Iowa clinics rushed to treat women before a 6-week ban began. Some couldn't make it in time

Abortion clinics across Iowa say they plan to continue operations after the state's six-week abortion ban officially goes into effect Monday morning ― even as their ability to provide abortion care will be drastically curtailed.

Iowa's so-called "fetal heartbeat ban" is enforceable as of 8 a.m. Monday, prohibiting abortion once fetal cardiac activity can be detected by ultrasound, typically around six weeks of pregnancy. The only exceptions are cases of rape, incest, fatal fetal abnormalities and to save the life of the pregnant woman.

More: Starting today, you can't get an abortion in Iowa if you're 6 weeks pregnant. Here's why:

The ban is expected to block nearly all abortions in the state, with Planned Parenthood North Central officials estimating the number of procedures performed in the state could drop by at least 97%. More than 4,000 surgical and medication abortions were performed in Iowa in 2023, according to estimates from the Guttmacher Institute .

Last week, abortion clinics across the state worked to see as many patients as they could before Iowa's ban went into effect. Alex Sharp, senior health center manager for Iowa's Planned Parenthood clinics, said the clinics overbooked appointments with patients who were originally schedule to be seen for care this week, after the new ban is in place.

However, clinic staff came across many patients were were unaware of the pending ban, Sharp said. She estimates 30% of the patients weren't able to come to an earlier appointment because they couldn't get time off work or find child care on short notice.

“I would say we were able to get in maybe 50% of the people that were scheduled for next week, but for the rest of them, the fact is that it was too late of notice for them to rearrange their schedules to be able to come sooner,” Sharp said Friday.

Iowa abortion clinics will continue abortion care under strict law

The new six-week law was passed in a 2023 special session called by Republican Gov. Kim Reynolds, but it was blocked from taking effect by a Polk County District Court judge.

The state appealed to the Iowa Supreme Court, which issued a ruling June 28 ordering the district court to lift its injunction and allow the law to take effect.

Reynolds, who has led the effort to enact the six-week ban since 2018, called the Iowa Supreme Court decision last week "a victory for life."

“There is nothing more sacred and no cause more worthy than protecting innocent unborn lives," Reynolds said in a statement.

Pulse Life Advocates Executive Director Maggie DeWitte applauded the court's decision to lift the injunction, saying in a statement last week that abortion opponents in the state celebrate the victory "with great joy and gratitude and abundant blessings."

"Monday is an important step forward for the protection of life in Iowa, but we will continue to work toward our gold standard of life at conception," DeWitte said. "We will continue to fight for the lives of all of our preborn brothers and sisters until the day they are all protected under our law."

Abortion care providers have strongly denounced the 6-week ban, saying the negative effect on Iowans will be "widespread and generational."

“We now live in a reality where politicians have control over Iowans' bodies and futures,” Dr. Sarah Traxler, chief medical officer of Planned Parenthood North Central States, said in a media briefing Friday.

Planned Parenthood and the Emma Goldman Clinic in Iowa City, the state's other surgical abortion provider, say they intend to continue offering abortion services within the parameters of the new law.

Moving forward, Traxler said Planned Parenthood clinics will continue to schedule patients for abortion care in Iowa if their pregnancy has not yet reached six weeks of pregnancy, or two weeks after their first missed menstrual period.

If patients are unsure of their last menstrual period, they are given the option to still be seen in Iowa or be scheduled for an appointment out of state.

Providers and patients also will continue to grapple with challenges arising from a law mandating a 24-hour waiting period for an abortion in Iowa. That law went into effect in 2022. Traxler said the law adds additional time before a patient can access care, creating inconvenience for patients as well as clinic operations.

Even if patients qualify for abortions under the new law's exceptions, some have speculated a lack of clarity from the Iowa Board of Medicine, the enforcing agency of the law, could mean patients will be turned away from care.

The administrative rules from the board offer no insight on the penalties doctors could face under the law, but the potential risk of losing their medical license could mean doctors will hesitate to act, opponents say.

"This ban ties doctors’ hands. It puts them in the impossible position of deciding whether to keep their license or provide life-saving health care and uphold their oath," Traxler said. "Every person comes to us with different and unique circumstances. They want full information about health care options that are best for their lives and their futures, and they expect to receive the care that they want and need. That unfortunately stops on Monday."

Advocates boost efforts to help patients travel for abortion care

Abortion care providers and other reproductive rights advocacy groups anticipate many Iowans will be forced to seek care out of state, and have worked to boost resources to help those patients reach their appointments.

Ruth Richardson, president and CEO of Planned Parenthood North Central States, said the organization has expanded capacity at clinics near the Iowa border, including its clinic in Mankato, Minnesota. Richardson said an expansion at the Omaha clinic is underway and will quadruple the number of exam rooms from four to 16.

However, Traxler said the Mankato location offers only medication abortion, meaning patients seeking a surgical procedure must travel to the Twin Cities.

Already, groups in nearby states without abortion bans are seeing an influx of Iowa patients. The Chicago Abortion Fund, which recently partnered with the Iowa Abortion Access Fund in light of the pending ban, says it's seeing the highest call volume to its hotline in its 40-year history.

In the first three weeks of July, the Chicago Abortion Fund saw 60 requests for support from Iowans anticipating the ban, a 165% increase compared with previous months, according to data from the Iowa Abortion Access Fund.

The state's six-week ban will dramatically shift the legal landscape for abortion not just in Iowa, but across the Midwest. With this new law, Iowa has joined 17 states ― mostly in the South ― that ban abortion entirely or as early as six weeks of pregnancy, according to an analysis of nationwide bans .

Since the U.S. Supreme Court's Dobbs decision in 2022, Iowa abortion clinics have seen many patients traveling from Missouri, which enacted a total ban on abortion, Traxler said. Most out-of-state patients in recent months have come from Nebraska after a state law there implemented a 12-week ban on the procedure.

Illinois and Minnesota are two neighboring states where most Iowans are likely to travel, but already, clinics there have seen a huge surge in out-of-state patient volume. The Guttmacher Institute estimates the portion of out-of-state patients to both states has more than doubled from 2020 to 2023.

Richardson said Planned Parenthood North Central States' patient navigators have helped 4,000 patients access care at an out-of-state clinic since 2022. Still, the possible strain on these clinics adds to the growing concern of abortion rights advocates in Iowa who worry about patients' ability to access abortion care in the future.

Already, patients lack the resources ― including financial ― to travel for care. Kristina Remus, a patient services associate with Planned Parenthood North Central States, estimates only about half of the patients she's worked with in recent weeks have told her they have the resources to be able to travel for care.

"Abortion bans do not ban abortion for everyone. They ban abortion for people who do not have the means or the opportunity to travel," Richardson said.

Abortion rights advocates have also raised concerns about the negative consequences for the health of Iowans. They point to studies that show infant mortality rose in states with a total ban, or reports that maternal deaths are more likely to occur in states with laws restricting abortion.

Iowa already has poor maternal health access, with one-third of its 99 counties designated as maternal health deserts, meaning they lack access to OB-GYNs or a birthing hospital, according to the March of Dimes .

Even as abortion clinics have prepared logistically for the ban, the reality of its impact on patients' health and well-being is a bitter pill for clinic providers and staff, they say.

“Come Monday, abortion access will look very different in Iowa," Sharp said. "It's a devastating blow, and it's hard to swallow.”

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: Iowa clinics rushed to treat women before a 6-week ban began. Some couldn't make it in time