DES MOINES, Iowa -- A surprising thing has happened since a controversial video-conferencing system tripled the number of Iowa towns where women could obtain abortions: The annual number of abortions has dropped 30 percent in the state.
Planned Parenthood of the Heartland installed the system in 2008 to allow its doctors in Des Moines to dispense abortion pills to women in clinics around the state. The system made abortions available in towns where no one else offered them. But it did not make abortions more common, state data show. In fact, the numbers have dropped from 6,649 in 2007 to 4,648 in 2012.
The system, the first of its kind in the nation, will be debated Wednesday during a public hearing before the Iowa Board of Medicine. Opponents say the system exposes women to potentially dangerous drugs without making a physician readily available to help patients deal with complications. Proponents say it offers women a proven way to obtain safe medication, and they say foes just want to make abortions harder to get.
It's not clear what would happen if the state bans doctors from using the video system, forcing women to travel to urban clinics to obtain abortions.
Jill June, president of Planned Parenthood of the Heartland, predicts there would be little effect on the number of abortions.
"Women will walk over hot coals to end a pregnancy that from their perspective is going to destroy their life," she said.
The main change, she said, would be that some rural women would have abortions later in their pregnancies, because it would take them longer to make arrangements.
Jenifer Bowen, executive director of Iowa Right to Life, believes abortions would become rarer if the video system is banned.
But she said people on her side also are concerned about the safety of patients who use the system.
"We can do both, can't we?" she said. "We can care about women, and we can care about babies."
Bowen said she's unsure of the accuracy of the abortion trend numbers, which are collected by the Iowa Department of Public Health. State law requires medical providers to report every abortion they provide, but Bowen suspects some go unreported.
However, she said she hopes it's true that abortions are becoming less common in Iowa.
Bowen said part of the explanation for a decline in abortions is that groups like hers have become more active. They've held numerous prayer vigils outside abortion clinics. They've also started about 70 "crisis pregnancy centers" around the state.
Supporters say such centers help pregnant women understand their alternatives to abortion, including keeping a baby or giving it up for adoption.
Bowen also said the increased use of sonograms has led more women to see that they're carrying babies, not just tissue.
June, the Planned Parenthood leader, said part of the explanation for the declining Iowa abortion numbers is that more women are using long-acting contraceptives. Such methods include hormone devices implanted in women's arms. They also include intrauterine devices, which June said have overcome safety concerns about earlier models.
Planned Parenthood and other Iowa agencies took part in a five-year demonstration project that provided free long-term contraceptives to women. The Iowa Initiative project, which ended last year, was financed by millions of dollars from the late wife of philanthropist Warren Buffett. During the project, Planned Parenthood of the Heartland implanted more than 3,400 long-term contraceptives per year, compared with about 470 annually in previous years.
June said the implants are an appealing alternative to many women, because they're reliable and reversible.
"Most women don't decide not to get pregnant; they decide not to get pregnant now," she said. In some cases, she added, the implants were given to women who'd just had abortions, so they wouldn't need to have repeat procedures.
Iowa's abortion numbers were relatively low even before the recent decline. In 2009, the latest year for which national statistics are available, Iowa saw 10.1 abortions per 1,000 women ages 15-44. The national rate was 15.1.
In that same year, Iowa reported 147 abortions per 1,000 live births, compared with a national average of 227.
Iowa's decrease in abortions accompanied a smaller decrease in live births, which might have been partly due to the recession.
A national expert said rural states tend to have lower abortion rates and noted that abortions have been declining in many states. But Guttmacher Institute analyst Elizabeth Nash expressed surprise at the 30 percent drop in Iowa over the past five years.
"That is a huge, huge decrease," Nash said. "You wouldn't expect that kind of decrease unless there was a change in behavior or a real change in access."
The change in access was that it became easier for Iowa women to obtain abortions, so the decrease must be due to changes in behavior, she said.
Nash, whose organization supports abortion rights, said June's explanation of increased use of long-term contraceptives makes sense.