Exceptions to Iowa’s abortion ban won’t provide much relief. Here’s why.

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The bigger picture will not change unless a newly formed Iowa legislature repeals this law, which violates human rights and, polls show, the wishes of Iowans.

The Register’s editorial commentary
| Des Moines Register

Six years of trying will pay off Monday for Gov. Kim Reynolds and Iowa Republicans: a law banning nearly all abortions will go into effect.

And “almost all” means “almost all.” By linking the ban on abortion to detecting the heartbeat, many girls and women will not find out they are pregnant until it is too late to seek help.

However, Iowa law also has five types of exceptions, under which a girl or woman could theoretically terminate a pregnancy at a later date.

Previous reporting in the Register and other media outlets has shown how those doors may not be as wide open as they first appear. But as reproductive freedom in the state winds down, it’s worth emphasizing just how unyielding the supposed exceptions really are.

Some Republicans are talking about drafting a full-blown “life begins at conception” bill to ban abortion entirely. But this bill, now approved by the courts, is almost here.

More: Inside a Planned Parenthood clinic in Iowa before abortion ban goes into effect

Rape and incest rules pay little attention to trauma or the role of doctors

The new law bans abortions when an unconventional ultrasound can detect electrical activity in a fetus, usually about six weeks after a woman’s last menstrual period. Survivors of rape and incest can get care later — if they meet strict deadlines and other rules for reporting the assault that resulted in pregnancy. After being sexually assaulted, survivors have exactly 45 days to tell police or a doctor. Survivors of incest have 140 days. To perform an abortion without risking professional discipline, doctors must document the assault in detail and assess the girl or woman’s credibility, according to rules set by the Iowa Board of Medicine.

If all this happens, abortion will be legal up to 20 weeks after conception.

Neither the timeline of the rape nor the requirement to share detailed information with strangers match what many victims of sexual abuse actually experience.

“If you just look at the statistics, most survivors don’t come forward,” said Tamika Payne, interim executive director of the Iowa Coalition Against Sexual Assault. “When the state … limits the options and choices that survivors of sexual assault have, you’re actually reinforcing the victimization that they’ve just endured. You’re telling them that you don’t have control over your body. The most horrific violations are happening where you had no control. And now, in response, they’re taking that control away.”

Dr. Emily Boevers of Iowans for Health Liberty, an obstetrician-gynecologist working in northeast Iowa, said that while she prefers to focus on the harms experienced by victims, doctors are also facing new pressures.

“It puts physicians in a position where they have to be investigators for legal purposes, rather than just medical providers,” Boevers said. “That patient-physician relationship is so precious. Spending our clinic time questioning patients about dates of seizures, who committed the seizure, whether they’ve reported it to the proper authorities — these are nonmedical details, and we’re asking them for nonmedical reasons. … It’s a betrayal of the patient-physician relationship.”

Payne said abortion is a necessary medical care and that restricting it in this way is a denial of human rights. “That’s like someone going to the emergency room and (being told), ‘Well, we can’t fix your broken arm unless you’ve actually been assaulted,'” she said.

“Rape” is a word that didn’t exist in the Iowa Code until this law was passed, so one of the jobs of doctors is to chart patients’ experiences under laws that criminalize sexual abuse. And the survivor has to start the process by reporting it within 45 days.

“This is a patient who may already be in a vulnerable situation,” Boevers said. “She may not have quick or accessible transportation to a police station or somewhere she can report this or to a doctor to get help for it. … Even though what happened to them is a form of sexual trauma, they may not recognize it in real time.”

Fetal abnormality exception defines little and discourages care

Ambiguity dominates this exception, which permits abortion in the case of “a fetal abnormality that, in the physician’s reasonable medical judgment, is incompatible with life.” What’s incompatible with life? A zero percent chance of survival? How about 0.1 percent? Who calculates the probability? What is “life” — does it include a few minutes in an operating room before a doctor formally pronounces death?

“There’s no standard definition in medicine of what that means,” said Dr. Andrea Greiner, who is also part of Iowans for Health Liberty. “I think that ambiguity just creates more fear. And it’s going to make people very conservative.”

Rather than addressing obvious questions, the rules for this law follow a pattern of, as Greiner noted, being vague enough to incentivize providers to refuse to provide abortion care. The alternative, in a case where someone somewhere might have a dissenting opinion, is to risk a complaint that sets up a potentially career-ending hearing before the Board of Medicine.

