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

Kathleen Reeves

Planned Parenthood of the Heartland deserves a medal for seeking to address the geographic (and often economic) disparity in access to abortion in a smart and safe way.

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.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

News Abortion

Leading Anti-Choice ‘Expert’ Suggests Women Turn to Crisis Pregnancy Centers to Cope With Abortion Restrictions

Ally Boguhn

Though crisis pregnancy centers often lie to women to persuade them not get an abortion, Priscilla Coleman suggested that people dealing with the additional financial and geographical barriers imposed by waiting periods turn to those organizations for help.

A leading anti-choice “expert” suggested during an interview with Rewire at the National Right to Life Convention last week that women should turn to crisis pregnancy centers to cope with the barriers to abortion care, including obstacles she helped create.

Priscilla Coleman, one of the “False Witnesses” previously featured on Rewire for her egregious falsehoods about the supposed link between abortion and mental health, said that the “scientific information” she provides in her speaking engagements and through her nonprofit, the World Expert Consortium for Abortion Research and Education (WECARE), has helped get anti-choice bills passed in states, particularly South Dakota.

Though her work has been widely discredited by the scientific and medical community, Coleman has nonetheless frequently appeared as an “expert witness” in trials and hearings. As Coleman told Rewire, she is “not a medical doctor” but has nonetheless “been really involved for ten years now with South Dakota” and its anti-choice legislation. This included the South Dakota Informed Consent Law (HB 1166), and what she deemed to be an “anti-coercion bill,” seemingly referring to HB 1217, which requires that a woman seeking an abortion wait 72 hours and visit a crisis pregnancy center prior to the abortion.

Coleman acknowledged that the anti-choice laws in the state such as the waiting period had created barriers to care, as “women have to … get a hotel, you know, or find a way back” to clinics.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

“And that’s the complaint on the other side, that it’s making access more difficult,” Coleman went on, “but as all the data out there is showing the long-term effects of abortion, spending three more days to make the decision is in the women’s best interest, no matter what side you’re on.”

When pressed to respond to those who note that anti-choice restrictions make accessing abortion more difficult, Coleman replied that she “would just say that it’s worth a three-day hotel room and … if you’re going to pay for an abortion, allow an extra couple hundred dollars … to take some time because it has lifetime implications.”

Coleman, however, struggled to account for how one might come up with that money.

“Well, they’re somehow coming up with the money for the abortion,” said Coleman. “I’m not familiar enough with fees and things, but my understanding is that most women, no matter how poor they are, still have to pay for the procedure. Is that correct?”

Though crisis pregnancy centers often lie to women to persuade them not get an abortion, Coleman suggested that those dealing with the additional financial and geographical barriers imposed by waiting periods turn to those organizations for help.

“I’m sure that if they contacted crisis pregnancy centers … women could find a place to stay for a couple of days,” said Coleman. “I’m sure that many people affiliated with those centers would be happy to house the women in their own home if there is a room for them.”

The other anti-choice law Coleman connected herself with, HB 1166, uses the same falsehoods she claims her research supports. South Dakota’s so-called informed consent law requires doctors to receive consent prior to performing an abortion, and mandates that physicians provide those seeking care with written information that, among other things, falsely claims there is a connection between abortion and both “depression and related psychological distress” and “increased risk of suicide ideation and suicide.”

Coleman “served as an expert in South Dakota” after Planned Parenthood affiliates challenged the legislation, according to WECARE’s website.

As the Guttmacher Institute explains, all states already require patients consent prior to receiving medical care, and materials provided by the states that require mandated abortion counseling often offer “information that is irrelevant or misleading.”

Commentary Abortion

It’s Time for an Abortion Renaissance

Charlotte Taft

We’ve been under attack and hanging by a thread for so long, it’s been almost impossible to create and carry out our highest vision of abortion care.

My life’s work has been to transform the conversation about abortion, so I am overcome with joy at the Supreme Court ruling in Whole Woman’s Health v. Hellerstedt. Abortion providers have been living under a very dark cloud since the 2010 elections, and this ruling represents a new day.

Abortion providers can finally begin to turn our attention from the idiocy and frustration of dealing with legislation whose only intention is to prevent all legal abortion. We can apply our energy and creativity fully to the work we love and the people we serve.

