Iowa abortion clinics prepare for new reality as six-week ban goes into effect

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

Iowa’s so-called “fetal heartbeat ban” goes into effect at 8 a.m. Monday, and prohibits abortions once fetal heart activity can be detected by ultrasound, usually around six weeks of pregnancy. The only exceptions are cases of rape, incest, fatal fetal abnormality and to save the life of the pregnant woman.

More: Starting today, you can no longer get an abortion in Iowa if you are 6 weeks pregnant. Here’s why:

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

Last week, abortion clinics across the state scrambled to see as many patients as possible before Iowa’s ban went into effect. Alex Sharp, senior health center manager for Planned Parenthood clinics in Iowa, said clinics overbooked appointments with patients who were originally scheduled to be seen this week, after the new ban goes into effect.

However, clinic staff encountered many patients who were unaware of the upcoming ban, Sharp said. She estimates that 30% of patients were unable to get an early appointment because they couldn’t get time off work or couldn’t find childcare on short notice.

“I would say we were able to get maybe 50% of the people who were scheduled for next week, but for the rest of them it was too late to adjust their schedules and come earlier,” Sharp said Friday.

Iowa abortion clinics continue to provide abortion care under strict laws

The new six-week law was passed during a 2023 special session called by Republican Gov. Kim Reynolds, but its enactment was blocked by a Polk County district judge.

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

Reynolds, who has led the effort to implement the six-week ban since 2018, called the Iowa Supreme Court’s decision last week “a victory for life.”

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

Maggie DeWitte, executive director of Pulse Life Advocates, applauded the court’s decision to strike down the ban. In a statement last week, she said abortion opponents in the state are celebrating the victory “with great joy, 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 unborn brothers and sisters until the day they are all protected under our law.”

Abortion clinics have strongly condemned the six-week ban, saying the negative effects on Iowans will be “widespread and generations-long.”

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

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

Traxler said Planned Parenthood clinics will continue to schedule patients for abortion care in Iowa if they are less than six weeks pregnant, or two weeks after their first missed period.

If patients are unsure whether their last menstrual period has occurred, they can choose to come to Iowa or schedule an appointment in another state.

Providers and patients will also continue to grapple with challenges stemming from a law requiring a 24-hour waiting period for abortions in Iowa, which went into effect in 2022. Traxler said the law adds extra time before a patient can access care, creating inconvenience for both patients and clinic operations.

Even if patients qualify for abortions under the new law’s exceptions, some suspect a lack of clarity from the Iowa Board of Medicine, the agency that enforces the law, could lead to patients being turned away.

The board’s rules do not provide insight into the sanctions doctors could face under the law. But opponents say doctors may be reluctant to take action because of the potential risk of losing their medical licenses.

“This ban ties the hands of physicians. It puts them in the impossible position of deciding whether to keep their license or to provide life-saving health care and uphold their oath,” Traxler said. “Everyone comes to us with different and unique circumstances. They want complete information about the health care options that are best for their lives and their future, and they expect to receive the care they want and need. Unfortunately, that ends on Monday.”

Advocates push efforts to help patients travel for abortion care

Abortion providers and other reproductive rights advocacy groups expect that many Iowans will be forced to seek care outside the state. They have been working hard to increase resources to help these patients reach their appointments.

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

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

Groups in nearby states without abortion bans are already seeing an influx of patients from Iowa. The Chicago Abortion Fund, which recently partnered with the Iowa Abortion Access Fund in light of the upcoming ban, says it’s seeing the highest number of calls to its helpline in its 40-year history.

In the first three weeks of July, the Chicago Abortion Fund received 60 requests for support from Iowans expecting the ban, a 165 percent increase over previous months, according to data from the Iowa Abortion Access Fund.

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

Since the U.S. Supreme Court’s 2022 Dobbs ruling, abortion clinics in Iowa have seen a surge in patients traveling from Missouri, which has a total ban on abortions, Traxler said. Most of the out-of-state patients in recent months have come from Nebraska after a state law there imposed a 12-week ban on the procedure.

Illinois and Minnesota are two neighboring states that most Iowans are likely to travel to, but clinics there have already seen a dramatic increase in out-of-state patients. The Guttmacher Institute estimates that the number of out-of-state patients in both states will more than double 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 potential pressure on these clinics adds to growing concerns among abortion rights advocates in Iowa, who worry about patients’ ability to access abortion care in the future.

Patients already lack the resources ― including financial resources ― to travel for care. Kristina Remus, a patient services representative at Planned Parenthood North Central States, estimates that only about half of the patients she’s worked with in recent weeks have told her they have the means to travel for care.

“Abortion bans don’t ban abortion for everyone. They ban abortion for people who don’t have the means or the ability to travel,” Richardson said.

Abortion rights advocates have also raised concerns about the negative health effects on Iowans, pointing to studies showing that infant mortality has increased in states with outright bans, or reports that maternal deaths are higher in states with laws restricting abortion.

According to the March of Dimes, Iowa already has poor access to maternal health care. A third of its 99 counties are designated as maternal health deserts, meaning they have no obstetricians or birthing hospitals.

As abortion clinics prepare logistically for the ban, the reality of its impact on the health and well-being of patients is a bitter pill for clinic workers and staff, they say.

“On Monday, abortion access in Iowa will look very different,” 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 [email protected], at (319) 339-7354 or on Twitter at @Michaela_Ramm.