"It's one of the rights of this position," Nixon said. "If you don't want to make something law by signing it, you don't do it."
Supporters of the legislation praised the governor's action, saying the new law will better protect the health and safety of women who seek abortions. They said it is important for doctors to physically examine a woman seeking an abortion to reduce the chance for problems.
"It will also, we believe, save the lives of the babies," said Susan Klein, the legislative liaison for Missouri Right to Life. "Whenever you are going to start a procedure that is going to kill the baby that is growing within the body of the woman, obviously you need to meet with that physician."
But opponents of the bill contend that drug-induced abortions are safe and that the new restrictions, like various restrictions proposed or passed in several conservative-minded states this year, is another obstacle meant to make it harder for women to get abortions.
"This bill is simply another way for anti-choice legislators to stop the expansion of abortion, continuing to put burdens on women — particularly women in our state who have to travel very long distances to have access to abortion services in Missouri," said Paula Gianino, the president and CEO of Planned Parenthood of the St. Louis Region and Southwestern Missouri.
Ten other states, including Arizona, Indiana, Kansas, Mississippi and South Dakota, require that the prescribing clinician be physically present, according to the New York-based Guttmacher Institute, a research group that supports abortion rights. The institute said a similar requirement exists in Wisconsin and North Dakota but that enforcement had been put on hold because of litigation.
Telemedicine has been an option in Iowa since 2008. Planned Parenthood of the Heartland said it started because of patient demand in rural communities for better access to abortions, and that the service currently is available at 16 health centers throughout that state. Telemedicine has been used there for more than 3,000 medication abortions.
Women who opt for telemedicine abortions in Iowa answer questions and review their medical histories with a doctor through a two-way video link while a staff member is there with the woman. The physician administers the drug using a computer to remotely open a secure drawer at the health center, and the woman is instructed to take the medication while under the supervision of the doctor and staff member. A second medication is given for her to take at home, and a follow-up visit is scheduled for within two weeks.
The process for drug-induced abortions in Missouri is similar.
Planned Parenthood for the St. Louis Region and Southwest Missouri has not used telemedicine, but said it has examined the possibility. Gianino said about 20 percent of those seeking an abortion at its clinic travel more than 100 miles to do so.
Missouri's law will require the doctor dispensing or prescribing the initial drug to be in the room with the patient. The physician or someone acting on his or her behalf also will need to make reasonable efforts to ensure patients return for the follow-up visit.
The Missouri legislation has received far less attention than abortion restrictions proposed or passed in other states this year. Lawmakers in Texas are pursuing a measure that requires doctors have admitting privileges at nearby hospitals, allows abortions only in surgical centers, limits where and when women may take abortion-inducing pills and bans abortions after 20 weeks.
In North Dakota, a lawsuit has been filed in federal court challenging what would be the nation's most restrictive abortion law. It would ban abortions if a fetal heartbeat can be detected, which can happen as early as six weeks into a pregnancy.
