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Iowa Supreme Court clears way for halted abortion law to take effect
In a 4-3 decision, justices said a 2023 law survives scrutiny under Iowa’s constitution and can be enforced
Jun. 28, 2024 8:40 am, Updated: Jun. 28, 2024 7:22 pm
- A divided Iowa Supreme Court ruled 4-3 Friday to remove an injunction blocking enforcement of a strict abortion restriction.
- The ruling clears the way for an Iowa law to take effect that bans abortions after doctors detect cardiac activity in an embryo or fetus, which can be as early as six weeks into pregnancy.
- 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 while the lawsuit challenging the ban proceeds.
- The decision is the result of a yearslong legal battle and makes Iowa the latest state to significantly restrict the procedure after the federal right to an abortion was overturned.
DES MOINES — Abortions in Iowa will be illegal once cardiac activity can be detected in an embryo after the Iowa Supreme Court cleared the way Friday for a 2023 state law to take effect.
The decision is the result of a yearslong legal battle over abortion in the state and makes Iowa the latest state to significantly restrict the procedure after the federal right to an abortion was overturned.
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 while the lawsuit challenging the ban proceeds. Under the Iowa court rules, it will take at least 21 days for the case to go back to the district court. Abortion will remain legal during that time.
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. That can be as early as six weeks, but it’s often closer to eight to 10 weeks.
In a 4-3 decision Friday, the Iowa Supreme Court said a 2023 law signed by Republican Gov. Kim Reynolds survives scrutiny under Iowa’s constitution and can be enforced. Changing course from a 2022 decision, the court employed the lower-level “rational basis” test to judge the law’s constitutionality.
Justice Matthew McDermott delivered the court’s opinion, joined by Justices David May, Dana Oxley and Christopher McDonald.
The court opinion states that the 2023 law “is rationally related to the state’s legitimate interest in protecting unborn life.
Download: Iowa Supreme Court Opinion.pdf
“We thus reverse the district court order entering the temporary injunction blocking enforcement of the fetal heartbeat statute and remand for further proceedings,” Justice McDermott wrote on behalf of the court.
The majority justices state the right to abortion is not “deeply rooted” in the state’s history and tradition. And, thus, “there is no support for abortion as a fundamental constitutional right in Iowa.”
McDermott noted abortion remained generally illegal in Iowa until the U.S. Supreme Court’s landmark ruling in Roe v. Wade in 1973, which has since been overturned.
About 4,200 abortions were performed in Iowa last year, according to the Guttmacher Institute, a nonprofit that supports abortion rights.
An estimated 940 Iowans traveled out of state to Minnesota, Nebraska and Illinois to get an abortion while an estimated 270 Nebraskans traveled to Iowa for an abortion in 2023.
Abortions increased 18 percent in Iowa between 2020 and 2023, according to the institute.
Chief Justice: Ruling ‘strips’ women of autonomy
Chief Justice Susan Christensen, joined by justices Thomas Waterman and Edward Mansfield, delivered a scathing dissent, stating the ruling undermines women’s rights.
Christensen, in her dissent, wrote that the majority decision "strips Iowa women of their bodily autonomy," that the law's exceptions are too narrow to protect women's health, and that Iowa should have kept its prior legal standard banning abortion restrictions that impose an undue burden on pregnant woman.
“I cannot stand by this decision. The majority’s rigid approach relies heavily on the male-dominated history and traditions of the 1800s, all the while ignoring how far women’s rights have come since the Civil War era,” Christensen wrote.
She said the question is not whether abortion, “with the polarizing reactions it evokes,” is a fundamental right, but rather “whether individuals have the fundamental right to make medical decisions affecting their health and bodily integrity in partnership with their health care provider free from government interference.”
She also wrote the law’s exceptions for rape, incest and medical abnormalities and emergencies “prioritizes the unborn over the living, placing pregnant women in harm in the process.”
“(T) his statute forces pregnant women (and young girls) to endure and suffer through life-altering health complications that range from severe sepsis requiring limb amputation to a hysterectomy so long as those women are not at death’s door,” Christensen wrote.
