to withstand judicial scrutiny (see Targeted Regulation of Abortion Providers). Nineteen other states have abortion facility requirements that are less onerous than the ones in Texas; the fate of these laws in the wake of the Court’s decision remains unclear. 

Ten states in addition to Texas had adopted hospital admitting privileges requirements. The day after handing down the Texas decision, the Court declined to review lower court decisions that have kept such requirements in Mississippi and Wisconsin from going into effect, and Alabama Gov. Robert Bentley (R) announced that he would not enforce the state’s law. As a result of separate litigation, enforcement of admitting privileges requirements in Kansas, Louisiana, and Oklahoma is currently blocked. That leaves admitting privileges in effect in Missouri, North Dakota, Tennessee and Utah; as with facility requirements, the Texas decision will clearly make it harder for these laws to survive if challenged.

More broadly, the Court’s decision clarified the legal standard for evaluating abortion restrictions. In its 1992 decision in Planned Parenthood of Southeastern Pennsylvania v. Casey, the Court had said that abortion restrictions could not impose an undue burden on a woman seeking to terminate her pregnancy. In Whole Woman’s Health, the Court stressed the importance of using evidence to evaluate the extent to which an abortion restriction imposes a burden on women, and made clear that a restriction’s burdens cannot outweigh its benefits, an analysis that will give the Texas decision a reach well beyond the specific restrictions at issue in the case.

As important as the Whole Woman’s Health decision is and will be going forward, it is far from the only good news so far this year. Legislators in 19 states introduced a bevy of measures aimed at expanding insurance coverage for contraceptive services. In 13 of these states, the proposed measures seek to bolster the existing federal contraceptive coverage requirement by, for example, requiring coverage of all U.S. Food and Drug Administration approved methods and banning the use of techniques such as medical management and prior authorization, through which insurers may limit coverage. But some proposals go further and plow new ground by mandating coverage of sterilization (generally for both men and women), allowing a woman to obtain an extended supply of her contraceptive method (generally up to 12 months), and/or requiring that insurance cover over-the-counter contraceptive methods. By July 1, both Maryland and Vermont had enacted comprehensive measures, and similar legislation was pending before Illinois Gov. Bruce Rauner (R). And, in early July, Hawaii Gov. David Ige (D) signed a measure into law allowing women to obtain a year’s supply of their contraceptive method.


But the Assault Continues

Even as these positive developments unfolded, the long-standing assault on sexual and reproductive health and rights continued apace. Much of this attention focused on the release a year ago of a string of deceptively edited videos designed to discredit Planned Parenthood. The campaign these videos spawned initially focused on defunding Planned Parenthood and has grown into an effort to defund family planning providers more broadly, especially those who have any connection to abortion services. Since last July, 24 states have moved to restrict eligibility for funding in several ways:

  • Seventeen states have moved to limit family planning providers’ eligibility for reimbursement under Medicaid, the program that accounts for about three-fourths of all public dollars spent on family planning. In some cases, states have tried to exclude Planned Parenthood entirely from such funding. These attacks have come via both administrative and legislative means. For instance, the Florida legislature included a defunding provision in an omnibus abortion bill passed in March. As the controversy grew, the Centers for Medicare and Medicaid Services, the federal agency that administers Medicaid, sent a letter to state officials reiterating that federal law prohibits them from discriminating against family planning providers because they either offer abortion services or are affiliated with an abortion provider (see CMS Provides New Clarity For Family Planning Under Medicaid). Most of these state attempts have been blocked through legal challenges. However, a funding ban went into effect in Mississippi on July 1, and similar measures are awaiting implementation in three other states.
  • Fourteen states have moved to restrict family planning funds controlled by the state, with laws enacted in four states. The law in Kansas limits funding to publicly run programs, while the law in Louisiana bars funding to providers who are associated with abortion services. A law enacted in Wisconsin directs the state to apply for federal Title X funding and specifies that if this funding is obtained, it may not be distributed to family planning providers affiliated with abortion services. (In 2015, New Hampshire moved to deny Title X funds to Planned Parenthood affiliates; the state reversed the decision in 2016.) Finally, the budget adopted in Michigan reenacts a provision that bars the allocation of family planning funds to organizations associated with abortion. Notably, however, Virginia Gov. Terry McAuliffe (D) vetoed a similar measure.
  • Ten states have attempted to bar family planning providers’ eligibility for related funding, including monies for sexually transmitted infection testing and treatment, prevention of interpersonal violence, and prevention of breast and cervical cancer. In three of these states, the bans are the result of legislative action; in Utah, the ban resulted from action by the governor. Such a ban is in effect in North Carolina; the Louisiana measure is set to go into effect in August. Implementation of bans in Ohio and Utah has been blocked as a result of legal action.


The first half of 2016 was also noteworthy for a raft of attempts to ban some or all abortions. These measures fell into four distinct categories:

  • By the end of June, four states enacted legislation to ban the most common method used to perform abortions during the second trimester. The Mississippi and West Virginia laws are in effect; the other two have been challenged in court. (Similar provisions enacted last year in Kansas and Oklahoma are also blocked pending legal action.)
  • South Carolina and North Dakota both enacted measures banning abortion at or beyond 20 weeks post-fertilization, which is equivalent to 22 weeks after the woman’s last menstrual period. This brings to 16 the number of states with these laws in effect (see State Policies on Later Abortions).
  • Indiana and Louisiana adopted provisions banning abortions under specific circumstances. The Louisiana law banned abortions at or after 20 weeks post-fertilization in cases of diagnosed genetic anomaly; the law is slated to go into effect on August 1. Indiana adopted a groundbreaking measure to ban abortion for purposes of race or sex selection, in cases of a genetic anomaly, or because of the fetus’ “color, national origin, or ancestry”; enforcement of the measure is blocked pending the outcome of a legal challenge.
  • Oklahoma Gov. Mary Fallin (R) vetoed a sweeping measure that would have banned all abortions except those necessary to protect the woman’s life.


In addition, 14 states (Alaska, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, South Carolina, South Dakota, Tennessee and Utah) enacted other types of abortion restrictions during the first half of the year, including measures to impose or extend waiting periods, restrict access to medication abortion, and establish regulations on abortion clinics.

Zohra Ansari-Thomas, Olivia Cappello, and Lizamarie Mohammed all contributed to this analysis.