Iowa has entered a “devastating and dark” moment in its history, Dr. Sarah Traxler said on Friday.
Traxler, the chief medical officer for Planned Parenthood North Central States (PPNCS), was speaking at an online news conference PPNCS held Friday morning to discuss the impact the near-total ban on abortions in Iowa that goes into effect at 8 a.m. on Monday morning.
“We now live in a reality where politicians have control over Iowans’ bodies and futures,” the doctor said. “This impact will be widespread and generational.”
The bill creating the ban passed with only Republican votes last year during a one-day special session of the Iowa Legislature called by Gov. Kim Reynolds. It prohibits almost all abortions after a mandatory ultrasound probe of a pregnant patient can detect any cardiac activity. That typically happens six weeks into a pregnancy, before many people even realize they are pregnant.
There are narrow and burdensome exceptions for rape and incest victims, as well as exemptions for cases where the embryo or fetus has a condition “incompatible with life,” the life of the patient is in immediate danger, or continuing the pregnancy would pose a “serious risk of substantial and irreversible impairment of a major bodily function” for the patient. The new law specifically prohibits consideration of the mental health impact of the pregnancy.
“This ban ties doctors’ hands,” Traxler said. “It puts them in the impossible position of deciding whether to keep their license or provide lifesaving health care and uphold their oath.”
“Every person comes to us with different and unique circumstances. They want full information about healthcare options that are best for their lives and their futures, and they expect to receive the care that they want and need. That, unfortunately, stops on Monday.”
Six years ago, the Iowa Supreme Court found the state constitution guaranteed the right to an abortion, as a fundamental aspect of a person’s right to bodily autonomy. According to a majority of the justices on the high court in 2018, the Iowa Constitution provided even stronger protections for the right to choose an abortion than the U.S. Constitution.
Two years ago, a majority of the seven justices on the Iowa Supreme Court — six of whom had been appointed by either Gov. Terry Branstad or Gov. Kim Reynolds — overturned the 2018 decision, declaring the right to an abortion a right guaranteed by the state constitution.
But in that decision, which came a week before the Republican-appointed justices of the U.S. Supreme Court eliminated federal protection for the right to an abortion, the Iowa justices still said that abortion regulations that create an “undue burden” were unconstitutional. Using that standard, a Polk County District Court judge issued a temporary injunction stopping the six-week abortion ban from taking effect just days after Gov. Reynolds signed it into law.
On June 28, a majority of justices on the Iowa Supreme Court — all of whom have now been appointed by either Branstad or Reynolds — overturned that injunction. The four-justice majority ruled that as long as the state could provide a rational-sounding reason for an abortion restriction, it could be considered constitutional. Whether it creates an undue burden on people should no longer be considered, according to the justices.
Following a standard administrative delay to allow for the Iowa Supreme Court to consider a petition for a rehearing, which the justices rejected, an order was issued dissolving the ban on July 29.
“Planned Parenthood has planned for this moment,” Traxler said. “We understand the real people who will be impacted by this reckless ban and we are doing everything we can to mitigate the harm caused by this dangerous policy.”
PPNCS is an affiliated group composed of the Planned Parenthood clinics and health centers in Iowa, Minnesota, Nebraska, South Dakota and North Dakota. PPNCS has expanded services in Minnesota and Nebraska ahead of Iowa’s ban going into effect. Its patient navigators are also helping people find the abortion care they need in other states, if it is already more than six weeks past their last menstrual period, whether that care is at PPNCS clinic or at relatively close clinic in Illinois.
Abortion is banned in North and South Dakota. It is illegal in almost all circumstances after 12 weeks in Nebraska. But a patient’s bodily autonomy and the right to an abortion are strongly protected in Minnesota and Illinois.
Along Iowa’s southern border in Missouri, abortion became illegal as soon as the U.S Supreme Court overturned Roe v. Wade in 2022. Many Missouri patients seeking abortion services had been coming to Iowa for medical care. After 8 a.m. on Monday, that will stop almost entirely.
PPCNS staff have found that many Iowans who contact them had no idea about the new ban.
“To say the last few weeks have been hard, is an understatement,” Kristina Remus, a PPNCS patient services associate, said during the news conference. “People are confused and seeking clarification, and a lot of patients are unaware that there is a law banning abortion at about six weeks, before many people know that they are pregnant, set to take effect.”
“We are having extremely difficult conversations in my department with patients. One patient I recently worked with initially had scheduled an abortion appointment in Iowa, but was forced to reschedule in Minnesota. She told me that she is feeling so extremely disheartened by this situation and it is unfair to the women of Iowa.”
“She actually called herself ‘lucky,’” Remus added. “Because she had the means to travel out of state and a lot of people don’t have the support needed to do that.”
Having to seek health care in another state does impose a significant burden on patients, not just in terms of additional expenses, but also in terms of taking more time off from work, arranging transportation, finding a place to stay near an out-of-state clinic, getting someone to look after other children (approximately 60 percent of those who have abortion already have children), among other things.
PPNCS does have its Justice Fund to help people who otherwise wouldn’t be able to afford access to the abortion care they need. Patient navigators will also help arrange transportation and even lodgings when possible. In addition to PPNCS services, the Iowa Abortion Access Fund (IAAF) will continue to help people afford abortion care despite the new ban, as it has since 1978. IAAF is partnering with the Chicago Abortion Fund to make it easier for Iowans to receive needed care in Illinois.
The impact of the new law isn’t just being felt by the patients of PPNCS, it’s also being felt by the staff.
“There’s a lot of anxiety and sadness among staff,” Alex Sharp, manager of Planned Parenthood’s Susan Knapp Health Center in Des Moines and its Ames Health Center, said during the online news conference.
“We don’t know what comes next. We listen to patients and try to provide the essential health care they need knowing next week everything will change. We will go from full schedules, where we were booking out abortion appointments by three or four weeks, to not seeing nearly as many patients.”
Sharp added, “Most everyone I work with are born and raised in Iowa, we just want the best for all of our patients.”
Dr. Traxler explained that the ban will have effects well beyond its impact on those seeking abortion services.
“As states across the nation have banned abortion, we’ve seen glimpses of our future. It’s clear Iowa’s dismal health outcomes will only worsen,” she said. “When abortion is banned, all health care is impacted. And Iowa can’t afford to worsen the state of care.”
Iowa ranks among the worst states when it comes to providing reproductive health care. A 2023 report by the March of Dimes found that a third of Iowa counties were “maternity care deserts,” with no OB-GYNs and no health centers or hospitals offering birthing services. A study from the University of Iowa published last year, found that expectant mothers in those underserved rural areas of the state are less likely to receive standard prenatal care.
“The state’s infant mortality rates are already skyrocketing,” Traxler said. “Iowans are more likely to die from pregnancy complications than they were three decades ago. The devastation is compounded for Black parents, who face maternal mortality rates six times greater than their white peers.”
According to Traxler, the ban “will widen already gaping health inequities affecting the working class Black people, people living in rural areas and young people.”
Despite the difficulties the ban will create, Traxler, Remus and Sharp said they and their colleagues will continue to work to provide the health care people need. And PPNCS will continue to work to restore reproductive rights in Iowa.
“We know the road to restoring Iowans’ reproductive freedom is long, but it gives us the opportunity to reimagine and rebuild the state’s failing healthcare system,” Traxler said. “Iowans always deserve better.”
