New abortion landscape in Iowa takes effect today

DES MOINES — Starting today, access to abortions will look drastically different in Iowa.

Last week, an Iowa District Court judge issued an order dissolving an injunction that blocked a near-total ban on abortion in the state from going into place. The order comes after the Iowa Supreme Court denied a request by Planned Parenthood of the Heartland, the ACLU of Iowa and the Emma Goldman Clinic in Iowa City to rehear the case in a last-ditch legal attempt to keep the law from taking effect.

The new law takes effect at 8 a.m.

While Alex Sharp, the senior health center manager who oversees Planned Parenthood's Des Moines and Ames health centers, called the new restrictions “a devastating blow,” advocates opposed to abortion rights will press for more — a law banning abortions at the moment of conception, according to Maggie DeWitte, executive director of Pulse Life Advocates.

Under the new Iowa 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.

Abortion had been legal in the state up to 20 weeks of pregnancy. Iowa law also required pregnant women to wait 24 hours for an abortion after getting an initial consultation.

The new law has limited exceptions that would allow for abortion after fetal cardiac activity is detected, including some cases of rape, incest, life or health of the mother or a fetal abnormality judged by a doctor to be incompatible with life. But doctors say the exceptions as written are impractical and will be difficult, if not impossible, to apply in real-life medical emergencies.

Abortion provider scrambles to help patients

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Sharp said the past few days have entailed juggling a packed schedule as clinic staff rushed to see as many patients as possible before the strict new abortion restrictions took effect, filed paperwork and answered phone calls.

“We tried to get in everyone that we could. We were overbooking our schedules” for three days last week, she said.

Sharp estimated Planned Parenthood was able to see about half the patients scheduled for appointments last week. For the rest, it was too late of notice for them to rearrange their schedules, get off work or find child care to be able to come sooner.

Staff also spent the past week contacting patients beyond six weeks into their pregnancies who had appointments scheduled after today to connect them with patient navigators to try and get them appointments in Minnesota or Nebraska instead.

On Friday, the Nebraska Supreme Court upheld a law there that bans abortions after 12 weeks of pregnancy. In Minnesota, abortion is not restricted based on gestational duration.

“With the impending ban, we have started seeing patients coming to us earlier in their pregnancy,” Sharp said. “If there is no cardiac activity, they have very little time to make choices and consider their options.”

Planned Parenthood said it will continue to provide abortion services in Iowa in compliance with the law, with no plans to reduce staffing or closing health centers in the state. Planned Parenthood is the largest provider of abortions in Iowa.

“If somebody is less than six weeks pregnant based on the last menstrual period, we will go ahead and schedule them in Iowa,” Sarah Traxler, chief medical officer of Planned Parenthood North Central States, told reporters Friday.

One of the state’s six Planned Parenthood Clinics offers surgical abortion (Ames), and three offer abortion through medication (Ames, Iowa City and Sioux City). The provider’s Cedar Rapid’s health center is temporarily closed due to issues with the building.

Those beyond six weeks of gestational age will be connected with patient navigators to coordinate care outside of Iowa, including scheduling an appointment, identifying sources of financial assistance and assisting with lodging and transportation.

“Our navigators work to find patients the closest appointment that is the soonest for them and works for the patient’s schedule,” Traxler said.

Planned Parenthood said it will continue to provide the full spectrum of sexual and reproductive health care at all of its Iowa health centers, including annual exams, birth control, sexually transmitted infections testing and treatment and cancer screening.

“We understand the real people who will be impacted by this ban,” Traxler said. “And we are doing everything we can to mitigate the harm caused by this dangerous policy. This ban ties doctors’ hands. It puts them in the impossible decision of deciding whether to keep their license or provide lifesaving health care and uphold their oath."

‘Joy’ in new restrictions for anti-abortion advocates

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DeWitte, who has been advocating for an end to abortion in Iowa for 25 years, described her feelings for today as “joy.”

“Just overwhelming joy and gratitude and feeling so blessed that we are at a point where we can protect moms and we can protect babies from the harm of abortion,” said DeWitte.

“Through the last few years, I was not certain that we were going to get to this day,” DeWitte said. “To finally see that come to fruition is such motivation for me to continue this fight. I know that it is the human rights issue of our time.”

DeWitte described the past 25 years as an anti-abortion advocate as a roller coaster — with highs and lows experienced throughout a string of laws and court rulings.

She credited the 2022 U.S. Supreme Court hearing that overturned Roe v. Wade and the conservative leadership of state government in Iowa for the shift in abortion policy.

