Inside an Iowa Planned Parenthood clinic before abortion ban takes effect

The day was, for the most part, business as usual for the Planned Parenthood clinic in Ames.

Patients trickled in and out of the small health care center in the Campustown neighborhood, one of only two clinics in Iowa that provide surgical abortions. The overseeing OB-GYN on duty managed a packed schedule as clinic staff filed paperwork and answered phone calls. A pair of clinic escorts sat outside to welcome in the next patient while they kept an eye on the lone protester who prayed on the nearby sidewalk.

Even as the day progressed as normal, Thursday marked what many clinic staff believed could be one of the last days for what has been its normal operations. Soon, an Iowa law will go into effect that prohibits most abortions after about six weeks of pregnancy, dramatically changing how the clinic cares for its patients.

“It's really demoralizing, and actually is such an invasion into the practice of medicine and the patient-physician relationship that really doesn't belong,” said Dr. Sarah Traxler, the OB-GYN overseeing the clinic Thursday and the chief medical officer for Planned Parenthood North Central States.

The law bans most abortions after fetal cardiac activity can be detected, which typically happens at about six weeks ― before many women know they’re pregnant. It includes narrow exceptions for rape, incest, fatal fetal anomalies and to save the life of the mother.

Once in effect, Iowa will join dozens of states across the country that have enacted some type of ban following the U.S. Supreme Court's Dobbs decision, which overturned the landmark Roe v. Wade legalization of abortion nationwide. Iowa's law is one of the most restrictive in the country, and further limits access to abortion in the Midwest.

But even as staff at the Planned Parenthood clinic worked to care for women they thought would be among the last patients treated under the current law, questions still lingered about when the law would actually go into effect.

After a court hearing Friday, an injunction blocking the law is expected to remain in place at least a few more days as legal challenges to the law continue. Clinic leaders are determined to provide care as long as they're allowed ― but they don't know how long that will be.

More: Iowa's 6-week abortion ban won't go into effect quite yet as legal challenges continue

Patients are still on the schedule to be seen for abortion services in coming weeks, said Alex Sharp, the senior health center manager who oversees the Ames clinic. Whether they can actually receive that care depends on when the injunction lifts.

“Here in Ames, we are not stopping our services,” Sharp said. “We will see patients. Our schedules are full for the next two weeks, so whatever happens (Friday), we'll decide … what we do come Monday morning.”

As she looked to the future of Iowa’s legal landscape, Traxler said she knows patients will soon face much greater hurdles to access abortion care. Not because she doesn’t have the ability to provide that care, she said, but because the state’s top elected officials have determined she shouldn’t.

When she thinks about that, Traxler gets angry.

“Legislators shouldn't be making these decisions. I think patients and their providers should be making these decisions together," Traxler said. "I think that it's going to really impact the future of Iowans."

'It's not us. It's state law,' clinic staff say about hurdles to abortion care

More than a dozen patients visited the clinic for care on Thursday, including those seeking abortions.

Many of the patients sat in the clinic’s small waiting room with their partners or others. As one woman entered the squat brown building Thursday afternoon for her appointment, the man who drove her to the clinic waited in the parking lot with a young child. Another patient received a hug from the nurse in the hallway as she left the exam room.

Behind closed doors with her patients, Traxler will "talk through them in a shared decision-making capacity of what's best for them, what's best for their lives and their families," she said. In the future, "I am faced with the challenge of having to tell them that I can't do it."

Patients declined to speak to the Register Thursday for fear of reprisal from others. Some clinic staff also declined interviews for the same reason.

Since the beginning of June, Planned Parenthood clinics in Iowa have doubled the usual amount of appointment slots during the week in an effort to see as many patients as they could before the Iowa Supreme Court's anticipated ruling, Sharp said. That decision came on June 28 and gave clinics at least another three weeks to provide abortion care before the ban went into effect.

Planned Parenthood North Central States President and CEO Ruth Richardson said Friday that its clinics would continue providing abortion care under the state’s current 20-week ban "until further action from the court."

Richardson also reaffirmed Planned Parenthood’s plan, once the ban goes into effect, to continue to provide abortions in Iowa when no fetal cardiac activity is detected or, afterward, to obtain care how and where it's lawful.

"Planned Parenthood has been preparing for this possibility and stands ready to help patients receive safe, legal abortion care, even if it’s in another state," Richardson said in a statement. " We know patients deserve so much more than navigating this landscape of manufactured confusion and are committed to helping them get the care they decide is best for their bodies and futures.”

