Qualifications for Iowa abortion medical exceptions remain unclear, providers and advocates say

Health care providers say there is uncertainty about what qualifies as a medical emergency that would allow an abortion under Iowa's new law. (Photo via Getty Images)

Enforcement has begun for Iowa’s ban on most abortions as early as six weeks of pregnancy, but medical professionals say there is still uncertainty about what qualifies as a medical emergency exemption under the law.

Iowa’s abortion law went into effect July 29 after years of court battles blocking the so-called “fetal heartbeat” law from enforcement. The measure, passed in a special session in 2023, makes most abortions illegal after cardiac activity can be detected in an embryo, which can occur as early as six weeks of gestation.

There are some exceptions outlined in the law, allowing abortions in cases of rape, incest or to save the life of the pregnant person. There are designated timelines for exceptions in cases of rape and incest if reported to law enforcement, a public health agency or doctor.

However, there is less guidance about what qualifies an abortion as legal. The exception stipulates that an attending physician “certifies that the fetus has a fetal abnormality that in the physician’s reasonable medical judgment is incompatible with life” or that an abortion is necessary due to a medical emergency.

Dr. Emily Boevers, an obstetrician-gynecologist practicing in Waverly, said she and most other OB-GYNs she knows are interpreting the law as meaning that for an abortion to be performed, the pregnancy must be actively putting the mother’s life at risk, or that the continuation of the pregnancy could cause very serious medical complications. Complications might include requiring a hysterectomy or loss of an organ, or causing liver failure or another unrecoverable organ function.

Boevers said she was in a unique position as the only practicing OB-GYN at her hospital. However, at many practices, she said, medical professionals would come together to make a decision about how to ensure they are practicing within compliance of the law — but that these conversations are happening internally by practitioners at health care institutions.

“This is not a decision that any one person wants to make in a vacuum,” Boever said. “But the reality is, is that there’s no more guidance than that. It’s, it’s truly — do you think the life or health of the mother is at risk? Do you think this patient … might have disease that is so severe that she might die or need a hysterectomy? That’s how I’m thinking of it.”

The Iowa Board of Medicine set rules for the abortion law in February , months before the Iowa Supreme Court ordered the injunction to be lifted. Reproductive health care advocates, including those affiliated with Planned Parenthood, have said the rules do not clarify how medical providers should evaluate when a fetal abnormality or medical emergency poses a large enough threat to constitute an abortion.

The rules state that attending physicians must certify that the diagnosis of a fetal abnormality and the doctor’s decision to perform an abortion “must be reached in good faith following a bona fide effort, consistent with standard medical practice and reasonable medical judgment, to determine the health of the fetus.”

Abortion exceptions challenged in other states

The language for these exceptions — and lack of specific guidance — have been a point of contention in other states with restrictive abortion bans. In Texas, the state Supreme Court rejected a challenge to the law banning abortions that asked for clarification from the state on when people facing serious medical complications caused by pregnancies can receive an abortion.

The Center for Reproductive Rights, the legal advocacy organization that filed the Texas lawsuit on behalf of women who said their lives were endangered by the state abortion law as well as two doctors, has also made challenges calling for more information on medical exceptions to abortion bans in Tennessee and Idaho .

Sally Frank, a law professor at Drake University, said in an interview that Iowa could see similar challenges to its six-week abortion ban in the future by people whose lives were endangered because of a lack of clarity on when an abortion qualifies as legal under the exception. Medical professionals may be less likely to provide an abortion, even when the pregnancy could cause a risk to the person’s life or health, because of the law, she said, as providers could face disciplinary action like losing their medical license for violating the ban.

Peter Im, staff attorney at Planned Parenthood Federation of America, said in July that the organization is considering a challenge to the Iowa Board of Medicine rules on the law. However, there has not yet been action on this potential challenge.

Boevers said OB-GYNs are already “constantly evaluating” the health of the mother and of the pregnancy while caring for patients, but that the lack of guidance could hamper health care providers’ ability to effectively address potentially fatal pregnancy complications.

“To put physicians in a position where they have to be doing this constant evaluation with a patient who is potentially, you know, severely ill, and having to make these decisions around if they’re ill enough to qualify for a life-saving exception or not — it adds an extra layer of stress to that evaluation,” she said. “We’re always watching for our patients to try to try to deter any threats to life. We are always watching, trying to be prepared for what might go wrong next, but to put the threat of action from the Board of Medicine or some sort of scrutiny from the government or the Attorney General on that, into that assessment and evaluation, is a tremendous burden on the health care system.”