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

When the so-called “fetal heartbeat” ban goes into effect, which is expected as early as Friday, Iowa will have one of the most restrictive abortion laws in the country. But already, access to abortion in Iowa has seen significant changes in recent years.

As of earlier this year, just two locations in a state of 3.2 million people provide in-person abortion care, and neither is in Des Moines, the state’s largest city. While three other brick-and-mortar clinics in the state provide medication abortions, they rely on telehealth to offer that care.

This reduced access to abortion care is a direct result of Iowa Republican lawmakers’ persistent, yearslong efforts to limit abortion in the state, advocates on both sides of this issue say.

Abortion opponents are celebrating this trend, even as they take in this week's victory. Reduced access to physical abortion clinics has been part of their longtime effort to "eliminate the abortion industry in the state of Iowa," said Pulse Life Advocates Executive Director Maggie DeWitte.

“It's all a big package," DeWitte said. "Yes, it is about eliminating abortion because we do see it's harmful, 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.”

But as policymakers have passed laws meant to restrict abortion providers, abortion rights advocates argue it also has chipped away at providers' ability to offer meaningful care.

“This is the whole point of all these abortion restrictions, which is just to make it harder and harder and harder for patients to access care," said Dr. Emily Boevers, an obstetrician-gynecologist and vocal advocate for abortion rights in Iowa. "There’s fewer doctors, so pretty soon, there’s fewer clinics. Pretty soon, the clinics are more concentrated and our patients are having to travel – and not just travel, but travel for 26 hours at a time because they have the 24-hour waiting period."

"All of this is designed to make it harder for patients to access care," she said.

More: 6-week abortion ban can take effect, Iowa Supreme Court rules, ending injunction

How did we get here? The reduction of abortion access in Iowa

Iowans seeking an abortion are able to access medication abortions in the state. However, abortion pills are less effective further along into a pregnancy, meaning some patients at a later gestation must seek out surgical care.

As of this month, elective surgical abortions are provided only by Planned Parenthood in Ames and the Emma Goldman Clinic in Iowa City, meaning Iowans living in the farthest corners of the state may have to travel hours to access the procedure. Those living in Sioux City or other parts of northwest Iowa, for example, could face a nearly 200-mile drive to the central Iowa clinic.

This comes even as abortions have increased in Iowa since the U.S. Supreme Court's decision to overturn Roe v. Wade, the landmark 1973 ruling that guaranteed a right to abortion nationwide.

In 2023, there were about 4,200 abortions, including medication and surgical procedures, provided in Iowa, according to a report from the Guttmacher Institute . That's a slight increase from the 4,062 abortions in 2022, the most recent data from the Iowa Department of Health and Human Services.

Last year, as it became clear that Gov. Kim Reynolds and top Republican lawmakers could be closer to reaching their goal of banning abortion at about six weeks, Planned Parenthood North Central States closed three of its Iowa clinics. That included the Rosenfield Health Center on the south side of Des Moines.

Some abortion rights advocates say this is just a peek into the reality caused by state abortion restrictions enacted over the years.

“We're working within a landscape where health care access is constantly on the defense, and systems that were serving the needs of Iowans well are being decimated," said Erin Wagner, senior director of strategic communications for Planned Parenthood North Central States.

Planned Parenthood officials pointed to several policies from state lawmakers over the years, including a law that banned abortion clinics from receiving federal funding to offer family planning services. That loss in funding was a major blow to the organization, and resulted in the closure of four clinics in 2017.

They also pointed to a law requiring a 24-hour waiting period for patients to receive an abortion, doubling the time it took for clinics to provide care.

Abortion rights advocates say these policies, among others, were a slow carve-out of abortion providers' resources. This came at a time when officials say they were already grappling with rising costs to provide health care and ongoing staff shortages in Iowa.

“These all compound each other," Wagner said. "Iowans are scared and confused, and Planned Parenthood is trying to adapt to meet patient needs however it can.”

But abortion opponents say the trends are a welcome result of their effort to boost alternatives to abortion, such as adoption.

“Anytime on the pro-life side that you see the closure of a clinic that provides abortion is honestly, as a person passionate about life, that’s a victory," said Kristi Judkins, executive director of Iowa Right To Life.

Judkins added, "It's not a personal attack on the clinic workers or anybody that works there. It's more of the passion that I personally feel, and I know the organization stands for, to make sure women and whoever is involved in that woman’s life have information about the alternative resources that are out there, so they feel they are supported during that time.”

More: As Iowa's 'fetal heartbeat' abortion ban looms, clinics prepare for an uncertain future

Access to abortion is shrinking further in Iowa. What happens next?

Among abortion providers and other advocates, the focus now is aiding the increasing number of Iowans who are traveling out of state for abortion services. In 2023 alone, researchers at the Guttmacher Institute estimated hundreds of Iowans traveled to nearby states, most of them to Illinois, Minnesota and Nebraska.

Organizations like the Iowa Abortion Access Fund, which offers grants to patients to cover travel expenses, have seen a 27% increase in requests for funding. Planned Parenthood North Central States, which oversees Iowa, has funneled more resources to boost services meant to help patients go out of state.

Still, advocates say many Iowa women will be left behind because they can't afford to travel out of state or can't take the time off work to drive hours for an appointment.

They also say these clinic closures have negative consequences for other reproductive health care. Already, more than 41% of Iowa women live in counties where they face a high to very high vulnerability to adverse outcomes because they lack access to health care, according to a recent report from March of Dimes .

“We don't need to be mad at Planned Parenthood, because they are trying to best use their resources," Boevers said. "We need to be mad at our legislators because they have put these clinics in a position where they can't get staff, they can't get providers, they can't meet all of the demands of the legislation against them, which is nonmedical and arbitrary.”

Advocates in favor of the six-week ban denounced these concerns as scare tactics, saying the state has boosted other services meant to help women. They point to Iowa lawmakers' decision to fund pregnancy resource centers ― also known as crisis pregnancy centers ― that counsel women on alternatives to abortion. However, many of these organizations are not certified health clinics.

Even as brick-and-mortar abortion providers face growing challenges, abortion opponents in Iowa say they will continue to call for legislation that further restricts access to abortion services. That includes restrictions on abortion pills through the mail, or a law that bans abortion at conception.

“Although it is a victory, I think that there is still a lot of work to do,” Judkins said. “Our work is not done. It’s ramping up.”

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