Iowa Republican lawmakers send near-total abortion ban to governor’s desk

DES MOINES — Iowa Republican lawmakers passed a near-total abortion ban during a one-day special session Tuesday, making another attempt to enact a law that was blocked by courts in 2018 and remained so after an Iowa Supreme Court decision last month.

Lawmakers voted mostly along party lines after seven hours of debate to ban abortions after cardiac activity is detected in an embryo or fetus, with some exceptions.

"This bill protects unborn children in Iowa," said Rep. Shannon Lundgren, R-Peosta, who managed the bill in the House. “This bill sets a clear standard where the state has an interest in the life of a child — when the baby’s heart starts beating. Where there is a heartbeat — there is life."

House File 732 passed in the House 56-34, with 10 representatives absent. Republican Reps. Mark Cisneros of Muscatine and Zach Dieken of Granville joined Democrats in voting no. Dieken and Cisneros previously sponsored a bill that would ban abortions from the moment of conception. Neither spoke during floor debate.

In the Senate, the bill passed mostly along party lines, 32-17. Republican Sen. Mike Klimesh of Spillville joined Democrats in voting no, and Republican Sen. Kevin Alons of Salix was absent.

“This was a radical, extreme abortion ban,” Senate Democratic Leader Pam Jochum of Dubuque told reporters. “ … I think all of us have pretty heavy hearts rights now.”

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Republican Gov. Kim Reynolds plans to sign the bill into law Friday, the same day as the Christian conservative Family Leadership Summit in Des Moines.

“The voices of Iowans and their democratically elected representatives cannot be ignored any longer, and justice for the unborn should not be delayed,” Reynolds said in a news release. “As a pro-life Gov., I am also committed to continuing policies to support women in planning for motherhood, promote the importance of fatherhood, and encourage strong families. Our state and country will be stronger because of it.”

House Speaker Pat Grassley, a Republican from New Hartford, said in a statement: "While Democrats across the country continue to devalue the life of an unborn child, Iowa House Republicans are following through on our promise to protect life."

A Des Moines Register/Mediacom Iowa Poll from March found 61 percent of Iowa adults believe abortion should be legal in all or most cases, while 35 percent said the procedure should be illegal in most or all cases.

“It’s time to elect more Democratic candidates who will continue to put people over politics, work to create balance, and protect our fundamental rights,” Iowa Democratic Party Chair Rita Hart said in a statement.

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The bill would ban abortions after cardiac activity is detected in an embryo or fetus, with some exceptions. With passage, Iowa would join 10 other states with similar abortion limits.

Abortion rights advocates say such a prohibition would end 98 percent of the now-legal abortions in Iowa. They argued during lengthy public hearings the bill went against the will of Iowans and would strip women of their bodily autonomy.

Rep. Jennifer Konfrst, a Democrat from Windsor Heights who leads the minority party House Democrats, said if the bill is signed into law before the state medicine board writes rules, it will lead to chaos and inconsistent medical care throughout Iowa.

“Doctors won’t know what to do. Patients won’t know what to do,” Konfrst said. “There will be questions. And most importantly, there will be inconsistent care across the state because different doctors will interpret it differently. Different patients will receive different kinds of care.”

How early does the bill ban abortions?

The bill prohibits abortions once a “fetal heartbeat” — defined as “cardiac activity, the steady and repetitive rhythmic contraction of the fetal heart within the gestational sac” — is detected. Iowa OB-GYNs said a doctor's ability to detect embryonic cardiac activity varies between pregnancies, but can occur as early as six to eight weeks of pregnancy — before many women know they are pregnant.

Current state law prohibits abortions at 20 weeks of pregnancy and later, with some exceptions.

The bill includes exceptions for pregnancies that are the result of rape in cases reported within 45 days, and incest in cases reported within 140 days. It also includes exceptions for miscarriages, a fetal abnormality that would result in the infant’s death, and for when the mother’s life is threatened.

