Iowa's abortion ban takes effect amid healthcare crisis

Aug. 2 (UPI) -- Iowa's six-week abortion ban took effect this week while healthcare providers are already grappling with one of the worst infant mortality rates in the country.

Iowa Gov. Kim Reynolds has pushed for the six-week ban to become law for more than six years, first signing it in 2018. The state supreme court ruled in June that it can move forward, taking effect on Monday.

"Today is a victory for life. There is nothing more sacred and no cause more worthy than protecting innocent unborn lives," Reynolds said in a statement last week. "As the fetal heartbeat law finally takes effect, our work will continue to strengthen a culture of life in Iowa. I remain deeply committed to supporting women in planning for motherhood, promoting the importance of fatherhood, elevating adoption, and protecting in vitro fertilization (IVF)."

The ban may only worsen an already existing issue in the state, Sen. Janet Peterson told UPI. About 62% of rural hospitals in the state do not have obstetrics and do not provide labor or delivery services. In some rural parts of the state a pregnant woman has to travel an hour and a half for prenatal care.

Dr. Emily Boevers is an OB-GYN practicing in a critical access hospital in Iowa. She is also the founding president of Iowans For Health Liberty, a coalition that supports access to medical care. She is the only full-time OB-GYN at her hospital, which has two family medicine physicians who help provide care to expecting mothers.

Boevers told UPI that her facility and about 30% of the rest of the state is one staff member away from being unable to perform labor and delivery services.

"Putting in place an abortion ban may accomplish some objectives of the governor and legislators. But we're already in a maternal health crisis," she said. "We have increased infant mortality which is related to prenatal care access and socioeconomic factors. Compounding this with a ban at this point, it's really kind of missing the mark."

Care remains under threat as healthcare facilities face the potential of downsizing, due in part to the state having one of the lowest privatized Medicaid reimbursement rates in the country. In May, MercyOne stopped providing gynecological oncology surgical services in Des Moines, leaving central Iowa -- the most populous part of the state, with only one facility to seek such services.

Iowa already has the fewest OB-GYNs per capita in the United States, according to the American College of Obstetricians and Gynecologists.

Meanwhile, Reynolds announced a $1.83 billion budget surplus last fall.

"They've been hoarding tax dollars to build a surplus and Iowans have been suffering the loss of their healthcare infrastructure, their education infrastructure and a number of other things," Petersen said. "The governor also rejected a summer food program for children. We have the strictest requirements for new moms to receive childcare assistance."

Every state that has had a voter-initiated ballot measure to amend its constitution has passed it since the U.S. Supreme Court 's Dobbs decision.

Ohio's voter-initiated ballot measure stopped the enforcement of a six-week ban. Dr. Allison Norris, associate professor at The Ohio State University's College of Public Health and co-chair of WeCount -- a nonprofit organization that measures state-level abortion statistics -- said increased restrictions on abortion have not curbed the instances of abortions. Instead, the opposite has happened.

"Across the United States the total number of abortions is increasing. It's a surprise in some regards because there are 14 states that have banned abortions completely," Norris told UPI. "We have really clear data that shows people who are denied an abortion have negative health consequences that endure for years afterward."

Between 200 and 400 abortions are performed in Iowa per month, according to WeCount. In states where access is greatly restricted or banned, Norris said those numbers drop to nearly zero while residents travel out of state for care.

Ahead of bans taking effect, there is an uptick in donations to organizations that assist women seeking abortion services. Philanthropic support aids in programs that fund women traveling for care, lodging and giving resources to clinics that perform services.

Clinic hours often expand in the weeks leading up to a ban in an effort to see as many patients as possible.

Iowa has two clinics that have performed abortions on a regular basis: Planned Parenthood in Des Moines and the Emma Goldman Clinic in Iowa City. The University of Iowa Hospital in Iowa City also performs abortion care, more often in the case that a fetal anomaly is present.

Boevers said hospitals and clinics have been preparing for the six-week ban for some time, knowing it was likely to take effect.

Those preparations are not enough to prepare for emergency situations, Boevers said.

"What you cannot account for ever is emergencies. That's what's so scary about this law and really any government interference in the practice of medicine and delivering medical care," Boevers said. "As a physician, I'm in a 10-minute window thinking about what to do next. You don't ever know if that 10 minutes is the last 10 minutes they will be stable or the 10 minutes that they begin to decompensate."

"There's no way for the legislature or board of medicine for that matter to put enough guidance in place for the emergencies that will present in small hospitals like mine eventually," she added.

Banning or restricting abortion plays a role in medical professionals leaving the state as well. Norris explains that this happens because many are uncomfortable or feel they are compromising their morals by not delivering the standard of care they have been trained to and promised to give their patients.

Iowa Democrats hope to enshrine the right to access an abortion in the state's constitution. This cannot be done by voter-initiated petition like it was in Ohio last year, or Florida where it will be on the ballot in November.

Instead, lawmakers in the House or Senate must propose and agree to an amendment in two consecutive general assemblies. The amendment must then be ratified by voters.

The legislative actions by Reynolds' fellow Republicans in the Hawkeye State have told a different story about the commitment to support family planning.

Since Republicans have taken a trifecta in the House, Senate and governor's office in 2017, they have brought forward legislation to codify the concept that life begins at conception, sought to make performing an abortion a felony and reduced Medicaid eligibility for pregnant women and infants.

House File 2575, introduced by Rep. Skyler Wheeler, R-Sioux County, called the "Fetal Homicide" bill, is the legislation that would make providing an abortion a felony. The bill passed the House after much debate about how it would threaten access to in vitro fertilization. This came on the heels of the Alabama Supreme Court ruling that frozen embryos are considered children.

Wheeler denied that his bill would outlaw IVF while noting that Alabama Gov. Kay Ivey later signed a bill to protect access to the procedure.

Wheeler's bill was later set aside in the Senate as some Republicans joined Democrats in voicing concerns about the impact on IVF.

Iowa had the third highest increase in infant mortality in the United States in 2022, according to the Centers for Disease Control and Prevention. Infant mortality rose 3% in the United States, the largest increase in 20 years. In Iowa, it rose 30%.

The impact of poor access to reproductive healthcare is experienced inequitably in Iowa and across the United States. In Iowa, Black women are six times more likely to die from complications during pregnancy or delivery than White women, according to the Iowa Maternal Mortality Review Committee.

Increased abortion restrictions create a level of uncertainty among medical professionals, Petersen said.

"There is a lack of clear guidance from the board of medicine on at what point they are able to step in and provide care to patients without risking their license," she said. "How sick and at risk does the life of the mother have to be before they can intervene?"

The U.S. Supreme Court weighed this question in the case Moyle vs. United States earlier this year. It ruled to, at least temporarily, allow for emergency abortions in Idaho.