University of Iowa student Aubrey Stark remembers coming home from elementary school to see her usually lively pregnant mother, Mandy Stark, ill and bedridden.
“She was in so much pain,” Stark said. “[Her condition] was not safe for her at all.”
Mandy Stark was suffering from a molar pregnancy, defined by the National Cancer Institute as a slow-growing tumor developing from cells that help an embryo attach to the uterus after an egg’s fertilization. These tumors can potentially spread to nearby tissue and become malignant. She had to receive two shots of chemotherapy because of the complication.
Mandy Stark endured five molar pregnancies between 2008 and 2010. Each required her to undergo a type of abortion called a dilation and curettage procedure (D&C) to remove.
One year after the U.S. Supreme Court overturned Roe v. Wade in the 2022 Dobbs decision, Iowa Gov. Kim Reynolds signed a law prohibiting most abortions except in the earliest weeks of pregnancy. This measure makes getting an abortion in Iowa illegal after six weeks without a special exception.
But the permissibility of such exceptions may not always be clear.
The medical community voices concern
Annie Galloway, a medical student at the University of Iowa’s Carver College of Medicine, is the co-president of Carver’s chapter of the national student-led organization Medical Students for Choice. The group’s mission is “to support future abortion care providers and advocate for reproductive justice globally.”
“It’s each person’s right to make [abortion] choices for themselves,” Galloway said. “And I think that as a future health care provider, I feel obligated to advocate for people’s health and safety in that way.”
On the University of Iowa campus, she said the organization of about 150 students leads efforts to support reproductive rights such as hosting lectures about legislation updates and workshops demonstrating abortion procedures. The group also fundraises for the local Emma Goldman Clinic, an independent nonprofit that provides abortion services.
Galloway said growing up in liberal Seattle caused her to take abortion protections for granted. But that feeling changed when she moved to more conservative Iowa.
“I’ve just felt called to work to provide this human right that I think everyone deserves, whether legislators in Iowa think so or not,” she said.
Galloway said a serious issue for medical practitioners is unclear wording in Iowa laws that fails to clarify when abortions are permitted out of medical necessity past the critical six weeks.
“A lot of these laws that are bans say things like, ‘No abortions unless the health of the mother is at risk,’” Galloway said. “And the problem is that’s a very gray line.”
To fit the definition of medical emergency defined by Chapter 146B of Iowa Code, an abortion must be performed to preserve the life of the mother against physical illness or injury caused by the pregnancy, or to prevent serious risk of substantial and irreversible impairment of a major bodily function caused by the pregnancy.
“There’s no definitive, ‘Once their vitals are this, you can do an intervention,’” Galloway said. “You’re just sort of waiting for them to get sick enough so that their life is at risk. Like, that’s the language. It’s not like, ‘When their blood pressure drops to this, then you can intervene.’ You’re just sort of watching them tank and you have to, in this gray zone, decide.”
And getting the call wrong can have extreme repercussions on practicing physicians. A doctor charged with violating Iowa’s abortion ban faces fins of up to $10,000 and the possibility of having their medical license revoked.
Galloway said this poses an unreasonable risk for medical providers.
“To have your license put on the line when you’re trying to decide, ‘Is this person sick enough that I could do an abortion because it would save their life?’ It’s putting doctors in high-risk situations and it’s unfair,” she said.
An Iowa City-based abortion provider, who elected to remain anonymous, said that the law “jeopardizes lives” by forcing women to endure otherwise dangerous pregnancies. She said these cases include pregnant women suffering from drug addiction, severe mental health disorders and domestic violence.
“Those are considered ‘elective’ reasons for an abortion because they’re not sort of ‘good enough’ life-threatening things,” she said. “But they are truly life-threatening. Maybe not necessarily physical pain, but they sometimes cross into that territory too.”
To have your license put on the line when you’re trying to decide, ‘Is this person sick enough that I could do an abortion because it would save their life?’ It’s putting doctors in high-risk situations and it’s unfair.
Annie Galloway, Medical Students for Choice
The provider added that intimate partner violence is one of the most common reasons she sees women seeking an abortion.
