A little-known lawmaker in Iowa, State Rep. Matt Windschitl (R), recently declared that he’d like to end abortion altogether. “If I could stop all abortion in this state, I would,” Windschitl said earlier this week. Although he likely won’t be able to accomplish that goal immediately, he’s inching closer to it — with potential implications that will stretch far beyond Iowa’s borders.

If you’ve never heard of Windschitl, and had no idea that Iowa has become a battleground for reproductive rights, you’re not alone. With national attention recently focused on high-profile battles in Texas, Virginia, and North Carolina, the unfolding fight in the Hawkeye State hasn’t captured as many headlines.

But Iowa’s current conflict over what’s called “telemedicine abortion” has actually stretched on for months, and the push to restrict this practice could end up having big consequences for abortion access across the country. If conservatives in the state are successful, they’ll further narrow the health care options for economically disadvantaged women in a society that’s already chiseled away at their right to choose. And Windschitl just filed a bill to take another step in that direction.

What’s telemedicine abortion, and why does it matter?

To understand what’s happening in Iowa, it’s important to backtrack to 2008, when Planned Parenthood of the Heartland began using telemedicine — essentially, video technology that allows doctors to interact with patients without physically being in the same place — to administer abortion care. As new technology continues to impact the way the health industry operates, telemedicine is becoming increasingly common, and is now used by about 10 million to 12 million Americans every year. And since telemedicine is especially advantageous for low-income and rural Americans who struggle to travel to a doctor’s office, it’s a natural fit for abortion patients — who aredisproportionately poor and increasingly losing access to nearby clinics.

The program has provided first-trimester abortion services to more than 3,000 women in the state since it began in 2008.

So the Planned Parenthood affiliate in Iowa piloted the new service, which allows doctors to prescribe the abortion pill (pictured above) to their patients over a video chat. The program has provided first-trimester abortion services to more than 3,000 women in the state since it began in 2008. It became a model for a few other states to start offering telemedicine abortions, too. Evidence mounted that this tactic was effectively expanding low-income women’s access to abortion care, and patients reported feeling satisfiedwith their virtual doctors’ consultations.

Particularly as abortion clinics are being forced to close at a record pace, there’s a huge opportunity for telemedicine programs to help maintain women’s access to safe, legal, early abortion. So it’s perhaps no wonder that conservatives like Windschitl want to put an end to them.

‘Robot skype abortion’

Iowa Rep. Steve King (R) has been one of the biggest crusaders against telemedicine abortion care, decrying it as “robot skype abortion” and attempting to ban it on a national level. Incidentally, although King typically stokes fears about the practice by suggesting that robots are performing invasive surgeries on women, that’s not actually how telemedicine works. It’s only offered for first-trimester, non-surgical, medicine-induced abortion. No robots are involved.

Interestingly enough, there’s no outcry about other advances in reproductive health that actually do rely on robot technology. According to a 2013 study published in the Journal of the American Medical Association, nearly ten percent of all hysterectomies — the surgery that removes a woman’s uterus — are now performed with robot-assisted technology here in the United States. Since surgical robots can help make the procedure slightly less invasive, an increasing number of women are opting to use them.

Republican lawmakers are happy to sign onto measures promoting telemedicine services among veterans.

There’s no controversy over over types of telemedicine programs, either, which are now used to treatAmerica’s ailing veterans who live in rural areas. Republican lawmakers are happy to sign onto measures promoting telemedicine services among this population. “We must encourage the Department of Defense to continue to work on implementing telehealth throughout our military health system,” Sen. Rob Portman (R-OH) said this past December to introduce a new piece of legislation on the subject.

When advances in health care technology are used to expand women’s abortion access, however, that’s another story.

Cloaked in the language of “preserving women’s safety,” conservative abortion opponents have seized on the opportunity to prevent telemedicine abortion programs from getting off the ground. Over the past several years, multiple state legislatures have rushed to ban the practice even before any local clinics even attempted to start implementing telemedicine abortion care — essentially, banning it where it doesn’t even exist yet. Fourteen statesnow require physicians to be in the physical presence of patients while administering the abortion pill, a medically unnecessary policy that essentially strikes at the heart of this new telemedicine technology.

Stacking the medical board

In addition to King’s national crusade against the practice, local lawmakers have repeatedly attempted to pass legislation to ban telemedicine abortion in Iowa — a move that would prevent the nation’s largest program of its kind from continuing to collect compelling data about how well it’s working. Since that’s been unsuccessful so far, abortion opponents in Iowa recently took a different tactic: going through the state’s medical board instead of the legislature.