She continues: “Nothing promotes life like a forced hysterectomy preventing a woman from ever becoming pregnant again because she could not terminate a doomed pregnancy under the medical emergency exception.”
AG Bird: ‘Iowa stands for life’
The Republican-led Legislature passed the law in a special session in 2023 after the state Supreme Court did not approve a petition from Reynolds to reinstate a nearly identical law that was passed in 2018 before the U.S. Supreme Court’s decision in Dobbs v. Jackson Women's Health Organization, which overturned the 50-year federal right to an abortion guaranteed under Roe v. Wade.
Abortion law in Iowa has shifted in the last six years through multiple laws and court decisions. In 2018, the Iowa Supreme Court decided that the state constitution guarantees a fundamental right to an abortion, enacting protections even stronger than the federal standard.
Just four years later, with a more conservative majority, the court reversed that decision, but stated that Iowa was bound by the “undue burden” standard then imposed by federal precedent that guaranteed a right to an abortion.
Reynolds, a Republican, appointed all but two of the justices serving on the court. Justices Waterman and Mansfield were appointed by her predecessor, Republican former Gov. Terry Branstad.
After the federal standard changed, Reynolds asked the court to revive the 2018 law, but in a non-binding, deadlocked 3-3 decision in 2023, the court did not reinstate the law. Republican lawmakers held a special session in 2023 to pass a new law that a district court blocked shortly afterward, saying that it violated the standard set out in the court’s 2022 opinion.
Justice Oxley, who recused herself from the 2023 litigation because of her former law firm's involvement in that case, provided the tiebreaking vote on Friday.
Both Reynolds and Republican Iowa Attorney General Brenna Bird, who pushed the court to uphold the 2023 law and overturn the lower court’s injunction, applauded Friday’s decision.
“Today’s supreme court decision to uphold Iowa’s heartbeat law sends a loud and clear message: Iowa stands for life,” Bird said in a statement. “ … While today’s decision is a landmark victory, we know that there is work left to be done. We will keep working to support Iowa families, parents and the unborn as the fight for life continues.”
Reynolds, in a statement, said there is “no right more sacred than life, and nothing more worthy of our strongest defense than the innocent unborn.” She said state officials will continue to develop policies that encourage strong families, which includes promoting adoption, supporting pregnant mothers and protecting in vitro fertilization (IVF).
Maggie DeWitte, executive director of the anti-abortion advocacy group Pulse Life Advocates, became emotional when describing her reaction to the ruling during an interview with reporters Friday at the Iowa Capitol.
“This is a monumental win for Iowa women, for Iowa families (and) for babies,” DeWitte said. “A baby is a unique and distinct person from its mother and it deserves protection under our law. And that’s exactly what this heartbeat ruling will do.”
The Association of Obstetricians and Gynecologists has flagged the term “fetal heartbeat” as misleading. While advanced technology can detect a flutter of cardiac activity as early as six weeks gestation, medical experts say the embryo at that point is not yet a fetus and does not have a heart.
When will abortions be legal in Iowa?
Under the law, doctors are prohibited from performing abortions once cardiac activity can be detected in a fetus or embryo through a transabdominal ultrasound.
There are exceptions for rape, incest and medical abnormalities and emergencies. The state medical board outlined the rules for the law this year.
A rape must be reported within 45 days to qualify for the exception, and an act of incest must be reported within 140 days. The report can be made to the doctor overseeing the procedure and does not need to be reported to the authorities.
Doctors will need to perform documented diagnostic tests and procedures to determine whether a pregnancy is “incompatible with life” and qualifies for a medical exception. An abortion also can be performed in a medical emergency, if the pregnant person faces risk of irreversible bodily impairment.
Iowans: ‘We need to make a stand. We need to vote.’
Mica Chase, 33, of Cedar Rapids, said they felt “completely let down” by the ruling as they unboxed and set out condoms and Plan B emergency contraception pill kits at a Planned Parenthood Advocates of Iowa “Solidarity Circle” Friday at Raygun in Cedar Rapids.
Chase is a Planned Parenthood storyteller who has had three abortions since the age of 19. In one case, Chase, who uses they/them pronouns, was young and did not have the means to care for a child. In the other cases, the birth control they were using failed and they “made that heavy decision to not carry on with the pregnancies.”