Multiple academic studies have found that a state’s domestic violence rate is positively correlated with restricted access to abortion, and that the exacerbation of such violence surrounding a pregnancy may lead to an uptick in maternal mortality.
Under Iowa law, such violence still does not qualify a patient for a special exception. The anonymous provider said this contributes to moral contention for its physicians.
“There’s a lot of moral injury that comes with having to tell somebody you can’t help them because of a law that’s in place that says that you can’t,” she said.
A chilling effect on doctors
An analysis by the American Association of Medical Colleges suggested this as a reason why senior medical residency programs in states with abortion bans have seen a disproportionate decrease in recent numbers of applications compared to those in states where abortion is protected.
According to the Gazette, Iowa has one of the lowest physician-to-patient ratios in the country, ranking 45th in the nation, with rural areas of the state feeling the shortage the most. The Iowa City provider believes Iowa’s abortion laws will worsen this dilemma.
“It’s going to be increasingly difficult to recruit OB-GYNs to states that have really restrictive abortion laws,” she said. “Because it’s scary to be an OB-GYN in a state where your medical license might be at risk for you providing medical care.”
She said this means the few physicians left are more tired and burdened than ever.
Medical student Galloway said she does not plan to stay in Iowa to practice.
“[The ban] creates a horrible cognitive dissonance of, like, you know what you can do to save someone in the moment and they’re right there and you could do it, but the legislation is saying you can’t. And instead, then you’re being put in this position where you have to wait until they get even sicker,” Galloway said. “But I guess at least you kept your medical license.”
Pro-life organizations deny the problem
While Galloway and her fellow Medical Students for Choice members voice discontent with Iowa’s strict abortion laws, anti-abortion advocates view them as a step in the right direction.
Pulse Life Advocates, a Christian-based non-profit based in West Des Moines and originally known as Iowans for Life, is the longest-standing pro-life organization in the state.
Pulse’s executive director, Maggie DeWitte, is also the spokesperson for the Iowa Coalition of Pro-life Leaders, a collective of organizations that have banded together to lobby for Republican-supported anti-abortion legislation in Iowa.
“The Republican Party is a party of life,” DeWitte said. “And so as such, they have a priority of life legislation.”
Iowa’s strict abortion law passed with only Republican votes during a one-day special session of legislature called by Gov. Reynolds for the sole purpose of creating the ban. DeWitte said the Coalition of Pro-life Leaders was instrumental in pushing for that law.
“We’ve been able to implement some really good, powerful pro-life legislation to safeguard Iowa citizens. So it’s been a good thing for us and a good thing for Iowa,” she said.
She believes the law as written is clear in terms of when medical exceptions should be allowed.
“Our law does have an exception for life of the mother and so I would trust that in the years and years of medical training that a doctor should certainly know when a life is in danger and they would take appropriate action to do so,” she said.
In Johnson County, Sheryl Schwager is the executive director of Johnson County Right to Life. The organization is a 501(c)(3) charity describing itself as dedicated to ensuring the legal protection of all human life.
Though its downtown Iowa City office is filled with images of Jesus and other Christian figures, Schwager said the organization is not religiously based. But she said many involved with the organization are religious, herself included.
Schwager works with and supports DeWitte and her organization. She agrees that the law is written clearly.
“They’re seeing gray areas where there are not gray areas,” Schwager said. “It clearly, as far as I understand, states that if an abortion is medically necessary to save the life of the mother, then that can be done. And it’s up to the doctor to determine if that’s the case.”
Schwager said abortion-rights advocates have made the medical exception issue seem more serious than it actually is.
“Sometimes I think that propaganda can sort of creep in there and they can use that as an excuse to say, ‘See, you know, you’ve made it so vague that we, our hands are tied and so women are dying,’” she said. “But that’s not the case.”
DeWitte said a genuine medical concern is posed by medication abortions, calling the pills taken to end pregnancies “very dangerous.” Schwager shares a similar belief. “[Women are] dying,” Schwager said. “They’re hemorrhaging. They’re suffering all sorts of terrible side effects and not the least to say witnessing the death of their little eight-, nine-, ten-week [old] baby.”
