A reality check on Iowa’s abortion ban exceptions

Abortion is now illegal in Iowa after detection of fetal cardiac activity, which usually occurs around six weeks of pregnancy, meaning six weeks from the last menstrual period. The ban has five exceptions, making it more generous than most current state abortion bans. But the exceptions are also not nearly as accessible as antiabortion advocates portray.

First are the exceptions for rape and incest. Recent research estimates that over 64,000 pregnancies have resulted from rape in abortion-banning states between July 2002 and January 2024. This includes states with exceptions for rape. And in those states, the same research concluded, that “[f]ew (if any)” of these pregnant people “obtained in-state abortions legally, suggesting that rape exceptions fail to provide reasonable access to abortion for survivors.” Iowa’s exception is theoretically more accessible because unlike other states’ exceptions, it allows reporting to a doctor instead of just to law enforcement. But also unlike other states’ exceptions, Iowa’s imposes time limits for that reporting. Regardless, often the problem with the rape exception is difficulty in finding a provider willing to perform the abortion. And that problem also will exist in Iowa.

Iowa’s ban also includes an exception allowing abortion for miscarriage "if not all the products of conception are expelled.” But again, this exception on is narrower than it appears. It doesn’t allow for medical treatment for pregnancy loss when cardiac activity is ongoing. In a missed miscarriage, the baby stops developing but cardiac activity continues. Miscarriage is inevitable. But intervention is illegal until the fetus’s heartbeat stops on its own. And now pregnant Iowans have no choice but to wait, increasing physical and emotional trauma.

Medical treatment will similarly be unavailable if a woman goes into premature labor before viability (meaning before the baby can likely survive outside of the womb, usually around 24 weeks of pregnancy). If a woman’s water breaks at 18 weeks and the doctors cannot stop the labor, the doctors can’t legally do anything if the fetal heartbeat still is going. The same is true for an ectopic pregnancy, where the fertilized egg implants outside the uterus, usually in a fallopian tube. Again, doctors cannot legally do anything if there’s still fetal cardiac activity.

If untreated, both the 18-week premature labor and ectopic pregnancy can be life threatening. Iowa’s ban has an exception for when abortion is needed to “preserve the life of the pregnant woman whose life is” physically endangered or when “continuation of the pregnancy will create a serious risk of substantial and irreversible impairment of a major bodily function.” But this language only creates questions. How endangered does her life need to be? 20% chance of dying? 51%? 99%? Similarly, how large must a risk be to be serious? When is impairment substantial? Which bodily functions are major? There’s no way for doctors to know ahead of time that the abortion they perform fits within the medical emergency exception. And they can lose their medical license if it turns out to not.

The last exception is for an “incompatible with life” fetal abnormality. But neither the statute nor additional commentary from the Iowa Medical Board define “incompatible with life.” Presumably, this includes conditions like anencephaly (where the baby’s skull and brain are not formed), Trisomy or Trisomy 18 chromosomal abnormalities, or bilateral renal agenesis (where the baby doesn’t develop kidneys). But even with these conditions, the baby could live days or weeks. But it also doesn’t matter whether conditions related to organs are incompatible with life. That’s because they are not diagnosable until the 20-week ultrasound as the organs haven’t developed enough yet before then. And Iowa’s ban exception only allows abortion due to such incompatible with life abnormalities before 20 weeks.

It’s no doubt true that Iowa’s abortion ban exceptions are broader than most abortion banning states. But that doesn’t mean that pregnant Iowans will be able to access abortion through those exceptions, at least not as they are currently written.

Jill Lens specializes in reproductive justice and rights in the University of Iowa School of Law. Her views are her own and do not represent the university.