"Generally, during the actual expulsion, it's like a miscarriage," said Grossman. "It can be painful, but it can be easily controlled with oral pain medications. Women come back for a follow-up a week or two later to have an ultrasound to confirm that the abortion is complete."
About 1 percent of the women had a complication related to the medical abortion -- but adverse events were not more prevalent in in one group more than the other.
"The most important thing the study demonstrated was how safe this provision model can be," he said. "There is no indication that this puts women at medical risk."
But the national anti-abortion group, Operation Rescue calls this procedure "push-button" abortion that "kills babies and endangers the lives of women." So far, five states -- Arizona, Kansas, North Dakota, Nebraska and Tennessee -- have passed laws limiting telemedicine abortions, according to the Guttmacher Institute.
The group filed several complaints against Planned Parenthood in 2009, but the Iowa Board of Medicine voted to close the file without any disciplinary action, according to Planned Parenthood of the Heartland spokeswoman Shelby Cloke. "We've always been confident we are offering safe and legal services for Iowa women and this ruling validates that," she said.
Operation Rescue President Troy Newman said telemedicine "reduces health care to something like a Skype connection."
"I can't go got my doctor to get headache relief without going through a quick exam," he said. "They weigh me and take my blood pressure and my temperature. The doctor-patient relationship is removed from this part of health care. It boils down to a pre-measured dose of abortion medicine that is pre-packaged and set in a drawer.
"Every woman, whether she is 80 pounds or 200 pounds, gets the same dose from the doctor, who pushes a button and out pops a pill. Women deserve better."
Newman is quick not to dismiss telemedicine in circumstances where doctors cannot get to patients, as in the Chile mine disaster last year or when astronauts are in space. "When all else fails, you do the best to administer medicine over whatever communication you have," he said.
"But it's like the McDonald's drive-through window of abortion service," he said. "What could be worse than to go home and take a pill or eat a hamburger and get sick. Women who live 100 miles away can have cramping and bleeding and having complications where they are forced to go to the emergency room."
But Todd Buchacker, a nurse and regional director of Planned Parenthood of the Heartland's health services, said telemedicine is widely and safely used throughout the medical world.
"If doctors can provide knee surgery with a physician sitting in his office across the street from the hospital doing it on the computer with robotics -- if they can do that -- why can't we somehow provide this mifepristone pill to women long distance?" he said.
Women choose medical abortions, not because of cost, but because of the privacy it provides in their own home, according to Buchacker.
"I never begin to guess what a woman goes through when making this decision, but I believe a lot of women choose a medical abortion because it's early in pregnancy and seems like an option that is less invasive," he said. "It may be more time-consuming over the course of a few days, as opposed to a 10-minute clinical procedure, but it is more personal and private and some women -- I hate to say this -- say it feels it is more natural."
Buchacker said making it easier for women seeking an abortion doesn't result in more abortions.
The number of abortions in Iowa has fallen from an all-time high of 10,022 in 1997 to 5,829 in 2009, according to statistics from the Centers for Disease Control and Prevention and state health departments, and it has continued to drop each year by about 10 percent.
As part of the Iowa Initiative, a program to reduce unintended pregnancies, Planned Parenthood of the Heartland has implanted 7,000 intrauterine devices (IUDs) and other long-acting reversible contraception in women.
"We won't know the numbers for several years, but I do think that certainly could be part of the reason we are seeing fewer abortions," Buchacker said. "History tells us that when the economy is bad, women tend to have more abortions, and that has not held true in Iowa."
This story has been amended to include more recent abortion statistics in paragraph 8.