As abortion activists push for broader chemical abortion access, and pro-life advocates continue to call for maintaining important federal safety protections for abortion drugs, abortion pills by mail have arrived in Iowa.
The Midwestern state is one of more than a dozen affected by a national pilot program from Gynuity Health Projects aimed at delivering chemical abortion pills via mail without abortion-seeking women first seeing a doctor in person, the Des Moines Register reports.
Gynuity is a New York-based “reproductive and maternal health” group that partners with Planned Parenthood and other abortion providers.
Its TelAbortion project involves mailing the abortion drugs to the woman after a video evaluation over the internet, a method of dispensing not normally permitted by the Food and Drug Administration (FDA).
Facilitating a chemical abortion without the pregnant woman having an in-person consultation and examination by a doctor, and the doctor likewise not present for the abortion, creates great risk for the mother, pro-life supporters say, and they underscore that any rolling back of regulations for an already potentially dangerous chemical abortion regimen will create additional peril for women.
“The mail order abortion pill program is shocking,” said Iowans for LIFE (IFL) Executive Director Maggie DeWitte. “Ru-486 is a dangerous medication that kills unborn children in the womb and harms women both physically and emotionally. The idea that girls and women across Iowa could receive this dangerous drug through the mail without ever seeing a physician in person is appalling.”
Statistics show that overall abortion numbers have declined, but chemical abortion is on the rise, now accounting for some 40 % of all U.S. abortions. The numbers show as well that the number of surgical abortion facilities is going down while abortion pills facilities are steadily increasing.
Iowa was first targeted for telemed abortion in 2008 by Planned Parenthood – the first system of its kind in the nation.
With Planned Parenthood’s webcam abortions, the prescribing doctor and the abortion client are at different locations, and the doctor uses a computer to remotely open a drawer at the client’s location, from where the abortion pills are dispensed.
From the time of its introduction the Iowa webcam abortion system was the subject of significant controversy over safety concerns, and ultimately a lawsuit, as Planned Parenthood sued to protect the arrangement.
The Iowa Board of Medicine initially did not take issue with the Planned Parenthood telemed abortion system, until its members were replaced by former Gov. Terry Branstad.
The Board then adopted rules for standards of practice related to chemical abortion later in 2013, requiring the physician to personally examine the woman, dispense the abortion-inducing drug and oversee follow-up medical care. Iowa law requires that abortions in the state be performed by a physician.
Planned Parenthood sued over the new standards, and the Iowa Supreme Court overruled the Board in 2015, leaving the webcam abortion system operating in Iowa since.
FDA REMS goal: “To mitigate the risk of serious complications associated with mifepristone”
The new mail-order abortion pill scenario goes a step further than previous telemed abortion systems by delivering the drugs outside of any medical or abortion facility, and is being conducted in Iowa and elsewhere even as the FDA has established safety measures for abortion drugs, its Risk Evaluation and Mitigation Strategy (REMS).
The REMS for abortion pills requires among other things that abortion drugs be dispensed by specially certified healthcare providers, who also must ensure the drugs are dispensed “to patients only in clinics, medical offices and hospitals by or under the supervision of a certified prescriber,” and “not distributed to or dispensed through retail pharmacies or other settings ...”
However, Gynuity got approval for its TelAbortion trial under former president Barack Obama’s FDA in 2015, with the project beginning in 2016.
The FDA has documented at least 4,000 cases of serious adverse events related to the abortion pill, including more than 1,000 women who required hospitalization. As of December 31, 2018, there had been 24 reported deaths of women in the United States associated with abortion pills.
"You can do it from the break room at work”
Tara Shochet, a senior program associate for Gynuity who is based in Iowa, told the Register there is no good reason why a telemed abortion appointment can’t be conducted over the internet with a secure connection. Shochet suggested that women could consult virtually on their prospective chemical abortion from anywhere and depicted it as parallel to consulting with a physician in person.
“You can do it from home. You can do it from your car. You can do it from the break room at work,” Shochet said. “It really mirrors the in-person experience.”
The TelAbortion project in Iowa will be administered by the Emma Goldman Clinic in Iowa City, the state’s only abortion provider not affiliated with Planned Parenthood, according to the Register.
The Goldman abortion facility’s Executive Director Francine Thompson said the facility’s lawyer assured her that it is legal for the facility to participate in the Gynuity pilot program, according to the report, though Thompson said, “It’s not something we would be able to do if we weren’t part of the study.”
DeWitte told the news outlet she was disappointed to learn about the mail-order abortion pill project in Iowa. If doctors are going to prescribe the abortion pills, DeWitte said, they should at least see the women in person, and that having women induce abortions themselves at home, “seems very reckless.”
“We’re not talking about Tylenol here,” DeWitte said.
Tweet This: “We’re not talking about Tylenol here” - Iowans for LIFE Executive Director Maggie DeWitte on the risks of abortion pills dispensed by mail
Those behind the project said it is “a safe and legal way” to provide abortion pills to women who might have trouble traveling to what it termed one of Iowa’s “shrinking number of abortion clinics,” the Register report said.
Thompson told the Register she hopes the Gynuity project proves the safety of telemed abortion, so federal and state regulators will allow them to expand.
Planned Parenthood, the nation’s largest abortion provider, had 24 Iowa sites in 2012, and now has nine, five from which it offers telemed abortion. Planned Parenthood does not offer in-home telemed abortion appointments or mail abortion pills to clients, according to the report, requiring clients to visit one of its sites to receive the drugs.
“Do-it-yourself,” “self-managed,” “at-home” abortion
In June, the World Health Organization (WHO) encouraged expansion of telemed distribution of abortion drugs, citing the pandemic.
