Iowa abortion providers bracing for new restrictions that could take effect Friday

The Iowa law banning most abortions could take effect as early as Friday, and health care and abortion providers are preparing for the drastic shift in the reproductive care permitted in the state.

A divided Iowa Supreme Court ruled 4-3 last month to remove an injunction blocking enforcement of a strict abortion restriction.

The ACLU of Iowa, Planned Parenthood and the Emma Goldman Clinic in Iowa City had challenged a law passed by Republicans during a special session of the Iowa Legislature in 2023 that will create sweeping restrictions on abortions.

Under the new law, a doctor will be prohibited from performing an abortion once cardiac activity can be detected in an embryo or fetus through a transabdominal ultrasound.

Cardiac activity typically can be detected at roughly six weeks of pregnancy, which is often before a woman is aware of the pregnancy.

The law has limited exceptions that would allow for abortion after fetal cardiac activity is detected, including some cases of rape, incest, fetal abnormality or if the pregnancy is endangering the life of the woman.

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When will the law take effect?

The ACLU of Iowa has asked the Iowa Supreme Court to rehear the case in a last-ditch attempt to keep the law from going into effect.

The Supreme Court must respond to that reconsideration request before the lower court can dissolve the temporary injunction that halted Iowa’s abortion law. The court rarely grants such requests, according to legal experts.

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For now, abortion remains legal in Iowa up to 20 weeks as the case gets sent back to the lower court to dissolve the temporary injunction.

The earliest that motion can be made is Friday, but the court could decide to take up the action at a later date, said Peter Im, staff attorney at Planned Parenthood Federation of America.

The district court judge hearing the case has scheduled a status conference for Friday with attorneys on both sides. Details have not been released on what will be discussed at the status meeting.

Im said Wednesday that in addition to the rehearing petition, Planned Parenthood is exploring all legal options to challenge Iowa's abortion ban.

“I think we really are just committed to leaving no stone unturned in this fight to ensure access, whatever that looks like,” Im told reporters during a conference call Wednesday.

How will the law impact abortion access in Iowa?

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Ruth Richardson, president and CEO of Planned Parenthood North Central States, said the organization estimates 97 percent to 98 percent of abortions would be banned in Iowa once the law takes effect.

An estimated 4,200 abortions took place in Iowa in 2023, which includes medication and surgical abortions, according to the Guttmacher Institute. That's an 18 percent increase from the 3,510 abortions performed in 2020.

The majority of abortions in Iowa happen after six weeks of gestation in 2021, according to the Centers for Disease Control and Prevention. More than half the 3,761 abortions reported by known gestational age were performed from seven to 13 weeks gestation, and about 5 percent at 14 weeks or later, while 44 percent were obtained at six weeks or earlier.

Planned Parenthood North Central States and the Emma Goldman Clinic said their organizations will continue to provide abortion care to some degree once the law goes into effect.

Richardson told reporters Wednesday that Planned Parenthood providers in Iowa will continue to legally provide abortion services until embryonic cardiac activity can be detected, with no plans to reduce staffing.

Richardson said providers in Iowa also will continue their other services, including providing access to birth control and emergency contraception, annual exams, HIV prevention and cancer screenings.

“Our teams, our providers there have been just dedicated and committed to ensuring that they’re able to see as many patients as possible for as long as possible, and that commitment has not changed,” she said.

And Planned Parenthood navigators are prepared to help Iowa patients seek medical services outside Iowa, Richardson said.

Since 2018, Planned Parenthood has provided abortions to more than 11,500 Iowans.

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Surrounding states

Richardson said Planned Parenthood is in the process of expanding its health centers in surrounding states, including in Omaha, Neb., and Mankato, Minn. Both states allow for more legal access to abortion.

"In the last few weeks, we've really been focused on the patients and the people that are going to be impacted by this," Richardson told reporters Wednesday. "We are standing by ready to help patients receive access to care even if that means traveling out of state."

In Omaha, Richardson said the abortion provider is the process of a 9,000-square-foot expansion that will triple the number of patients it can see, going from four exam rooms to 13. In St. Paul, Minn., she said Planned Parenthood has expanded the number of abortion appointments for both medication abortion and procedural abortion.

She said patient navigators, who help patients find appointments and resources to pay for expenses related to an abortion, have helped more than 4,000 patients so far since the U.S. Supreme Court’s 2022 decision that overturned the 50-year federal right to an abortion guaranteed under Roe v. Wade, Richardson said.

“And a significant number of those folks have been from Iowa, even before” last month’s Iowa court decision, she said.

Richardson also emphasized the impact of the ban on low-income and marginalized communities, particularly Black Iowans, who are at a higher risk of maternal mortality.

“I just think it’s important as we have these conversations to continue to lift up the reality that abortion bans do not ban abortions for everyone,” she said. “They ban abortions for people who don’t have the means or the opportunity to travel.

