Iowa abortion providers, advocates prepare for state law to take effect

Hundreds of Iowans rallied for and against abortion restrictions on July 11, 2023 in the Capitol rotunda. (Photo by Kathie Obradovich/Iowa Capital Dispatch)

Reproductive health care advocates and providers are preparing for how to help Iowans access abortion following Friday’s Iowa Supreme Court decision that will allow the state’s six-week abortion ban to take effect.

The state Supreme Court issued a 4-3 ruling Friday morning that would allow for enforcement of a 2023 law banning most abortions after cardiac activity can be detected in an embryo, sometimes as early as six weeks of gestation. There are limited exceptions for cases of rape — if reported to law enforcement, a public health agency or doctor within 45 days — incest — if reported in 140 days — and when an abortion is necessary to save the life of the pregnant woman.

In a news conference Friday, ACLU and Planned Parenthood advocates said the Supreme Court decision will have a negative impact on Iowa women seeking abortions.

“We are heartbroken by the court’s decision,” Rita Bettis Austen, legal director for the ACLU of Iowa said. “We know that Iowans will now face unjust and for some impossible obstacles in getting abortion care. For many whose resources, circumstances and safety allow them to do so, they’ll now be required to leave the state to get care. Others will face serious and even life-threatening health consequences as a result of this dangerous, poorly written law. Some will be forced to remain pregnant against their will.”

Though the state Supreme Court has ordered that an injunction be lifted, there will still be time before enforcement of the abortion law begins. The court ordered the case to be returned to the district court in Polk County, which will hear the case and likely lift the temporary injunction. Iowa court rules state that there is a minimum 21-day period before the district court regains jurisdiction of the case, according to ACLU of Iowa.

Abortion is still currently legal in Iowa up to 20 weeks of pregnancy while the law is blocked from enforcement.

Reproductive health care providers said they have spent a significant amount of time getting ready for abortion restrictions to take effect in Iowa. Francine Thompson, executive director of the Emma Goldman Clinic, an Iowa City reproductive health care clinic that provides abortions, said  advocates supporting abortion access were “disappointed” but “not surprised” by the Supreme Court decision.

Ruth Richardson, president and CEO of Planned Parenthood North Central States, said the organization has “spent months planning for this moment.” Moving forward, she said, Planned Parenthood ” isn’t going anywhere” and will continue to provide abortions in accordance with state law.

“And when the ban goes into effect, we will provide access to abortion care in Iowa if no cardiac activity is detected,” Richardson said. “… We stand ready to connect Iowans with the essential health care they so desperately need, even if that means traveling out of state.”

She said Planned Parenthood’s abortion patient navigators will continue to work with people seeking access to the procedure. Since the U.S. Supreme Court overturned Roe v. Wade in 2022, Planned Parenthood navigators have helped 4,000 patients access abortion care, Richardson said, “a majority of who came from Iowa.” The organization has also worked to expand abortion care in other states, she said, including expansions to the organization’s health centers in Omaha, Nebraska and Mankato, Minnesota.

“While anytime a patient is forced to travel across state lines for essential health care is devastating, we’ve been making long-term regional investments to ensure patients who face bans have regional options,” Richardson said.

Abortion remains legal in several states surrounding Iowa. Minnesota and Illinois laws allow abortions to be performed until a fetus is able to survive outside the uterus, which typically occurs around 25 weeks of pregnancy. Exceptions are granted in these states for the limit when an abortion is necessary to save the life of the pregnant patient, or if their health is in danger.

Kansas and Wisconsin allow abortions up to 22 weeks of gestation, and Nebraska has a law restricting abortion after 12 weeks of pregnancy. South Dakota and Missouri have implemented near total abortion bans, with certain exceptions.

Concerns raised about access to reproductive health care beyond abortion

Iowa Democratic Party chair Rita Hart said Friday she was concerned about how the ruling will impact “all aspects of reproductive health care,” not just abortion procedures.