In 2010, Planned Parenthood of the Heartland’s telemedicine program got approval to continue operating from the state’s Board of Medicine. But since then, the state’s anti-choice governor has worked to change the makeup of the board so that won’t happen again. Gov. Terry Branstad (R) replaced all ten members of the supposedly nonpartisan medical board with his own conservative appointees.

This past June, the new board approved new rules to require doctors from prescribe the abortion pill in person, taking a huge step toward abolishing to telemedicine abortion in the state. At the end of August, the Board of Medicine held a public hearing on the matter that stretched on for over three hours — and the medical professionals who attended said they were “embarrassed” by the board members’ actions. The vice president for the Iowa Medical Society pointed out that even though the proposed rule was written by anti-choice activists who have been collecting signatures for a petition to ban telemedicine abortion, the board simply accepted that wording “hook, line and sinker.”

“I’m going to ask you to please make your decision not on your personal prejudice and not on your religious beliefs, and not on political pressure.”

“I’m going to ask you to please make your decision not on your personal prejudice and not on your religious beliefs, and not on political pressure, whether it’s subtle or not so subtle. But make it based on the evidence,” one retired obstetrician, Dr. William Burke,told the board members.

They didn’t listen. On the Friday before the Labor Day weekend, Iowa’s Board of Medicine quietly voted to eliminate abortion access for low-income women in the state.

All eyes on a big court battle

After the medical board voted to ban telemedicine abortion, Planned Parenthood quickly filed a legal challenge. “There was no medical evidence or information presented to the Board that questions the safety of our telemedicine delivery system,” Jill June, the president of Planned Parenthood of the Heartland, said in a statement announcing the group’s lawsuit against the state. “It’s apparent that the goal of this rule is to eliminate abortion in Iowa, and it has nothing to do with the safety of telemedicine.”

A district judge agreed, ruling in favor of Planned Parenthood in November and temporarily blocking the board’s new regulations from taking effect while the legal challenge proceeds. District Judge Karen Romano’s scathing 16-page opinion essentially chastises the Board of Medicine for blocking access to reproductive health care without any good reason.

“The court strains to understand how decreasing the number of apparently effective and safe abortion services offered to Iowa women pending the resolution of this case supports the public’s interest in receiving ‘adequate’ health care,” Romano wrote, noting she’s “not entirely persuaded” that banning telemedicine abortion services would achieve the board’s stated goal of protecting women.

Nonetheless, she won’t have the final word. Planned Parenthood is still awaiting a final decision on the matter — a ruling that will impact the future of telemedicine abortion programs across the country. If Iowa’s program is halted, that will carry even more weight than the recent rash of state laws designed to target telemedicine abortion. There will be legal precedent for squashing this type of clinic program for good.

Part of a larger strategy

That brings us back to Rep. Matt Windschitl, who doesn’t want to wait for the court to hand down its decision about telemedicine. Backed by 18 other Republican lawmakers in Iowa, Windschitl just filed a bill to outlaw telemedicine abortion the old-fashioned way — through the legislature.

This is merely a strategy to carry out his bigger goal of putting an end to abortion.

Considering the long battle over abortion access in Iowa, it’s not hard to see what Windschitl’s motives are. Jill June of Planned Parenthood of the Heartland points out that “this is merely a strategy to carry out his bigger goal” of putting an end to abortion. “Do we want the government and people like Matt Windschitl, who never have to be pregnant, who never have to take birth control, to control our health care?” June told the Quad-City Times.

Windschitl’s new bill could easily pass the GOP-controlled House. It faces more of an uphill battle in the Senate, where Democrats could resist bringing it up for a floor vote. But at least one key Democratic senator, an anti-abortion Catholic who often breaks from his party on reproductive rights issues, has indicated that he supports the measureand would like the full Senate to consider it.

There are some important takeaways from Iowa’s ongoing fight that speak to a larger anti-choice strategy to eliminate abortion access. First of all, the whole point is to keep these efforts too complicated to understand, weighed down with legal jargon that prevents the average American from realizing what exactly poses a threat to reproductive rights. That’s why abortion opponents are increasingly going after abortion providers, enacting yards of red tape around clinics and doctors that often don’t seem to be problematic on the surface. Particularly when the new restrictions are framed in terms of “women’s safety,” it’s hard to figure out what’s really at stake.

It seems logical to keep women safe by requiring doctors to be present during an abortion. It seems logical to require abortion clinics to adhere to strict building codes. It seems logical to require abortion providers to get the proper licenses, including from local hospitals. Those laws aren’t supposed to spark headlines or inspire protests. But in fact, these type of policies represent some of the most insidious threats to abortion access in states across the country. And they’re succeeding because Americans don’t realize they should be paying attention.

Tara Culp-Ressler

Think Progress