Physicians and opponents called the use of the term “fetal heartbeat” misleading. Some major medical organizations, including the American College of Obstetricians and Gynecologists, note that what is detected at six weeks is electrical impulses. An actual heartbeat does not occur until roughly 17 to 20 weeks of pregnancy, they say.

Supporters say the presence of a heartbeat indicates life that merits equal protection.

“ (T) he truth is abortion harms women, kills unborn children and it creates a society that devalues human life,” Maggie DeWitte, executive director of the anti-abortion rights group Pulse Life Advocates (formerly Iowans for LIFE), said during a 90-minute public hearing on the bill Tuesday morning.

DeWitte called the bill “the next step in providing more protection for the most vulnerable in our society.”

House and Senate Democrats offered amendments voted down by majority Republicans that would have removed the time-limited reporting requirements for instances of rape and incest to be eligible for exceptions.

Democrats said most rapes and instances of incest are not reported, and so the short time frame will require many people who were victims of rape or incest to give birth.

"Anyone who votes for this bill as is uses the state to commit a second act of violation upon victims of rape and child victims of incest and sexual abuse by forcing pregnancy," said Sen. Liz Bennett, a Democrat from Cedar Rapids.

Republicans also voted down amendments that would create exceptions for any pregnant children 12 years old or younger, and another that would create an exception for people under 16. Republicans voted those down, saying children would be protected under exceptions for rape, incest and medical emergency.

Iowa’s statutory rape statute, though, does not apply to somebody who is less than four years older than someone who is 14-15.

Republicans also voted down amendments that would create exceptions for people with mental illnesses or with developmental disabilities.

Bill enforced by Board of Medicine

Physicians who perform an abortion in violation of the proposed law would face disciplinary action from the Iowa Board of Medicine, including the possibility of losing their license. The bill does not carry a criminal penalty for physicians.

A woman who receives an abortion would not face civil or criminal liability.

The bill states the law takes effect upon enactment, and directs the Board of Medicine to adopt rules to administer the bill.

Democrats argued the immediate nature of the law would create confusion for doctors who are unsure what services are allowed once it is in law.

Iowa Code allows the Board of Medicine to discipline a physician for "violating a law of this state, another state, or the United States." Sinclair said this catchall allows the board to discipline doctors for violating the law as soon as it is in code.

That existing code allows the board to suspend or revoke a physician's license.

"My recommendation (for physicians), I suppose, would be that they follow the plain text of the law,” Sinclair said.

Still, Democratic Sen. Janet Petersen, from Des Moines, said those circumstances will create confusion for providers who will have to change their services and offerings quickly.

"I cannot even imagine what providers are going through right now," she said. "Not knowing how they're going to handle certain situations that are unclear in this legislation."

Physicians warn of compromised care

Iowa physicians warned the bill’s restrictions do not account for complications that occur during pregnancy, and will hinder their ability to provide medically necessary care, prevent disease, avert emergencies and respond to time-sensitive issues.

Dr. Francesca Turner, an OB-GYN in Des Moines, said the language in the bill is ambiguous about when doctors can intervene in cases of pregnancy complications.

“At what point when your wife or your daughter or your sister is having a medical emergency during a pregnancy do I get to save her life?” she asked. “At what moment do I get to intervene? It’s unclear in this bill.”

Dr. Amy Bingman told lawmakers “abortion is health care.”

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“Reproductive freedom is necessary for a healthy and functional community,” she said.

The proposed bill forces women “into a lifelong obligation which impacts her education, career, family and community. Yet, the man does not have the same consequences,” she said.

Katie Buck, a West Des Moines resident, brought her son, Alex, with her to Tuesday’s public hearing. Alex was born with a genetic disorder caused by an extra chromosome. The condition can be fatal. Buck said it qualifies as one of the fetal abnormality exceptions allowed in the bill.

She urged lawmakers to remove the provision.

