Watch: Iowa Supreme Court Rules 6-Week Abortion Ban Can Go Into Effect
Hear from advocates at the Iowa State Capitol after the Iowa Supreme Court ruled that the state’s 6-week abortion ban can go into effect.
When the so-called “fetal heartbeat” ban goes into effect, which is expected as early as Friday, Iowa will have some of the most restrictive abortion laws in the country. But access to abortion in Iowa has already undergone significant changes in recent years.
At the start of this year, there were only two locations in the state of 3.2 million people offering in-person abortion care, and neither is in Des Moines, the state’s largest city. While three other brick-and-mortar clinics in the state offer medication abortions, they rely on telehealth to provide that care.
This limited access to abortion care is a direct result of ongoing, years-long efforts by Republican lawmakers in Iowa to restrict abortion in the state, advocates on both sides of the issue say.
Anti-abortion advocates are celebrating the trend, even as they absorb this week’s victory. Reducing access to brick-and-mortar abortion clinics is part of their long-standing effort to “eliminate the abortion industry in the state of Iowa,” said Maggie DeWitte, executive director of Pulse Life Advocates.
“It’s all one big package,” DeWitte said. “Yes, it’s about eliminating abortion because we see that it’s harmful, but it’s also about helping women and families make good, healthy decisions that will lead to positive outcomes for them in their lives.”
Policymakers have passed laws aimed at restricting abortion providers, but abortion rights advocates argue that they have also eroded providers’ ability to provide meaningful care.
“This is the whole point of all these restrictions on abortion, is to make it harder and harder for patients to access care,” said Dr. Emily Boevers, an obstetrician-gynecologist and outspoken abortion rights advocate in Iowa. “There are fewer doctors, so soon there are going to be fewer clinics. Soon the clinics are going to be more concentrated, and our patients are going to have to travel — and not just travel, but travel for 26 hours at a time because they have a 24-hour wait.”
“All of this is designed to make it harder for patients to access care,” she said.
More: Six-week abortion ban can go into effect, Iowa Supreme Court rules, ending executive order
How Did We Get Here? Iowa’s Decrease in Abortion Access
Iowans seeking abortions can obtain medication abortions in the state. However, abortion pills become less effective as the pregnancy progresses, meaning some patients may need to seek surgical care later in their pregnancy.
Starting this month, elective surgical abortions will be performed only by Planned Parenthood in Ames and the Emma Goldman Clinic in Iowa City, meaning Iowans living in the farthest reaches of the state may have to travel hours to access the procedure. People living in Sioux City or other parts of northwest Iowa, for example, could drive nearly 200 miles to the clinic in central Iowa.
This comes as the number of abortions in Iowa has increased since the U.S. Supreme Court overturned Roe v. Wade, the landmark 1973 ruling that guaranteed abortion rights nationwide.
About 4,200 abortions, including medication and surgical procedures, were performed in Iowa in 2023, according to a report from the Guttmacher Institute. That’s a slight increase from 4,062 abortions in 2022, the most recent data from the Iowa Department of Health and Human Services.
Last year, as it became clear that Gov. Kim Reynolds and top Republican lawmakers were moving closer to their goal of banning abortions after about six weeks, Planned Parenthood North Central States closed three of its clinics in Iowa, including the Rosenfield Health Center on the south side of Des Moines.
Some abortion rights advocates say this is just a glimpse of the reality created by state restrictions on abortion that have been put in place over the years.
“We operate in an environment where access to health care is constantly on the defensive, and systems that were well-suited to meeting the needs of Iowans are being decimated,” said Erin Wagner, senior director of strategic communications for Planned Parenthood North Central States.
Planned Parenthood officials pointed to several policies passed by state legislatures over the years, including a law that barred abortion clinics from receiving federal funding to provide family planning services. That loss of funding was a major blow to the organization and resulted in the closure of four clinics in 2017.
They also pointed to a law that requires a 24-hour waiting period before patients can have an abortion, which doubles the time it takes for clinics to provide care.
Abortion rights advocates say these policies, among others, have been a slow drain on abortion providers’ resources, at a time when officials say they were already struggling with rising health care costs and persistent staffing shortages in Iowa.
“All of these things are compounding each other,” Wagner said. “Iowans are scared and confused, and Planned Parenthood is trying to adapt to meet the patient’s needs, no matter what.”
Abortion opponents say these trends are a welcome result of their efforts to promote alternatives to abortion, such as adoption.
“Anytime you see a clinic that performs abortions being closed on the pro-life side, frankly, as someone who is passionate about life, it’s a victory,” said Kristi Judkins, executive director of Iowa Right To Life.
Judkins added: “It’s not a personal attack on the clinic staff or anyone who works there. It’s more the passion that I personally feel, and I know the organization stands for, to make sure that women and anyone who is involved in that woman’s life has information about the alternative resources that are out there, so that they feel supported during that time.”
More: As Iowa’s ‘fetal heartbeat’ abortion ban looms, clinics brace for uncertain future
Access to abortion is shrinking in Iowa. What happens next?
Among abortion providers and other advocates, the focus now is on helping the growing number of Iowans who travel out of state for abortions. In 2023 alone, researchers at the Guttmacher Institute estimate that hundreds of Iowans traveled to nearby states, most of them to Illinois, Minnesota and Nebraska.
Organizations like the Iowa Abortion Access Fund, which provides grants to patients to cover travel expenses, have seen a 27 percent increase in requests for funding. Planned Parenthood North Central States, which oversees Iowa, has increased funding to boost services designed to help patients leave the state.
However, advocates say many Iowa women will be left behind because they can’t afford to travel to another state or take time off from work to drive hours to an appointment.
They also say these clinic closures are negatively impacting other reproductive health services. According to a recent March of Dimes report, more than 41% of women in Iowa already live in counties where they have high to very high vulnerability to adverse outcomes because they lack access to health care.
“We don’t have to be mad at Planned Parenthood for trying to use their resources to the best of their ability,” Boevers said. “We have to be mad at our legislators for putting these clinics in a position where they can’t get staff, they can’t get providers, they can’t meet all the requirements of the laws against them, which are non-medical and arbitrary.”
Supporters of the six-week ban condemned those concerns as scare tactics, saying the state has bolstered other services meant to help women. They point to Iowa lawmakers’ decision to fund pregnancy resource centers ― also known as crisis pregnancy centers ― that counsel women about alternatives to abortion. However, many of these organizations are not certified health clinics.
Even as brick-and-mortar abortion providers face mounting challenges, abortion opponents in Iowa say they will continue to push for legislation that would further restrict access to abortion services. That includes restrictions on abortion pills delivered through the mail, or a law banning abortion at conception.
“While it’s a victory, I think there’s still a lot of work to be done,” Judkins said. “Our work is not done. It’s accelerating.”
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.