“We’ve already seen the effects that these extreme abortion bans have had on states like Alabama, where (in vitro fertilization) was put into jeopardy, and in Texas, where women have been forced to miscarry in lobby restrooms , for God’s sakes, because hospitals refuse to help them while they’re experiencing medical emergencies,” Hart said.

Hart, alongside health care advocates, have criticized the medical exceptions in the law, saying that it is often difficult for doctors to determine when an abortion is “necessary” to save the life of the pregnant woman. In other states with more restrictive abortion bans, advocates argue doctors avoid performing needed procedures due to fear of losing their medical license or facing criminal penalties.

Sally Frank, a law professor at Drake University, said Iowa’s law may see “applied challenges,” in the future from women who faced life-threatening experiences, or families of those who died, due to medical professionals not performing abortion procedures because of a lack of clarity on what constitutes a “medical emergency” under the law.” These challenges have been brought forward against abortion restrictions in other states, including Texas.

The U.S. Supreme Court issued a 6-3 decision Thursday ordering Idaho to not enforce its criminal abortion ban in emergency rooms as litigation continues over whether that state’s law violates the federal Emergency Medical Treatment and Labor Act, or EMTALA.

Another major concern following the abortion law ruling is the potential effect on in vitro fertilization. Gov. Kim Reynolds, in a statement Friday, expressed her commitment to keeping access to IVF available in Iowa. But reproductive health care advocates and legal experts said the Supreme Court decision could lead to restrictions of the fertility treatment. In her dissenting opinion, Chief Justice Susan Christensen wrote that there were concerns about protections for “unborn” children language in Iowa law, similar to measures enacted in Alabama that caused IVF clinics to temporarily cease care.

Christensen also wrote that the law could cause conflicts with people seeking IVF treatments as multiple embryos  typically are implanted in a woman’s uterus to achieve pregnancy. If multiple pregnancies occur, high-risk obstetricians sometimes recommend “selective pregnancy reductions,” removing some potentially viable embryos to ensure the safety of both the mother and developing fetus.

If this process occurs after six weeks of gestation, Christensen wrote that it could also be subject to the state’s ban on abortions after embryonic cardiac activity is detectable.

“Like the medical emergency exception, it is unclear how this exception applies in practice,” she wrote. “And like the medical emergency exception, physicians will be left guessing and turning to lawyers for help making their medical decisions in addressing how to treat these high-risk pregnancies.”

Further restrictions predicted

Frank said that while there are many questions about the full impacts of the Supreme Court decision on the future of reproductive health care access in Iowa, she also expected to see Reynolds and Republican Iowa lawmakers move forward with further restrictions.

“I expect the Legislature — unless we have a big change in the Legislature — to pass the kinds of things we’ve seen in other states,” she said, referring to measures in other states aimed at restricting travel or assistance for out-of-state abortions. For example, an Idaho law would make the act of helping a pregnant minor get an abortion in another state punishable by up to five years in prison.

Iowa Democrats say they hope voter dissatisfaction with GOP abortion policy will help them win back some power in the state. Iowa Republicans have control of all but one statewide elected office, a majority in the Iowa House and supermajority in the Senate. House Minority Leader Jennifer Konfrst said Friday that Republicans “have gone too far” with the abortion law, and are not in tune with what a majority of Iowans want.

“As women out there are thinking about what this means, please pause and know … that we are with you, and that there can be change, and that the people who are to blame for this will be held accountable,” Konfrst said. “And we all need to come together and act.”

But Republican leaders say state lawmakers’ moves to restrict abortion reflect what Iowans want. House Speaker Pat Grassley said in a statement that Iowa is a “pro-life and pro-family state,” praising the state Supreme Court decision.

“This ruling is a victory in the fight to protect unborn children in Iowa,” Grassley said. “The Legislature is elected by the people, and for too long, the courts have stood in the way of Iowans having their voices heard on this matter.”

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