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“What I’ve learned over the years is that every little bit helps,” DeWitte said. “Our goal is to protect women. We want to help women in unplanned pregnancies. We want them to know that they have choices other than abortion."

But it’s not the last step for anti-abortion rights advocates, DeWitte said. She said the ultimate goal is a law that would ban abortions at the moment of conception.

“Our goal has been and will continue to be to educate on the sanctity of human life,” DeWitte said. “ … We want to work tirelessly and endlessly until we have eliminated abortion from our state.”

Provider: Transition has been ‘devastating and tragic’

An estimated 4,100 abortions took place in Iowa in 2023, which includes medication and surgical abortions, according to the Guttmacher Institute.

The majority of abortions in Iowa happened 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.

Traxler said the provider has been planning for months for the ban taking effect. She said Planned Parenthood is in the process of expanding its health centers in surrounding states, including tripling the number of exam rooms in Omaha, Neb., and moving to a larger site in Mankato, Minn., to assist women from Iowa.

Traxler said Planned Parenthood is also looking to recruit more physicians and support staff to increase the number of patients it can see in Nebraska.

Patients face hurdles to obtain abortion care

Kristina Remus, patient services associate at Planned Parenthood North Central States, has been helping staff manage difficult conversations with patients who are confused, unaware or frustrated by the changes in abortion access.

In 2023, 410 Iowans traveled to Minnesota, 370 traveled to Illinois, and 180 traveled to Nebraska to seek abortion care, per the Guttmacher Institute. Prior to the six-week ban, Iowans drove an average of 53 minutes to their nearest clinic. Travel times are expected to increase significantly, similar to trends observed by the Center for American Progress in Indiana after its abortion ban.

“It's important in this moment that we lift up the reality that abortion bans only stop those without means to travel out of state,” Traxler said. “This abortion ban will further widen already gaping health inequities affecting the working class, Black people, people living in rural areas and young people.”

The Iowa Abortion Access Fund has seen a 27 percent jump in requests for help since 2021, officials said, and requests to date this year are up 7 percent over 2023.

Leah Vanden Bosch, development and outreach director at Iowa Abortion Access Fund, said the fund is committed to helping Iowans access abortion care and has partnered with the Chicago Abortion Fund to provide financial support to Iowans seeking abortion care.

Since the U.S. Supreme Court ended the federal protection for abortion in 2022, the Chicago Abortion Fund has helped 465 Iowans seeking the procedure and anticipates even greater need. In just the first three weeks of July, as many anticipated the impending enforcement of the ban, the fund received more than 60 support requests from Iowans — a 165 percent increase from previous months, despite abortion still being legal in Iowa.

Patient advocate: ‘Iowans deserve better’

Iowa is the latest front in a nationwide battle over abortion rights since Roe v. Wade was overturned. State and national polling shows most Americans support abortion rights.

Planned Parenthood representatives stressed the consequences of the ban go beyond restricting access for those who wish to end unwanted pregnancies. States with the most restrictions generally also have the worst rates of maternal mortality.

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, one-third of Iowa counties are considered “maternity care deserts” according to the March of Dimes, and sixty-one percent of rural Iowa hospitals have no labor and delivery services.

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Abortion rights advocacy group Iowans for Health Liberty, a political action committee founded by a group of female physicians, said the restrictive law will deter specialists from staying or moving to Iowa, exacerbating a shortage of critical health care providers in the state.

Mica Chase, a 33-year-old engineering student from Cedar Rapids, is a patient advocate and recovering alcoholic who has had three abortions since the age of 19.

Chase, who uses they/them pronouns, expresses concern for the impact of near-total abortion bans on Iowans, particularly those struggling with addiction or financial instability. They said they grew up in a small Iowa town where they received little sex education.

“I had to learn about it on my own after my first pregnancy,” Chase said.

They said they were disconnected from their family, faced financial barriers and struggled with substance use, homelessness and mental health challenges. They got pregnant twice more with their now husband, despite using birth control. Each ended in an abortion.

“At the time, we were low income, and I was still struggling with drinking and symptoms of undiagnosed (post-traumatic stress disorder),” Chase said. “Each time I discovered I was pregnant, I was in no position to start a family and be a parent. Adoption was definitely off the table, because I could not handle the thought of the heartbreak involved. I also don't know if a pregnancy would have survived my severe substance use.”

Chase said they are now sober, healthy and stable — all of which they attribute to having access to safe and legal abortion care.

“Having the ability to make financial decisions that were best for my health and my future was crucial to me getting to the … thriving place I am today,” they said. “With this law, Iowans no longer will have that option, and I can't even think about the lives that will be devastated. It shouldn't be this way. Iowans deserve better with that.”

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