“And so that’s why the work of our patient navigators are so important to break down those barriers, to ensure that people have the funds that they need to travel or the other support that they need in order to get to their appointments.”

Illinois clinics staff up to avoid increased wait times

In the first six months of 2024 alone, Hope Clinic in Granite City, Ill., near St. Louis, saw a 357 percent increase in the number of Iowans traveling to the clinic for abortion care compared to the first six months in 2023.

Of those who traveled to the clinic from Iowa, 90 percent required some sort of financial support or assistance, co-owner Chelsea Souder said.

“And we expect that to just continue to grow” as new restrictions in Iowa take effect, Souder said.

She said the clinic has undergone a 40 percent staffing increase collectively over the past two years as it builds capacity to help people from other states.

“Most of our clinics in Illinois are not sitting on long wait times,” Souder said. “Specifically at Hope Clinic, we can get most patients in within the same week, sometimes within a day or two.”

Souder said many patients coming to the clinic, including those from Iowa, are confused about abortion laws, leading to fear, trauma and financial burden for those seeking care, particularly women in rural areas.

“There's a lot of misinformation, and so a lot of folks don't know if what they're doing is legal by crossing state lines and coming in to Illinois and receiving care,” she said. “So I think there's a lot of fear also involved in people's decision-making and access points.”

Abortion funds ‘carrying the weight’

Obstetricians and gynecologists have warned the law will worsen Iowa’s already weak system of prenatal and maternal health care. Iowa has among the fewest OB-GYNs per capita of any state, and one-third of Iowa counties are considered “maternity care deserts” according to the March of Dimes.

More than 60 percent of rural Iowa hospitals have no labor and delivery services, according to federal data analyzed by The Center for Healthcare Quality and Payment Reform.

“On average, our patients are traveling one way over 250 miles,” Souder said. “And so, really, these restrictions … have caused some wait time issues, but primarily the largest hurdle is people trying to rearrange their entire life to get halfway across the country, or even to another state, and be able to take the time off work, figure out child care (and) book a hotel.”

In 2023, 390 Iowans traveled to Minnesota, 370 traveled to Illinois and 180 traveled to Nebraska to seek abortion care, according to the Guttmacher Institute.

Before the 6-week ban, Iowans drove an average of 53 minutes to their nearest clinic, according to the Center for American Progress.

It observed that travel time in Indiana increased from 42 minutes to 1 hour and 44 minutes after that state’s near-total abortion ban took effect, a trend Souder and others anticipate will happen in Iowa.

“The decision about whether, when or how to become a parent is one of the most important life decisions that most of us will ever make,” Souder said. “And I think when someone (makes) a decision to have an abortion, that no one should be standing in their way, especially politicians or courts.”

She stressed Illinois has a strong network of clinics that are ready and wanting to help patients and have formed strong relationships with clinics and abortion access funds in Iowa and across the Midwest.

"Abortion funds are carrying the weight for people to access health care,“ Souder said.

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Providers: Patients scared and confused

Leah Vanden Bosch, development and outreach director at the Iowa Abortion Access Fund, said it remains committed to helping Iowans access abortion care and has partnered with the Chicago Abortion Fund to provide financial support to Iowans in need of abortion care.

Since 2021, Bosch said the Iowa fund has seen a 27 percent increase in requests for funding. This year, funding requests are up 7 percent compared to last year.

Bosch and Planned Parenthood’s Richardson noted Iowa’s maternal mortality rate has risen as birthing units close, and is higher in states with more abortion restrictions. And a recent study out of Texas shows that abortion restrictions increase infant mortality.

“Abortion is essential health care that needs to be accessible to all,” Bosch said in a statement to The Gazette.

Eleanor Grano, communications manager with the Chicago Abortion Fund, said it was partnered with the Iowa Abortion Access Fund to provide case management support.

Iowans who need support can visit the Chicago Abortion Fund website or call the helpline at (312) 663-0338 to complete an intake.

Over the past two years, Grano said the Chicago fund has fielded support requests from 390 Iowans seeking abortions, a number she expects will rise once Iowa’s new law takes effect.

She said independent abortion clinics like Hope Clinic have not experienced increased wait times for appointments due to proactive hiring and are equipped to manage increased patient volume.

They also can triage care to Chicago hospitals for those requiring hospital-based abortion care. The Chicago Abortion Fund’s Complex Abortion Regional Line for Access (CARLA) program supports patients needing hospital-based abortion care.

Patients traveling from out-of-state and requiring hospital-based abortion care receive an average pledge for appointment costs of more than $2,700, with wraparound support — such as hotel stays, child care, transportation and medications — averaging about $850, Grano said.

“So because of the bans and confusion that causes, we'll be able to redirect people individually, answer questions, calm fears, and just make sure that they feel supported as they're having to leave the state and any additional barriers that come up,” she said.

Comments: (319) 398-8499; tom.barton@thegazette.com