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Medication Abortion Through Telemedicine: Implications of a Ruling by the Iowa Supreme Court

Yang, Y. Tony, ScD, LLM; Kozhimannil, Katy B., PhD, MPA

doi: 10.1097/AOG.0000000000001251
Contents: Current Commentary

In summer 2015, the Iowa Supreme Court unanimously struck down a restriction that would have prevented physicians from administering a medication abortion remotely through video teleconferencing. In its ruling, the Iowa Supreme Court stated that the restriction would have placed an undue burden on a woman's right to access abortion services. It is crucially important for clinicians—especially primary care clinicians, obstetrician–gynecologists (ob-gyns), and all health care providers of telemedicine services—to understand the implications of this recent ruling, especially in rural settings. The Court's decision has potential ramifications across the country, for both women's access to abortion and the field of telemedicine. Today telemedicine abortion is available only in Iowa and Minnesota; 18 states have adopted bans on it. If telemedicine abortions are indeed being unconstitutionally restricted as the Iowa Supreme Court determined, court decisions reversing these bans could improve access to abortion services for the 21 million reproductive-age women living in these 18 states, which have a limited supply of ob-gyns, mostly concentrated in urban, metropolitan areas. Beyond the potential effects on abortion access, we argue that the Court's decision also has broader implications for telemedicine, by limiting the role of state boards of medicine regarding the restriction of politically controversial medical services when provided through telemedicine. The interplay between telemedicine policy, abortion politics, and the science of medicine is at the heart of the Court's decision and has meaning beyond Iowa's borders for reproductive-age women across the United States.

The Iowa Supreme Court decision on telemedicine abortion emphasized that available science, not political rhetoric, should drive America's telemedicine policies.

Department of Health Administration and Policy, George Mason University, Fairfax, Virginia; and the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota.

Corresponding author: Y. Tony Yang, ScD, LLM, Department of Health Administration and Policy, George Mason University, MS: 1J3, 4400 University Drive, Fairfax, VA 22030; e-mail:

Supported in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under award number R24HD041023. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank David Van Riper and Jason Borah in the Spatial Analysis Core at the Minnesota Population Center for assistance in preparation of the map, presented as Figure 1. The authors also thank Sara Abiola, JD, PhD, for her helpful comments on an earlier draft of this paper.

© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.