What a post-Roe era means for medication abortions

With Iowa Republican leaders likely to restrict access to abortion in the state following the U.S. Supreme Court’s decision to overturn Roe v. Wade last month, a potential legal battle over access to abortion pills is brewing.

Medication abortions account for more than half the abortions in Iowa — as well as more than half of all abortions in the United States — and often are obtained by patients through telehealth appointments.

Businesses offering abortion pills through the mail has grown in recent years, and likely will continue growing as the country becomes a patchwork of abortion access. But whether states can ban the actual medication itself — which has approval from a top federal health agency — is the next question that may be answered in upcoming court cases, some experts have said.

What is a medication abortion?

Medication abortion involves taking two different medications that can be administered up to 10 weeks gestation. The first is mifepristone, which is followed by misoprostol one or two days later.

Since the U.S. Food and Drug Administration first approved the drug regimen in 2000, its use nationwide has grown rapidly.

As of 2020, medication abortion has become the most common method for elective abortions, making up 54 percent of abortions in the United States, according to the Guttmacher Institute. By comparison, in 2017, it accounted for 39 percent of all abortions nationwide.

The majority of abortions in Iowa in recent years have been medically induced, surpassing the number of surgical abortion procedures in the past decade or so, according to the Iowa Department of Public Health.

In 2020, there were 3,222 medically induced abortions compared to the 835 surgical abortions in Iowa, according to the latest data from the state health department.

The IDPH first began reporting medically induced abortions in reports from 2005. That year, public health officials say there were 1,753 medical abortions, compared to 4,128 surgically induced abortions.

Iowa likely to restrict telemedicine abortions

With the U.S. Supreme Court’s decision to overturn the landmark 1973 case that established federal abortion protections, 13 states already have enacted laws that ban nearly all abortions, including medication abortions.

It’s likely GOP-led states — including Iowa — could go further. Some states already have proposed legislation that would ban telehealth appointments with abortion providers, and some have attempted to make it a crime for an out-of-state provider to provide abortion services to a resident.

Sally Frank, a Drake University law professor, said if Iowa restricts or bans abortions, telemedicine abortions similarly would be restricted or banned. Frank said the question is what would happen if an Iowa woman attempted to obtain abortion medication via telemedicine in a state where abortion remained legal. In such an instance, the out-of-state physician would mail the abortion medication to the Iowa woman.

“That remains to be decided (legally),” Frank said. “I think it would be difficult to try to bring that provider under Iowa law.”

Gov. Kim Reynolds and other Republican statehouse leaders did not respond to requests for comment about how they might approach regulating telemedicine abortions.

Reynolds did tell reporters earlier this past week she did not plan to call a special legislative session to pass abortion restrictions, but did say she may consider it if her efforts to bring back Iowa’s “fetal heartbeat” law fails.

For now, Reynolds is asking the Iowa Supreme Court to rehear a recent case with the hopes the court will establish legal standards for future abortion restrictions. She also is asking state courts to lift the injunction on a 2018 law that would ban abortions after six weeks of pregnancy, which often is before a woman knows she is pregnant.

During this year’s session of the Iowa Legislature, 21 Republicans in the Iowa House signed onto legislation that would ban telemedicine abortions. But the bill, House File 2119, did not advance past the early steps of the lawmaking process.

Despite their agenda-setting majorities, Republicans did not pass any abortion-related legislation during this session. Leaders said they preferred to wait for the U.S. Supreme Court and Iowa Supreme Court rulings on abortion cases. Both were delivered last month.

Abortion — including medication abortion — is legal up to 20 weeks in Iowa.

Telehealth providers navigating changing legal landscape

Planned Parenthood, the state’s largest abortion provider, offers telehealth abortions at its clinics across the state. Patients schedule a virtual visit with a provider at one of its health centers, where they receive the first pill to take at the clinic. They are given the second pill to take at home the next day.

For Iowans, with the rapid expansion of telehealth during the pandemic, access to abortions has grown beyond brick and mortar facilities. Nowadays, individuals can receive these pills in the privacy of their home, with a video call with a provider and a credit card.

Options for Iowans are increasing as companies that offer virtual abortion care rapidly have expanded their services nationwide.

Carafem is one company that began offering services in Iowa in September 2021 after seeing an influx of patients traveling to its physical location in Illinois. Chief Operating Officer Melissa Grant said the increase in demand occurred after state policies resulted in the closure of reproductive health clinics in the state.

“What that has done is really increase the availability of access for those who couldn’t travel,” Grant said.

To date, Carafem offers telehealth abortion in 14 states and Washington, D.C.

Under current Iowa law, patients are required to have at least one in-person appointment for an ultrasound before receiving the medication, Planned Parenthood spokeswoman Sheena Dooley said.

“We follow the law, and what we’re required to do under that law is to have patients come in-person for the first pill,” Dooley said.

However, Carafem’s interpretation of the law is different.

Carafem does require patients to receive an ultrasound from a provider in Iowa, but Grant said the rule does not require the first abortion pill to be administered within a health care setting. Instead, both pills are mailed to patients to take at home.

Grant said Carafem is working closely with legal experts as the landscape of abortion laws is rapidly changing, but officials hope to continue offering this service to patients nationwide. Moving forward, as they’ve prepared for a post-Roe era, Carafem’s strategy is to continue to increase its telehealth offerings in accordance to state regulations.

“Our mission right now is to work as a pressure valve to take off pressure from the increased number of visits where abortion is not restricted,” Grant said.

Comments: (319) 398-8469; michaela.ramm@thegazette.com

The Washington Post contributed to this article.