“It just puts a ridiculous emotional burden on the patients, who are having to grieve in an already difficult situation for a pregnancy that is not what they expected,” Greiner said.

More: ‘It was just desperation’: Abortion bans leave doctors uncertain about care — even in emergencies

A ‘medical emergency’ can also be in the eyes of the beholder (or the supervisor)

Abortion remains legal in Iowa when the mother’s “life is in danger” or she suffers “substantial and irreversible impairment of a major bodily function.” Strict abortion bans in other states have produced dozens of stories of women suffering permanent, preventable injuries because lawyers and doctors ruled that a supposed exception in the law did not unquestionably apply to the women’s cases.

Iowa Supreme Court Chief Justice Susan Christensen dissented from the court’s 4-3 decision to reinstate the abortion ban, citing scholarly and journalistic evidence that demonstrates its inhumanity.

“Does this mean that there is no exception, even in cases where a woman is forced to undergo a hysterectomy because she could not obtain a timely abortion under this law?” Christensen wrote. “The board’s rules provide no additional insight into what constitutes a ‘medical emergency’ under the exception. Nationally, this lack of guidance on what constitutes a life-threatening medical emergency in states with similar laws continues to baffle physicians, to the detriment of the pregnant women who seek their care.”

More: Iowa’s Six-Week Abortion Ban Undermines the Dignity of Girls and Women. Vote Out the Authors.

The situation, Christensen pointed out, completely undermines one of the state’s supposed goals in enacting the law, which is to protect maternal health. Greiner described a potential dilemma: “Is it a medical emergency now? Or could it become an emergency two hours from now? For example, sepsis, which is an abnormal functioning of the entire body, organs, as a result of an overwhelming infection; that’s not a binary process, like, you either have sepsis or you don’t have sepsis. It’s an evolving medical condition. Initially, you might just have low blood pressure and a high heart rate, but two hours from now, that person could have kidney failure or liver failure or respiratory arrest or cardiac arrest. So, is it a medical emergency now, only if their heart rate is high, their blood pressure is low? Or do we have to wait?”

According to Boevers, this will lead to reluctance to perform abortions that may be legal.

“I think we’re going to see a lot of physicians and hospitals who are reluctant to provide care under these exemptions, no matter what, for fear that they’ll be subject to that scrutiny again and that there will be doubts about whether they meet the criteria,” she said.

Cautious optimism about treatment after miscarriage

Greiner said the wording of the Iowa law is less concerning than restrictions in other states, where women who have indisputably suffered a miscarriage are forced to continue a potentially deadly, doomed pregnancy rather than undergo an abortion-like “D&C” procedure.

But Boevers pointed out that gynecologists who can perform these and other specialized procedures are already hard to find in some parts of rural Iowa. She said she expects the problem to get worse because the abortion law will make Iowa a professionally risky and undesirable place for gynecologists to practice.

Iowa’s law makes much illegal. But a continued exodus of gynecologists — Iowa’s per capita rate is already the worst in the country — could mean that one effect of the ban is to make it impossible to get legal care locally.

Legal battles and private support continue, but only elections can restore equality

The litigation over the law and its governing rules is far from over. Christensen noted in her dissent that specific parts of the rules could be challenged separately. But the window for preserving robust reproductive rights has closed

Volunteers and professional women’s health advocates have pledged to help girls and women get the care they need as much as possible, here or outside of Iowa.

The bigger picture won’t change unless a reconstituted Iowa legislature repeals this law, which violates human rights and, as measured by polls, the wishes of Iowans. Voting for Democrats who promise to take this step in the Iowa House and Senate is crucial.

More: Iowa Poll: More than 60% favor legal abortion as state Supreme Court weighs restrictions

This call goes beyond favoring one party’s view on relatively mundane issues. It’s not about firing lawmakers for, say, incompetent management that leads to tax increases or wrong-headedness about speed cameras. It’s about restoring the ability of girls and women in Iowa to participate fully in society, to be safe, and to be treated with basic respect.

Lucas Grundmeier, on behalf of the editorial board of the Register

More: These 12 enduring principles guide the decisions of the Des Moines Register editorial board

This editorial is the opinion of the Des Moines Register Editorial Board: Carol Hunter, Editor in Chief; Lucas Grundmeier, Opinion Editor; and Richard Doak and Rox Laird, Editorial Board Members.

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