New York ? Ten years ago, after long and bitter debate, the U.S. Food and Drug Administration approved use of the abortion pill by American women. It is hailed as safe and effective, but new turmoil may lie ahead as the pill’s proponents consider using telemedicine to make it more available.

Already, a pioneering telemedicine program in Iowa has provided the pill to about 1,900 women — with a doctor able to consult with a faraway patient in a video teleconference, then unlock a container by remote control to release the pill. To the alarm of anti-abortion activists, abortion providers in other states are pondering whether similar programs would enable them to serve more women, especially in rural areas.

“There are many affiliates that are carefully considering this option, within the confines of their state laws,” said Dr. Vanessa Cullins, vice president for medical affairs of the Planned Parenthood Federation of America, the nation’s leading abortion provider.

Initially known as RU-486, the pill was introduced in France in 1988, and anti-abortion activists fought doggedly over 12 years to keep it out of the U.S. The FDA finally gave its OK on Sept. 28, 2000, and nearly 1.4 million American women have used the pill since then.

Affording women more privacy than a surgical abortion, the pill marketed as Mifeprex now accounts for about one-quarter of U.S. abortions performed in the first nine weeks of pregnancy and about 15 percent of all U.S. abortions. In 2008, about 184,000 American women used the pill — up from 55,000 in 2001 even though the overall number of U.S. abortions wasn’t rising.

The pill’s manufacturer, Danco Laboratories, says it is effective about 95 percent of the time, with surgical procedures needed in most of the other cases to end the pregnancy or stop heavy bleeding. According to Danco, since approval in 2000 there have been eight deaths from sepsis, a bloodstream infection, among women taking the pill — a death rate of roughly 1 in 168,000 that’s far lower that the rate of women dying in childbirth.

Dr. David Grimes, a North Carolina obstetrician/gynecologist who formerly headed the abortion surveillance branch at the Centers for Disease Control and Prevention, said the pill’s impact has been overwhelmingly positive.

“I just don’t see any downsides,” he said. “For those women who don’t like the invasiveness of surgery, it gives them a very important option.”

He noted the option enables a woman to undergo an abortion in the privacy of her home after getting the pill from her doctor, avoiding the need for surgery at an abortion clinic that might be targeted by protesters.

Some of the pill’s opponents “said this would make it too easy for women,” Grimes said. “That implies that the procedure should be punitive. I don’t buy that.”

The procedure, which works during the first nine weeks of pregnancy, involves swallowing Mife-prex, known chemically as mifepristone. The pill causes an embryo to detach from the uterine wall, and a second pill, misoprostol, is used two days later to cause contractions and push the embryo out of the uterus.