Access to abortion services in Iowa was already waning in the years leading up to the expected enforcement of the six-week ban, even as demand has been on the rise.

The Ames clinic is one of two remaining brick-and-mortar abortion clinics in the state that offer in-person surgical abortion care; three other clinics rely on telehealth to offer medication abortion. Sharp said most of the clinic’s patients travel from Polk County, where in-person abortion care is no longer available.

Reduced access to physical abortion clinics has been part of abortion opponents' longtime effort to "eliminate the abortion industry in the state of Iowa," Pulse Life Advocates Executive Director Maggie DeWitte told the Register earlier this month.

"Yes, it is about eliminating abortion because we do see it's harmful," DeWitte said, "but it's also about helping women and helping families make good and healthy decisions that's going to lead to positive outcomes for them in their life.”

More: Access to abortion in Iowa 'harder and harder' even before state's looming 6-week ban

The number of abortions performed in Iowa has increased in recent years. Providers say they are seeing an influx of demand from not just Iowans, but also from residents traveling from states with more severe restrictions.

Traxler, who is based in Minnesota but was filling in for the clinic's sole OB-GYN, said the patients who received abortion care Thursday were grateful and relieved they could be seen before the state’s ban goes into effect.

Confusion about the current legal status in Iowa is already evident among patients, according to Planned Parenthood staff.

Iowa clinics are trying to inform patients about the uncertain legal landscape as best they can, but many individuals both in Iowa and other states are unaware of the pending ban, Sharp said. The Ames clinic has one patient on the schedule for abortion services in mid-August, likely far beyond the six-week limit.

“There’s no way they know,” she said. “That’s too late. It’s just unfortunate, and that’s the reality. When we are providing these services, people think we're making them jump through hurdles because it's our policy. But that’s not us. That’s state law.”

Some patients face 'monumental logistical challenge' to obtain abortion care, doctor says

In between appointments last week, Traxler recalled the many patients she's come across who had to clear high hurdles to get that care because of laws across the country that restrict abortion access.

She recounted a recent patient she saw in Iowa who was diagnosed by three different Planned Parenthood physicians with an ectopic pregnancy, but was turned away from care by her local hospital. In such a pregnancy, a fertilized egg implants outside the main cavity of the uterus. The fertilized egg can't survive, according to the Mayo Clinic , and if untreated, the condition may cause life-threatening bleeding.

Traxler also recalled an interaction with a patient who had traveled from Texas to seek an abortion. However, her complicated medical history meant she was unable to receive an outpatient abortion procedure and needed to go to a hospital. Because she couldn't get that care in Texas, Planned Parenthood patient navigators had to find her an appointment in a hospital where abortion is legal.

Traxler said these are examples of the "monumental logistical challenge" that patients must navigate in the patchwork of abortion laws across the country.

Enforcement of the six-week ban will mean many Iowa women would be faced with traveling out of state to access care or may make an unsafe choice to take matters into their own hands, Traxler said. And many more women may be forced to continue their pregnancies, which could have major ramifications for their futures.

History has shown that the consequences of making abortion illegal include increased infant and maternal morbidity and mortality, she said. She believes the future holds "some pretty bad outcomes for patients and for their children."

Most patients Traxler and other Planned Parenthood physicians see already have children or work low-paying jobs that don't allow them to take time off work to seek care, which under Iowa law requires two visits a day apart because of a mandated 24-hour waiting period. Many more are living below the federal poverty level.

Iowa's looming ban is not a new scenario for Traxler, who had provided care for Planned Parenthood clinics in South Dakota before that state's ban went into effect in 2022. She also saw firsthand the impact in Nebraska when lawmakers there implemented a 12-week abortion ban last year.

The difference in Iowa, Traxler said, is that abortion providers and other abortions rights advocates have a much better understanding now of the negative consequences that will result because of the ban.

"It's a huge burden to expect them to go out of their communities in order to access health care," she said. "We know that this disproportionately impacts people of color, people who live in rural areas, people who are poor, people who are uneducated and LGBTQ+ people.

"It's important for us to understand that even if there is a fund or a navigator to help you get where you need to go, that's not an easy thing to do and not everybody can do it."

Michaela Ramm covers health care for the Des Moines Register. She can be reached at mramm@registermedia.com , at (319) 339-7354 or on Twitter at @Michaela_Ramm .

This article originally appeared on Des Moines Register: Inside an Iowa Planned Parenthood clinic before abortion ban takes effect