By Natalie Krebs, Iowa Public Radio
Iowa, IA-Abortions dropped in Iowa after a controversial new law went into effect in late July, according to new data obtained by IPR.
Iowa’s so-called ‘fetal heartbeat’ law bans abortion when cardiac activity is detected, which can be as early as six weeks of pregnancy. State lawmakers passed the law during a special session last year, but it faced legal challenges and didn’t go into effect until July 29, 2024, following an Iowa Supreme Court ruling in June.
The Guttmacher Institute, a nonprofit that supports abortion rights, estimated for the first half of the year — when abortion was still legal up to 20 weeks of pregnancy — that there was an average of about 400 clinician-provided abortions in Iowa per month.
That number dropped to an estimated 260 clinician-provided abortions in August, the first full month after Iowa’s new law went into effect, a 35% decrease as compared to the monthly average for the first part of 2024, according to new data from the organization.
Isaac Maddow-Zimet, a data scientist at Guttmacher Institute, said the data includes abortions performed by providers in Iowa and those by patients who obtained abortion pills by mail from out-of-state providers. It doesn’t include Iowans who traveled out of state for care.
“It’s important to keep in mind that doesn’t mean that those Iowans who would have otherwise gotten care in the state aren’t accessing abortion,” he said. “What it does mean is that they have a lot less choice in how they can access it, particularly if they want or need to access in-person care at a clinic.”
More Iowans are crossing state lines for care and getting abortion pills by mail
Planned Parenthood North Central States, Iowa’s largest abortion provider, is also reporting a significant decrease in abortions.
Ruth Richardson, the CEO of Planned Parenthood North Central States, told IPR the number of abortions they performed in Iowa dropped 64% when comparing the number of procedures performed in the two months before the law went into effect — June and July — to the number performed in the two months after — August and September.
The organization started preparing months before the Iowa Supreme Court decision came out for the possibility of the law going into effect, Richardson said.
This included expanding abortion access at Planned Parenthood clinics in Omaha and southern Minnesota in anticipation of more Iowans traveling across state lines for care, she said.
“We wanted to be prepared, no matter what the outcome was, just recognizing with this ever shifting landscape that we find ourselves in, in terms of thinking about access to abortion care,” Richardson said. “We really wanted to ensure that a number of our border communities would be prepared for what we knew would be an increase in the number of people traveling outside of the state for care.”
In the two months following the law’s enactment, the number of Iowans who traveled out of state across the region for care at Planned Parenthood clinics increased 159% as compared to the two months prior, she said.
More than 5,400 people across the country, including many Iowans, have been aided by Planned Parenthood’s patient navigator program, which helps those seeking an abortion get appointments in another state and find the resources to get there, Richardson said.
“Over 80% of those individuals are people who wouldn’t have been able to get to that appointment, [that] financial support …is really creating a connection for them,” she said.
However, Richardson said increase in demand for abortion support resources has added pressure to the organization, which is already dealing with provider shortages in some areas and a tighter budget due to inflation and low insurance reimbursement rates.
“With an increased number of people traveling, we’re seeing an increase in the amount of charitable care that is being provided, and we’re also providing services,” she said. “So I just think that there are a lot of pressures right within the nonprofit health care system that we as Planned Parenthood are seeing.”
Abortion rights supporters also expect an increasing number of Iowans to obtain abortion pills by mail from providers in states with shield laws, which protect those providers from legal action.
Previously enacted abortion restrictions like a 24-hour required waiting period meant Iowans were already finding alternative ways to access abortion even before the most recent law went into effect, Maddow-Zimet of the Guttmacher Institute said.
“We know that even pre-six-week ban, many people were accessing abortion in Iowa through shield law provision, so clinicians based in states with shield laws prescribing abortion medication and sending abortion medication through the mail to Iowa residents,” he said.
Anti-abortion groups respond
For Iowa’s anti-abortion advocates, the state’s drop in abortions is a positive shift.
“We’re hopeful that the abortion numbers continue to go down. We’re hopeful we get to a point where we don’t have any abortion facilities here in Iowa that are performing abortions,” said Maggie DeWitte, the executive director of Pulse Life Advocates.
She said her goal is focusing on creating a “culture of life” in the state and discouraging Iowans from obtaining abortions by traveling out-of-state or getting pills by mail.
“We want them to realize the vast resources that we have available in Iowa for them should they decide to parent or place for adoption, and that’s what we’re going to continue to focus on is our own state — our own backyard — and try and help these Iowa women understand that abortion is not the answer for them,” she said.
DeWitte said she’ would like to see the procedure outlawed entirely with some exceptions, such as for the life of the pregnant person.
“We will, and will always, continue to push the gold standard, which for us is life at conception,” she said.
Republican stronghold
Iowa Republicans retained their supermajority in the legislature and even added a few seats during the election earlier this month, making it more likely the Legislature could pass further abortion restrictions, like a total ban.
But whether this is something Iowa Republicans will pursue this session is yet to be seen.
Data and some recent election results suggest severe abortion restrictions, like Iowa’s current cutoff, aren’t popular with the general public. This includes some Republicans.
A Midwest Newsroom poll in October found 55.7% of Iowans found the law “too strict,” while an Iowa Poll in September found 59% “disapprove” of the law.
At the same time, Democrats campaigned hard on the issue of abortion rights this election cycle, but it appeared to have little effect on Republicans, as they had sweeping victories across the country.
As Republicans also prepare to take control of the federal government, there is support by some for additional abortion restrictions, such as using the Comstock Act to prohibit sending abortion pills by mail.
But many Republicans have backed away from a national abortion ban, and President-elect Donald Trump has said he doesn’t support one and would leave it up to the states to decide.
Anti-abortion policymakers are likely still going to push for more restrictions, Candace Gibson, the director of state policy at the Guttmacher Institute, said. At the same time, ten states had citizen-led constitutional amendment measures supporting abortion rights on their ballots this election, even in Republican-majority states. Seven of those passed.
“You’re seeing these ballot initiatives go on in states where folks didn’t think there was a chance, for example, in Nebraska, Missouri [and] Florida,” she said. “So people know that the public supports abortion access, and so I think that’s still something that policymakers actually need to keep in mind here.”
Changing access in Iowa’s neighboring states
Three of Iowa’s neighbors — Missouri, Nebraska and South Dakota — voted on such measures this election.
Nebraska voters passed a measure backed by anti-abortion advocates limiting the procedure to 12 weeks of pregnancy, which is the current law, while rejecting a competing initiative by abortion rights supporters that would have restored access to the procedure until fetal viability.
South Dakota voters also rejected an amendment that would have restored abortion access to fetal viability, leaving its near total abortion ban in place.
On the other hand, Missouri voters voted to overturn a near total abortion ban, only allowing exceptions for life-threatening situations enacted by state Republicans in 2022 shortly after the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision, which ended the constitutional right to abortion.
The amendment enshrines abortion rights in the Missouri state constitution, restoring access to abortion up to fetal viability, which is about 24 weeks of pregnancy.
The Iowa Constitution doesn’t allow for citizen-led amendments to go on the ballot, meaning the state’s abortion law couldn’t face a similar challenge.
The restoration of abortion access in Missouri could affect where Iowans choose to seek abortion care, but abortion providers say it could take awhile for the state to get the point where they can meet the demand for abortion care for both Missourians and those coming from out-of-state.
“When restrictions are repealed or they’re overturned, there is this sort of process that now has to take place in order to rebuild the infrastructure because it doesn’t happen overnight,” Richardson of Planned Parenthood North Central States said.
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