According to Yale Medicine, medication abortions, which account for over half of all abortions, require first taking a mifepristone pill which blocks activity of the pregnancy-supporting hormone progesterone. Within 48 hours, a second pill containing misoprostol is taken, which causes the uterus to contract and expel its contents.
Side effects of the second pill often cause discomfort with symptoms similar to a heavy period, including cramps, heavy bleeding and the potential for nausea and fever. But a 2013 study by the international reproductive health journal Contraception reported less than a 0.4 percent risk of serious complications.
In an article published by the National Library of Medicine, Frontiers in Public Health called abortion “one of the safest medical procedures.” Yet, it reported in 2023 that maternal death rates were 62 percent higher in states with abortion restrictions compared to those with greater abortion access.
Such discrepancies could not exist before the Dobbs decision. But since respecting citizens’ abortion rights has become something state legislatures can opt in or out of, 20 states have instituted a full or partial abortion ban, according to the New York Times.
While campaigning for president last year, Donald Trump repeatedly said returning the issue of abortion to the states would put the issue “where everyone wanted it from a legal standpoint.” This, of course, was not true. Abortion advocates and most legal scholar supported the Roe decision.
Schwager also opposes letting states set their own abortion laws, but for a very different reason.
“I compare it to slavery and a lot of people don’t like it when I do this,” Schwager said. “But if slavery is wrong, we’re not going to send it back to the state to let each state decide.”
Schwager would prefer a federal mandate banning all abortion procedures.
Defying the majority
DeWitte attributes much of Pulse Life Advocates lobbying success to the Republican majority held in the Iowa legislature. Republicans have controlled both chambers of the Iowa Legislature since 2017, and hold significant majorities in both.
But Iowa Rep. Elinor Levin said despite their fewer numbers, Iowa Democrats are still pushing for reproductive protections.
Levin is a Democrat representing Iowa House District 89, which covers parts of Iowa City, as well as University Heights. She supports abortion rights.
“Bodily autonomy, the right to determine what we do with our bodies is one of the most fundamental rights I think we have and making abortion illegal strips away that autonomy,” Levin said. “And in my mind, that is wrong.”
But Levin says it’s not just her opinion that she considers in her push for greater abortion access in Iowa. She said 63 percent of Iowans believe access to safe and legal abortions should be protected by state law.
This statistic is similar to results of the Iowa Poll from the Des Moines Register, which found 59 percent of Iowans disagree with the state’s abortion restrictions. Considering only responses from women, the number increases to 69 percent.
“Most Iowans agree that this is a matter to be decided between a pregnant person and their physician,” Levin said.
She also said that while the restrictive laws have led to fewer reported abortions, that may not guarantee fewer abortions are actually occurring.
“Those of us who follow the science know [banning abortion] does not end abortion,” she said. “It makes them unsafe and it makes them available only to those who can access them.”
NPR reported that countries where abortion is prohibited or heavily restricted do not have a significantly lower abortion rate than those where abortion is more easily accessible. And a 2023 analysis by the Guttmacher Institute reported that restrictive abortion laws serve to aggravate inequity in healthcare access for women in minority communities.
Levin said Iowa’s abortion restrictions are detrimental not only to female patients, but also their providers.
“We have physicians who are very concerned because they have to make a lot of judgment calls that will determine whether or not they get to keep their jobs,” Levin said. “If somebody disagrees with their judgment on whether something is a medical emergency… that physician could lose their job.”
Levin said medical providers have been clear with lawmakers that the wording of current restrictions are too vague, but “preying upon that lack of clarity” is part of the law’s design.
“It was intended to scare physicians out of performing procedures, medically necessary procedures, because of uncertainty about what is, or is not, or would, or would not be deemed medically necessary under the judgment of another physician or someone who is not a medical professional but gets to play one in the judiciary.”
Levin acknowledged that many groups lobbying for abortion restrictions, such as Pulse Life Advocates, are religiously motivated. But this makes the legislation even more legally dubious.