My work has been with independent providers who have always proudly delivered most of the abortion care in our country. It is thrilling that the Court recognized their unique contribution. In his opinion, after taking note of the $26 million facility that Planned Parenthood built in Houston, Justice Stephen Breyer wrote:

More fundamentally, in the face of no threat to women’s health, Texas seeks to force women to travel long distances to get abortions in crammed-to-capacity superfacilities. Patients seeking these services are less likely to get the kind of individualized attention, serious conversation, and emotional support that doctors at less taxed facilities may have offered.

This is a critical time to build on the burgeoning recognition that independent clinics are essential and, at their best, create a sanctuary for women. And it’s also a critical time for independent providers as a field to share, learn from, and adopt each other’s best practices while inventing bold new strategies to meet these new times. New generations expect and demand a more open and just society. Access to all kinds of health care for all people, including excellent, affordable, and state-of-the-art abortion care is an essential part of this.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

We’ve been under attack and hanging by a thread for so long—with our financial, emotional, and psychic energies drained by relentless, unconstitutional anti-abortion legislation—it’s been almost impossible to create and carry out our highest vision of abortion care.

Now that the Supreme Court has made it clear that abortion regulations must be supported by medical proof that they improve health, and that even with proof, the burdens can’t outweigh the benefits, it is time to say goodbye to the many politically motivated regulations that have been passed. These include waiting periods, medically inaccurate state-mandated counseling, bans on telemedicine, and mandated ultrasounds, along with the admitting privileges and ambulatory surgical center requirements declared unconstitutional by the Court.

Clearly 20-week bans don’t pass the undue burden test, imposed by the Court under Planned Parenthood v. Casey, because they take place before viability and abortion at 20 weeks is safer than childbirth. The federal Hyde Amendment, a restriction on Medicaid coverage of abortion, obviously represents an undue burden because it places additional risk on poor women who can’t access care as early as women with resources. Whatever the benefit was to late Rep. Henry Hyde (R-IL) it can’t possibly outweigh that burden.

Some of these have already been rejected by the Court and, in Alabama’s case, an attorney general, in the wake of the Whole Woman’s Health ruling. Others will require the kind of bold action already planned by the Center for Reproductive Rights and other organizations. The Renaissance involves raising an even more powerful voice against these regulations, and being firm in our unwillingness to spend taxpayer dollars harming women.

I’d like to entertain the idea that we simply ignore regulations like these that impose burdens and do not improve health and safety. Of course I know that this wouldn’t be possible in many places because abortion providers don’t have much political leverage. This may just be the part of me that wants reproductive rights to warrant the many risks of civil disobedience. In my mind is the man who stood in front of moving tanks in Tiananmen Square. I am yearning for all the ways to stand in front of those tanks, both legal and extralegal.

Early abortion is a community public health service, and a Renaissance goal could be to have early abortion care accessible within one hour of every woman in the country. There are more than 3,000 fake clinics in this country, many of them supported by tax dollars. Surely we can find a way to make actual services as widely available to people who need them. Of course many areas couldn’t support a clinic, but we can find ways to create satellite or even mobile clinics using telemedicine to serve women in rural areas. We can use technology to check in with patients during medication abortions, and we can provide ways to simplify after-care and empower women to be partners with us in their care. Later abortion would be available in larger cities, just as more complex medical procedures are.

In this brave new world, we can invent new ways to involve the families and partners of our patients in abortion care when it is appropriate. This is likely to improve health outcomes and also general satisfaction. And it can increase the number of people who are grateful for and support independent abortion care providers and who are able to talk openly about abortion.

We can tailor our services to learn which women may benefit from additional time or counseling and give them what they need. And we can provide abortion services for women who own their choices. When a woman tells us that she doesn’t believe in abortion, or that it is “murder” but she has to have one, we can see that as a need for deeper counseling. If the conflict is not resolved, we may decide that it doesn’t benefit the patient, the clinic, or our society to perform an abortion on a woman who is asking the clinic to do something she doesn’t believe in.

I am aware that this last idea may be controversial. But I have spent 40 years counseling with representatives of the very small, but real, percentage of women who are in emotional turmoil after their abortions. My experience with these women and reading online “testimonies” from women who say they regret their abortions and see themselves as victimized, including the ones cited by Justice Kennedy in the Casey decision, have reinforced my belief that when a woman doesn’t own her abortion decision she will suffer and find someone to blame for it.