And in May the American Civil Liberties Union (ACLU) filed a lawsuit in federal court against the FDA and the Department of Health and Human Services (HHS) on behalf of the American College of Obstetricians and Gynecologists (ACOG) and other abortion-supporting groups to remove restrictions on access to the abortion pill, again with the virus as justification.
Last week week a federal judge in the case suspended the FDA rule mandating that pregnant women see a doctor to obtain a chemical abortion.
U.S. District Judge Theodore Chuang's ruling temporarily halts the requirement for women to visit a hospital, abortion facility or medical office in person to get a chemical abortion, allowing abortion providers to dispense abortion pills through the mail or other delivery to the abortion client for the time being.
Chuang’s ruling said that states can still have regulations that extend "above and beyond" the FDA's guidance.
The chemical abortion process consists of two drugs, the first, RU-486, or mifepristone/Mifeprex. This drug blocks progesterone, the natural hormone in the mother’s body necessary for a pregnancy to thrive. The second abortion drug, misoprostol, is taken a day or so later, and causes the mother to then deliver her deceased child.
Potential complications of a chemical abortion include an incomplete abortion, possibly resulting in the need for a follow-up surgical abortion, heavy and prolonged bleeding, infection, fever and digestive system discomfort, according to the Mayo Clinic. Numerous additional negative side effects have also been reported.
“Women who have taken this drug report back the enormous physical implications, including an extreme loss of blood and severe cramping,” DeWitte said. “Many thought they would die. This is done in their home, alone, often in their bathroom.”
“The isolation these women feel is something not easily dealt with,” she added. “They are faced with the harsh reality of what they did when they see their dead baby in a toilet. Because, let’s be clear- that is the reality of medical abortion through the mail.”
Chemical abortion is legal in the U.S. up until 10 weeks in pregnancy.
A new study focusing on women’s personal experience with chemical abortion found that even aside from medical complications, 83% of the women reported that their medication abortion changed them, 77% stated openly that they regretted their decision, and 38% reported experiencing anxiety, depression, drug abuse and suicidal thoughts because of their abortion. Study participants gave numerous heart-wrenching accounts of post-abortion suffering.
“TelAbortion: a new way to obtain the abortion pill”
A Live Action News report last year raised the question of whether the Gynuity TelAbortion study was being used to by-pass FDA abortion pill safety requirements.
It included statements from a co-leader of the trial discussing circumventing states where telemed abortion is illegal by introducing the program in neighboring states.
The report also detailed how the TelAbortion project kept escalating, from an ever-increasing number of trial states and study participants, to expanding the age range of the participants (to include girls as young as 10) and continued extension of the study’s completion date.
Live Action’s report also noted how the study had changed after its implementation, morphing from a “cohort” study to now be a “case-only” clinical trial.
Abortion pills by mail now being tried in more states
Gynuity first had two study locations in 2016. Its TelAbortion study is currently running in 13 U.S. states: Colorado, Georgia, Hawaii, Illinois, Iowa, Maine, Washington, Maryland and D.C., Minnesota, Montana, New Mexico, New York, Oregon and Washington.
Live out of state? An Iowa mailing address = abortion pills
Seventeen states outlawed telemed abortions after Planned Parenthood started using its system in Iowa, the Register report said. Those include adjacent states South Dakota, Nebraska, Missouri and Wisconsin. The Gynuity project is not established in any of those states, it said, however according to Gynuity, women from outside Iowa could take part in its TelAbortion project if they arrange for an Iowa address to which the pills could be mailed.
The mail-order telemed abortion project in Iowa will be conducted in three steps.
The client calls Goldman facility to determine if they qualify for the drugs by confirming they are in the first 10 weeks of pregnancy. If yes, they must get an ultrasound and provide it to the Goldman abortionist, with whom the client then has an appointment via video. The abortionist then sends the pills through the U.S. Postal Service after the client pays the $750 fee.
Ripe for abuse
DeWitte also raised the question of risk that this project could pose to underage girls.
“And, what about minor girls?” she asked. “Will 14-year-olds be able to obtain this drug without their parents even knowing about it?”
IFL’s Board President Tom Quiner concurred.
“Mail order abortion pills are ripe for abuse,” he said. “They pose special risks for younger teens, who may attempt to access this bloody procedure without a parent’s knowledge.”
This is exactly what happened to an early user of RU-486, Holly Patterson, Quiner noted.
Patterson was 17 when she took part in Planned Parenthood’s implementation of an unapproved off-label regimen of the abortion pill in 2003. She died a week later shortly after her 18th birthday of complications from her chemical abortion.
Quiner had written an essay at the time about webcam abortions for the Des Moines Register, and Holly Patterson’s father, Monty Patterson, who became an advocate for raising awareness about the abortion pill after his daughter’s death, contacted Quiner with additional warnings on the dangers of abortion pills.
Patterson was critical of how thoroughly abortion providers were informing women of chemical abortion risks, and the fact that, already at that time, it was “increasingly becoming a do-it-yourself procedure.”
“This will create more injuries and fatalities that probably will go unreported,” Patterson said.
Nothing to do with health
DeWitte explained that with fewer doctors willing to perform surgical abortions now, this is driving the abortion industry to push for more chemical abortion, including the mail-order abortion pills.
“This project allows Iowa abortionists to leverage their deadly trade and kill more babies with a couple of pills,” she said. “They are able to do it at a much higher profit margin, since they no longer need brick and mortar clinics, and yet they charge the same for a medical abortion as they do a surgical one.”
“Gynuity’s Iowa ‘project’ treats fertility, pregnancy, and healthy human life as a disease, as if it is unwanted,” said DeWitte. “It has nothing to do with health.”
Editor's note: Heartbeat International manages Pregnancy Help News and the Abortion Pill Rescue Network. The author was previously associated with IFL via contract employment.