“When we make laws based on our own morals that govern other people who might have different religions and therefore different morals, that’s where I think we get into trouble,” she said. “And where we have contention, and where we have a potential First Amendment violation.”
Levin, who describes herself as one of the few openly non-religious legislators in Iowa, said the religious lobbying for restrictions is “frustrating” to see.
“[The restriction is] an issue that is unpopular with Iowans. Regardless of their faith, regardless of their party,” Levin said. “Unpopular with Iowans, pushed forward by folks who do share a religious agenda.”
A new paradigm for a new legislative session
Student Aubrey Stark, now 19 years old, remembered seeing her mother in pain as she cast her first-ever ballot in November’s presidential election. Abortion protections were at the top of her priority list as she voted for Vice President Kamala Harris.
“It’s just surreal it ever happened to [my mother], and it’s scary that it could ever happen to someone else, and they just could not get the help that my mom got,” Stark said.
Harris was outspoken during her campaign about her support for Roe v. Wade, and her desire to reinstate the discarded U.S. Supreme Court decision. But the election did not turn out in Harris’, or Stark’s, favor.
Medical Students for Choice Co-President Annie Galloway was also disappointed in the election results.
“There’s definitely shame, I think, especially for people who are from Iowa and, you know, really support reproductive justice. There’s a certain shame to the way that Iowa voted,” Galloway said. “I think in that way, I’m lucky to feel a little detached because I’m not from here.”
According to a CNN chart, 13 states have stricter abortion laws than Iowa — Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, South Dakota, Tennessee, Texas and West Virginia — which all ban abortion outright.
Maggie DeWitte said the Pro-Life Coalition plans to continue to lobby for a similar total ban in Iowa.
“It would entail that life begins at the moment of fertilization and as such would be guaranteed full protection under our law,” DeWitte said.
Johnson County Right to Life’s Schwager supports these efforts. She said she is thankful for the Dobbs decision, and hopes to one day see abortion outlawed in the U.S. entirely.
“That would be the goal,” Schwager said. “But right now, we’ll work with what we have.”
Rep. Levin anticipates these efforts, but said their outcome is far from decided.
“I am a hundred percent sure there will be a bill,” Levin said. “I will be interested to see how many co-sponsors that bill has and to see where it starts. I am not at the moment feeling concerned that it will become law this year.”
Hope for change
Levin said the recent retirement of outspoken anti-abortion Republican Representatives Luana Stoltenberg and Brad Sherman may dampen the fervor for anti-abortion legislation in the Iowa government. She also said Iowa Democrats will be presenting their own bills directly opposing those pushed by anti-abortion lobbyists.
“You will definitely see us putting forward legislation that would reverse the six-week ban,” she said. “And make it very clear that it has never been our intent to make abortion illegal in Iowa, and that we want to see it completely reversed.”
Meanwhile, the anonymous abortion provider stressed the importance of contraception for those looking to avoid pregnancy. She fears the vague wording of the Iowa law will dissuade those who find themselves pregnant from seeking help, and she encourages them to find a trusted physician who will support and advocate for their well-being.
She said she will continue to practice in Iowa.
“This is my home,” she said. “I’m from Iowa and I want to stay here in Iowa and try to help people in Iowa have their best possible health.”
Annie Galloway said she has seen an influx of fellow University of Iowa medical students interested in joining Medical Students for Choice in light of the election.
“I think there’s shame and then there’s also a lot of motivation to help,” Galloway said.
And Levin reminds her fellow abortion-rights advocates that they have power in their voice.
“When they’re losing hope, I remind them that Iowans at large believe in the right to healthcare access, including abortion access,” Levin said. “I remind them that not too long ago, less than 12 years ago, this was a state that was caucusing for Obama and then voting for Barack Obama and strongly supporting individual freedoms in healthcare.”
Alice Cruse is a soon-to-be graduate of the University of Iowa School of Journalism and Mass Communication with a minor in International Studies. She has a passion for video production and strives to tell critical stories across multiple media.
