Iowa physicians say proposed abortion rules vague, restrictive

DES MOINES — Proposed rules meant to provide guidance to physicians for performing abortions under a new law that remains tied up in court are too vague and restrictive and would hinder efforts to recruit and retain physicians, doctors and opponents argued Thursday to the Iowa Board of Medicine.

The warnings came during a public hearing in advance of the board meeting Jan. 12 to review feedback and further consider rules for the implementation of the law that would ban most abortions after about six weeks of pregnancy.

Lawmakers last year passed and Gov. Kim Reynolds signed into law House File 732 — which remains tied up in court — during a rare special session of the Legislature. It would change the amount of time women have to seek an abortion from 20 weeks post-fertilization to as little as six weeks — before many women know they’re pregnant. The legislation prohibits abortions after cardiac activity is detected in an embryo.

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The law quickly was stayed by a Polk County District Court judge, who granted a request from Iowa abortion providers to halt enforcement of the new restrictions until the law’s constitutionality can be considered by the courts, while allowing the process that will draft rules for the law’s implementation to continue.

The proposed rules include specific guidance on how medical providers are to implement exceptions for rape, incest, fatal fetal abnormalities and medical emergencies contained in the new law.

While the ban contains some exceptions for abortions, some Iowa physicians have warned the restrictions do not account for complications that occur during pregnancy, and would hinder their ability to provide care and respond to time-sensitive issues.

“There is no set of rules that ever adequately address the spectrum of pregnancy emergencies or private reproductive health decisions we are entitled to make for ourselves,” Leah Vanden Bosch, of Des Moines, said during the hearing.

Bosch said she struggled with severe depression and eating disorders, and chose to receive a “safe and legal” abortion due to medical concerns pregnancy would cause.

Republican lawmakers and supporters of the law say the exceptions allow medical providers to exercise judgment and provide abortions when they believe one applies. Opponents contend the uncertainty and worry among physicians of potentially losing their medical license could prompt providers to put off abortions if they're uncertain.

Under the proposed rules, to determine whether patients qualify for the exceptions for rape and incest, physicians would be required to gather details from women to determine when a sex act occurred, including if and when the act was first reported to law enforcement, a public or private health agency or a family physician.

Doctors would be required to document the information in the patient’s medical records and make a “good-faith assessment that the woman is being truthful, and may require them to attest the information “was true and accurate to the best of her understanding.”

Dr. Emily Boevers, an obstetrician-gynecologist in Waverly, said the rules mandate medically trained professionals to try to interpret legal concepts.

Dr. Rebecca Shaw, an OB-GYN and associate professor at Des Moines University, speaking on behalf of the state’s sexual assault response teams, encouraged the board to consider input from sexual assault nurse examiners before implementing the rules.

As for determining whether a fetus has an abnormality “that in the physician's reasonable medical judgment is incompatible with life,” doctors would be required to document diagnostic tests and procedures performed and their results, along with a description as to why they support the diagnosis.

Sue Huppert, chief external and government affairs officer at Des Moines University, said she worries the rules would prevent the full scope of medical training necessary to practice in Iowa.

The University of Iowa houses the only obstetrics and gynecology residency program in the state. However, Huppert, said there has been interest from other health care organizations to create another residency program in the state. She urged the board consider national accreditation requirements that are needed for the programs.

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. One-third of Iowa counties are considered “maternity care deserts” without a hospital or birth center offering obstetric care and without any obstetric providers, according to a 2022 report by the March of Dimes, a nonprofit focused on maternal and infant health.

The lack of providers, particularly in rural areas, force expecting women to frequently take off work and drive long distances for appointments.

“Obstetrician gynecologists are already rare in Iowa,” Boevers said. “ … I do anticipate that adopting rules like these will make that situation even harder.”

Boevers said she is the only OB-GYN at the hospital where she practices, and has been unable to recruit another to replace two who retired.

“Treating our patients as people who need to be interrogated about their traumas, and treating providers as extensions of government needed to gather these details and document them in what should be records that reflect medical care, is going to jeopardize our ability to form a bond with our patients and provide them good care,” she said. “And it’s also going to jeopardize our ability to recruit and retain providers in the state.”

Steven Wahle, a physician and member of the board at of UnityPoint Health-St. Luke's Hospital in Cedar Rapids, urged the board to provide better clarity to “help avoid some of the risks that our provides face under these uncertain type of parameters.”

“This is not a Democrat or Republican issue. This is a health care issue,” Wahle said. “...Physicians are very risk averse. They have their patient’s interests in mind. And when they’re faced with this dilemma of not knowing whether they’re going to be adversely affected in their careers, making clinical decisions is not the appropriate direction they need to be faced with.”

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