Changes in Service Delivery Patterns After Introduction of Telemedicine Provision of Medical Abortion in Iowa

Abstract

Telemedicine could improve access to medical abortion, especially for women living in remote areas, and reduce second-trimester abortion.

Did increasing use of highly effective contraception contribute to declining abortions in Iowa?

“…Our estimates suggest that a small increase of 1 new LARC user per 100 women in a region was associated with a 4% decline in abortions each year. This decline happened in conjunction with an increase in the number of facilities offering abortion care to women, particularly in rural and remote areas [15]. Given the increase in abortion access and lack of legal restrictions placed on abortion from 2005 to 2012, we can reasonably assume that reductions in abortions over the study period were not a result of restricted access to care.…”

“…The number of abortion facilities in a region may be an indicator of LARC access. Eleven of the 15 facilities where telemedicine abortion provision was introduced were existing family planning facilities that had not previously offered abortion services [15]. Thus, the places where women had access to abortion services in Iowa were the same places where women could access LARC methods.…”

“…All facilities offering surgical abortions prior to the introduction of telemedicine abortion continued to offer this procedure after telemedicine was introduced. While the overall abortion rate declined in Iowa during the 2 years after telemedicine services were introduced, women living in rural areas of the state were more likely to obtain an abortionespecially early medical abortion [15]. The introduction of telemedicine abortion resulted in an overall increase in the number of abortion facilities in Iowa, from 9 in 2005 to 18 in 2011 [3].…”

Update on Medical Abortion: Expanding Safe and Equitable, Patient-Centered Care

“…Telemedicine improves access to medical abortion in regions where access to surgical abortion is limited [41] and is feasible and effective in simplifying follow-up for patients across varied international settings including the UK [42], Vietnam [43], and the USA [44]. Additionally, this practice has high patient and provider satisfaction [45,46].…”

How health services can improve access to abortion

“…The first is a full medical consultation by remote communication with the patient. [19,20] The second is an internet-based medical screening questionnaire to assess eligibility before sending out pills for medical abortion by post. [21] The latter is used in high-income countries that have restrictive abortion laws such as the Republic of Ireland as well as in low-and middleincome countries.…”