“Alex is 7 years old. How can he be incompatible with life?” she said. “You have no idea how hard we had to fight against this fatal fetal anomaly label to get him the medical care he needed to survive.”

Rep. Lundgren pushed back on assertions the bill would restrict pregnancy care.

“I want to assure Iowans this bill does not in any way stop health care for pregnant women,” she said. “The medical emergency definition has been in place since 2017, and Iowa health care providers will continue to provide medical care in their reasonable medical judgment.”

Court battles expected

Planned Parenthood, a reproductive health care system that provides abortions, has said it will challenge any abortion restrictions that come from the special session — teeing up what’s sure to be another legal battle that could take a year or more to resolve. That expected legal challenge could center on the level of legal scrutiny that should be applied by the courts to abortion restrictions.

“This is not the end of our fight for safe and legal abortion and reproductive health care,” Ruth Richardson, president and CEO of Planned Parenthood North Central States, said in a news release. “We will exhaust all options to ensure Iowans have control of their bodily autonomy, now and for generations to come."

In the wake of Iowa and U.S. Supreme Court rulings last year that reversed a fundamental right to abortion at both the state and federal levels, abortion rights opponents argue that the current “undue burden” test should no longer apply, and that a new “rational basis” test should now apply. That would effectively lower the legal bar for abortion restrictions, making it easier for them to survive court challenges.

"This law is deeply cruel and callously puts the lives and health of Iowans at risk," Rita Bettis Austen, legal director for the ACLU of Iowa, said in a statement. "Every day this law is in effect, Iowans will face life-threatening barriers to get desperately needed medical care — just as we have seen in other states with similar bans. … But we will not stop fighting to protect Iowans’ right to abortion."

The catalyst for the special session was a tied Iowa Supreme Court decision that declined a request from Reynolds to reinstate the 2018 law. That case centered on procedural questions, so Republicans hope the court will allow the bill to go through when deciding on the merits of the bill itself.

Fate of OB-GYNs in balance

Multiple OB-GYN residents and medical students who spoke at the public hearings said restrictive abortion laws will discourage them from practicing in Iowa and drive prospective OB-GYNs away from the state.

Iowa has among the fewest OB-GYN specialists per capita of any state in the country, according to data from the American College of Obstetrics and Gynecology.

Maren Betterman, an OB-GYN resident at the University of Iowa on the university’s rural resident track, said the bill would further drive prospective OB-GYNs out of Iowan. She said the law would force her to leave the state because she could not get the full scope of medical training necessary to practice as an OB-GYN.

“Iowa is dead last in terms of providers per capita in providing care to people across the state, specifically rural health care,” Betterman said. “This is a crisis, and this is why the University of Iowa designed this rural residency, and it's completely going to negate that if this bill passes. Because I won’t stay in the state of Iowa.”

OB-GYN residency applicants dropped by 10.5 percent in states with near-total abortion bans after the fall of Roe v. Wade last year, according to data from the American Association of Medical Colleges.

Iowa lawmakers earlier this year funded family medicine obstetrics fellowships in rural areas in an effort to address the shortage of OB-GYN and reproductive health care in Iowa.

House Democrats offered amendments to extend postpartum Medicaid coverage, reinstate the Iowa Family Planning network under Medicaid to draw down federal funds for family planning and expand tax credits and incentives for providing child care.

All were defeated by majority Republicans.

Iowa abortion providers have said they will continue to provide abortions in Iowa as long as it is legal to do so, and are prepared to advise people who are beyond six weeks of pregnancy to refer them to abortion providers in other states where they could still have the procedure.

“We will remain committed to and will not stop our fight to restore Iowans' fundamental right to reproductive freedom,” Francine Thompson, executive director of the Emma Goldman Clinic in Iowa City, said in a statement. “We deserve better as a state and our future generations deserve better."

Erin Murphy of The Gazette contributed to this report.

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