“I think the impacts are gonna be devastating and we're gonna be seeing a lot of people in desperate situations needing an abortion and not being able to get one,” Chase said. “The impacts are financial, physical, mental as well and emotional. ... I like to share my story to remind people that people that they know and love have had an abortion and needed access to them.”
Tiaja Butler, 28, of Cedar Rapids, said she is disappointed and concerned the ruling could lead to more division and a lack of control over one's body and medical choices. She emphasized the importance of spreading awareness of the ruling and getting more Iowans engaged in the legislative process and to vote to prevent further harm.
“We need to make a stand,” Butler said. “We need to vote. We need to be more engaged in what decisions are being made for our community, before it's too late.”
Planned Parenthood: ‘This is not the end of the road’
Abortion rights advocates said the ruling will have serious and swift consequences for Iowans’ health and futures.
“Today’s dangerous and reprehensible ruling will impact Iowans for generations to come,” said Ruth Richardson, president and CEO of Planned Parenthood North Central States. “Abortion is essential, time-sensitive health care.”
Planned Parenthood North Central States will continue to provide abortion care in Iowa to the extent legally allowed and help patients connect with providers and resources to access the care they need, including in other states where the procedure still is legal.
The Chicago Abortion Fund, in partnership with the Iowa Abortion Access Fund, said it is committed to ensuring women and girls forced to leave Iowa “receive the comprehensive support and resources they need in Illinois.”
Francine Thompson, executive director of the Emma Goldman Clinic in Iowa City, called Friday’s ruling “a devastating blow to reproductive freedom and health care in Iowa that will affect generations to come and not be easily undone.”
Thompson said the clinic, like Planned Parenthood, is committed to helping connect Iowans with essential, lifesaving health care.
New abortion law has wide impact
Opponents of the law have said it will threaten women’s lives and force doctors to make difficult decisions about when and how to provide care. The law’s supporters, though, say the exceptions allow doctors to exercise medical judgment.
Dr. Emily Boevers, an obstetrician and gynecologist and co-founder of the abortion rights advocacy group Iowans for Health Liberty spoke through tears Friday at the Iowa Capitol in Des Moines when she described to reporters how she will counsel future patients who seek an abortion.
“It’s devastating to think about when women come and they are experiencing life-threatening, life-changing complications of pregnancy, what they want are the options in front of them,” Boevers said. “And now I will tell those patients that they can stay in Iowa and become more sick, potentially carry a non-viable pregnancy and then watch their infant suffer. Or they can travel out of state to get proper standard of care medicine.”
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.
According to a report by the Idaho Physician Well-Being Action Collaborative, more than 1 in 5 Idaho obstetricians stopped practicing in that state since a near-total abortion ban took effect there in August 2022.
“This will impact not just women, but families and communities,” by making it harder to recruit health care providers to the state, Boevers said.
Election issue
Democrats have made access to abortion and reproductive care a central issue in the upcoming November election, and continued to do so Friday in remarks to reporters.
“Iowa Republicans have gone too far. They are out of touch with the majority of Iowans who want reproductive freedom, and everyone deserves the right to make their own health care decisions,” said Jennifer Konfrst, a state lawmaker from Windsor Heights who leads Democrats in the Iowa House.
A Des Moines Register/Mediacom Iowa poll from last year found that 61 percent of adults in the state believe abortion should be legal in most or all cases, while 35 percent believed it should be illegal in most or all cases.
“This despicable and dangerous ruling cannot be the last word on reproductive rights and personal freedom in Iowa,” retiring Iowa Senate Minority Leader Pam Jochum, D-Dubuque, said in a statement. “Activist judges and anti-choice Republicans cannot be allowed to control Iowans’ lives.”
Iowa House Speaker Pat Grassley, a Republican from Hartford, said in a statement that statehouse Republicans have enacted abortion restrictions to give voice to Iowans who elected them.
“We are a pro-life and pro-family state,” Grassley said in his statement. “In Iowa, we respect both the life of the unborn child and the life of the mother.”
Comments: (319) 398-8499; tom.barton@thegazette.com
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