Iowa’s new abortion law could have domino effect across the region

It’s quiet during the lunch hour on a recent Friday at the Planned Parenthood clinic in Mankato, Minnesota.

Brooke Zahnle, the health center’s manager, steps into the small hallway of the clinic in southern Minnesota to point out the lab and five exam rooms, including an ultrasound room. The clinic is tucked into a strip mall near Minnesota State University, Mankato. It’s about an hour’s drive from the Iowa border.

“We plan to see 14 patients a day here in Mankato, and we’d like to expand that to 22,” Zahnle said.

As Iowa’s so-called “heartbeat law” worked its way through the courts, she said the clinic was preparing to take on more patients in Iowa. Last November, it moved to a new location, adding an exam room, and recently began offering abortion services, she said.

“We started offering medication abortion services in January,” she said. “And we are now cross-training staff to expand access on Wednesdays when we offer that service.”

Iowa law prohibits abortions when cardiac activity is detected, which can happen as early as six weeks of pregnancy, or even before some people know they are pregnant.

The law goes into effect on July 29. Planned Parenthood expects it to block virtually all abortions in the state.

The ban will likely impact abortion access not only in Iowa, but across the Midwest region.

‘They feel crushed’

Shira Klane, a nurse practitioner who works at Planned Parenthood clinics in Minnesota, is already seeing patients from Iowa who sometimes have to travel three to four hours to get to the nearest clinic in Minnesota.

“They feel crushed,” she said. “It feels like a heavy burden that they have to carry, and then extreme gratitude that they can find care through us.”

An estimated 940 Iowans sought abortions in Nebraska, Minnesota and Illinois last year, according to data from the Guttmacher Institute, which advocates for abortion rights.

A similar 2018 law was blocked by the state Supreme Court. The justices remained deadlocked, preventing the law from taking effect. Then, in a special session in July 2023, a nearly identical bill passed the legislature. The new version was also stayed until June 28, when the justices ruled that the injunction must be lifted.

Even without the so-called “heartbeat law,” Iowa still has far more abortion restrictions than neighboring states Minnesota and Illinois, said Candace Gibson, director of state policy at the Guttmacher Institute.

“You have a forced 24-hour waiting period after the (mandatory in-person) counseling, forced ultrasounds, there are parental notification requirements in Iowa. And so all of those restrictions add up in terms of barriers for an individual to get care,” she said.

According to Gibson, the new Iowa law is likely to significantly increase the number of Iowans seeking abortions in another state.

An increase in out-of-state patients

Since the U.S. Supreme Court’s Dobbs decision more than two years ago, which ended the constitutional right to abortion, Planned Parenthood has expanded abortion services in states including Minnesota, Nebraska, Kansas and Illinois. That’s to accommodate the surge in people coming from states such as South Dakota, North Dakota, Missouri, Indiana, Kentucky – and now Iowa – that have severely restricted or nearly abolished the procedure.

This influx of abortion candidates can put a burden on clinics and health care providers, Gibson said.

“As states consider policies to protect and meet the needs of other states, they must also ensure that residents of their own state can continue to receive that care,” she said.

A Planned Parenthood worker in Mankato, Minnesota, sits at the front desk during a lunch break. The clinic recently moved to a new, larger location closer to a major state university.

In Illinois in particular, the number of out-of-state people seeking abortions has increased dramatically since the Dobbs ruling two years ago.

About 25% of patients now come from out of state, compared with 3% to 5% before Dobbs, according to Julie Uhal, manager of the abortion expansion program at Planned Parenthood of Illinois.

“It was really limited (before Dobbs) to people who lived in Milwaukee, for example, like in the neighborhood that came down (to the Chicago area),” she said. “But now we’ve seen patients from 41 states across the country.”

Since Dobbs, Planned Parenthood of Illinois has opened new clinics near state lines, including a clinic in Carbondale late last year. More than 90 percent of the patients there come from outside Illinois, Uhal said.

The organization is monitoring how Iowa’s new law changes the region where people travel for abortion care, she said.

“It’s also going to impact people from the northern part of Missouri, for example, who may have gone to Iowa for care, or even further west, like Nebraska, South Dakota,” she said. “It’s hard to say, and there are a lot of factors that determine why someone would travel to Illinois versus Minnesota or fly to California.”

Planned Parenthood of Illinois has no plans to open a clinic closer to the Iowa border, but it is “certainly a possibility in the future,” Uhal said.

Where is that line?

Meanwhile, health care providers in Iowa are still trying to figure out what they can and can’t do under the new law.

For example, Francesca Turner, a gynecologist in Des Moines and co-founder of Iowans for Health Liberty, an abortion rights organization, said that the rules approved by the Iowa Board of Medicine state that you can perform an abortion on someone who has had a miscarriage in which not all of the tissue in the uterus has been removed.

“But it doesn’t explicitly say that if that embryo has a heartbeat or the fetus has a heartbeat, can you still provide emergency medical care? Where is that line?” she said.

While the law has exceptions for rape, incest and life-threatening conditions, Turner said that properly documenting these can be complicated. Doctors must collect information they normally wouldn’t, such as the date the “sexual act” occurred and whether it was “rape” or with a “closely related person.”

Doctors fear a misstep could have consequences for their medical license, she said.

“If I see something that I can’t fix, I can call my high-risk gynecologist colleagues and specialists and get their opinions based on their experiences and make those decisions in real time,” Turner said. “I don’t want to stop after we’ve made a few decisions and say, ‘Well, maybe I should call my attorney from the hospital and get some more information about whether I can act now or not.'”

She said this means many of Iowa’s patients will still have to cross the border for abortion care — or won’t get it at all.

This story was born from a collaboration between Public Media Side Effects and the Midwest Newsroom — a collaboration in the field of investigative journalism, including IER, KCUR-89.3, Nebraska Public Media News, St. Louis Public RadioAnd NPR.

Side Effects Public Media is a health reporting partnership based at WFYI in Indianapolis. We partner with NPR stations in the Midwest and surrounding areas, including KBIA and KCUR in Missouri, Iowa Public Radio, Ideastream in Ohio, and WFPL in Kentucky.