Iowa among states that piloted delivery of abortion drugs by mail

The federal Food and Drug Administration on Tuesday finalized a rule change that broadens availability of abortion pills to many more pharmacies, including large chains and mail-order companies.

The Biden administration partially implemented the change last year, announcing it would no longer enforce a long-standing requirement that women pick up the medicine in person. Tuesday's action formally updates the drug's labeling to allow many more retail pharmacies to dispense the pills, so long as they complete a certification process.

The change could expand access at both brick-and-mortar stores and online pharmacies. Women can get a prescription via telehealth consultation with a health professional, and then receive the pills through the mail, where permitted by law.

More than half of U.S. abortions are now done with pills rather than surgery, according to the Guttmacher Institute, a research group that supports abortion rights.

Most Iowa abortions are medically induced

A vast majority of abortions performed in Iowa are medically induced.

More than 79 percent of the 4,058 abortions performed in the state in 2020 were medically induced; 835 were surgically induced, according to the Iowa Department of Health and Human Services. Final data for 2021 was not yet available, according to a department spokeswoman.

In 2019, 2,404 of the 3,566 abortions performed in Iowa were medically induced.

Iowa House Republicans last year tried to pass a bill that would have required Iowa women to receive an abortion pill in a health care setting. The move came after the FDA eased restrictions during the COVID-19 pandemic, allowing women to receive abortion pills through the mail.

The proposed Iowa bill also would require doctors to inform patients of risks commonly associated with a medical abortion and that they have the option to reverse it, if they change their mind within a certain period of time.

Supporters believe the pills are dangerous and need to be dispensed only in a health care setting. Opponents contend the bill prevents Iowans from accessing legal abortion that is safe and effective.

Additionally, the American College of Obstetricians and Gynecology has said the use of progesterone to reverse abortions is not supported by science.

The bill passed out of committee but failed to make it to a vote on the Iowa House floor.

Leaders in the Republican-led Iowa Legislature have said any moves to further restrict abortion in the state likely will wait on an Iowa Supreme Court decision on whether to reinstate a blocked law that would ban the procedure except in the earliest weeks of pregnancy.

Republican lawmakers and anti-abortion rights advocates hope the court will use the case to set a more permissive legal standard for considering abortion restrictions after the U.S. and Iowa supreme courts struck down abortion rights protections last summer.

In 2015, the Iowa Supreme Court unanimously overruled the Iowa Board of Medicine, stating a ban on Planned Parenthood’s telemedicine system in the state placed an “undue burden” on women’s right to abortion.

Though a majority of the justices last summer ruled the Iowa Constitution does not provide a fundamental right to an abortion, the Iowa Supreme Court did not definitively decide what standard should be applied to abortion restrictions under the state constitution.

In the meantime, they declared that the “undue burden” standard from the U.S. Supreme Court’s decision in Planned Parenthood v. Casey would govern Iowa law “for now.”

Iowa helped pilot telemedicine program

The first telemedicine abortion program began in Iowa in 2008. Iowa was also one of 13 states that participated in a national pilot and research project used by the FDA to suspend in-person dispensing requirements for abortion pills for the duration of the pandemic.

Gynuity Health Projects, a reproductive health group based in New York, partnered with the Emma Goldman Clinic in Iowa City to distribute abortion pills by mail after video appointments with a physician. Gynuity obtained federal permission for the study, which started in 2016 and ended in September 2020.

Patients spoke with clinic staffers over the phone to see if they might qualify for the medications, which induce abortions in the first 10 weeks of pregnancy. If they qualified, an ultrasound was done and followed by a video appointment with a physician.

Sites sent study packages containing mifepristone and misoprostol by mail and had remote follow-up consultations within one month.

Researchers determined that outcomes were comparable to in-clinic care and that the direct-to-patient telemedicine service was highly effective and critical to protecting patient safety during the COVID-19 pandemic.

The Associated Press contributed to this report.

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