We can transform the conversation about abortion. As an abortion counselor I know that love is at the base of women’s choices—love for the children they already have; love for their partners; love for the potential child; and even sometimes love for themselves. It is this that the anti-abortion movement will never understand because they believe women are essentially irresponsible whores. These are the accusations protesters scream at women day after day outside abortion clinics.

Of course there are obstacles to our brave new world.

The most obvious obstacles are political. As long as more than 20 states are run by Republican supermajorities, legislatures will continue to find new ways to undermine access to abortion. The Republican Party has become an arm of the militant anti-choice movement. As with any fundamentalist sect, they constantly attack women’s rights and dignity starting with the most intimate aspects of their lives. A society’s view of abortion is closely linked to and mirrors its regard for women, so it is time to boldly assert the full humanity of women.

Anti-choice LifeNews.com contends that there have been approximately 58,586,256 abortions in this country since 1973. That means that 58,586,256 men have been personally involved in abortion, and the friends and family members of at least 58,586,256 people having abortions have been too. So more than 180 million Americans have had a personal experience with abortion. There is no way a small cadre of bitter men with gory signs could stand up to all of them. So they have, very successfully so far, imposed and reinforced shame and stigma to keep many of that 180 million silent. Yet in the time leading up to the Whole Woman’s Health case we have seen a new opening of conversation—with thousands of women telling their personal stories—and the recognition that safe abortion is an essential and normal part of health care. If we can build on that and continue to talk openly and honestly about the most uncomfortable aspects of pregnancy and abortion, we can heal the shame and stigma that have been the most successful weapons of anti-abortion zealots.

A second obstacle is money. There are many extraordinary organizations dedicated to raising funds to assist poor women who have been betrayed by the Hyde Amendment. They can never raise enough to make up for the abandonment of the government, and that has to be fixed. However most people don’t realize that many clinics are themselves in financial distress. Most abortion providers have kept their fees ridiculously and perilously low in order to be within reach of their patients.

Consider this: In 1975 when I had my first job as an abortion counselor, an abortion within the first 12 weeks cost $150. Today an average price for the same abortion is around $550. That is an increase of less than $10 a year! Even in the 15 states that provide funding for abortion, the reimbursement to clinics is so low that providers could go out of business serving those in most need of care.

Over the years a higher percent of the women seeking abortion care are poor women, women of color, and immigrant and undocumented women largely due to the gap in sexual health education and resources. That means that a clinic can’t subsidize care through larger fees for those with more resources. While Hyde must be repealed, perhaps it is also time to invent some new approaches to funding abortion so that the fees can be sustainable.

Women are often very much on their own to find the funds needed for an abortion, and as the time goes by both the costs and the risk to them increases. Since patients bear 100 percent of the medical risk and physical experience of pregnancy, and the lioness’ share of the emotional experience, it makes sense to me that the partner involved be responsible for 100 percent of the cost of an abortion. And why not codify this into law, just as paternal responsibilities have been? Perhaps such laws, coupled with new technology to make DNA testing as quick and inexpensive as pregnancy testing, would shift the balance of responsibility so that men would be responsible for paying abortion fees, and exercise care as to when and where they release their sperm!

In spite of the millions of women who have chosen abortion through the ages, many women still feel alone. I wonder if it could make a difference if women having abortions, including those who received assistance from abortion funds, were asked to “pay it forward”—to give something in the future if they can, to help another woman? What if they also wrote a letter—not a bread-and-butter “thank you” note—but a letter of love and support to a woman connected to them by the web of this individual, intimate, yet universal experience? This certainly wouldn’t solve the economic crisis, but it could help transform some women’s experience of isolation and shame.

One in three women will have an abortion, yet many are still afraid to talk about it. Now that there is safe medication for abortion, more and more women will be accessing abortion through the internet in some DIY fashion. What if we could teach everyone how to be excellent abortion counselors—give them accurate information; teach them to listen with nonjudgmental compassion, and to help women look deeper into their own feelings and beliefs so that they can come to a sense of confidence and resolution about their decision before they have an abortion?

There are so many brilliant, caring, and amazing people who provide abortion care—and room for many more to establish new clinics where they are needed. When we turn our sights to what can be, there is no limit to what we can create.

Being frustrated and helpless is exhausting and can burn us out. So here’s a glass of champagne to being able to dream again, and to dreaming big. From my own past clinic work:

At this clinic we do sacred work
That honors women
And the circle of life and death.