( Iowa Capital Dispatch) – The Republican-controlled Iowa Legislature, in a daylong special legislative session, passed legislation late Tuesday to outlaw most abortions in Iowa after six weeks of gestation.

The House adjourned just after 9 p.m. Tuesday after sending House File 732 to the Senate with a vote of 56-34. Rep. Zach Dieken, R-Granville, and Rep. Mark Cisneros, R-Muscatine, voted no and 10 House members were absent. 

About two hours later, the Senate voted 32-17 to pass the bill, with one Republican, Sen. Mike Klimesh of Spillville, voting no. Abortion-rights supporters shouted from the gallery, causing the Senate president to ask troopers to eject them.

Gov. Kim Reynolds said in a statement she would sign the bill Friday, after which it will take effect immediately. She called the special session after the Iowa Supreme Court, split 3-3, left in place an injunction that blocked enactment of a nearly identical 2018 law.

“The Iowa Supreme Court questioned whether this legislature would pass the same law they did in 2018, and today they have a clear answer,” Reynolds said in a statement. “The voices of Iowans and their democratically elected representatives cannot be ignored any longer, and justice for the unborn should not be delayed.”

The bill would prohibit abortion after embryonic cardiac activity can be detected, usually as early as six weeks after conception. The bill contains exceptions for rape or incest reported within a certain period of time to law enforcement or a medical professional, or for the life of the pregnant patient.

“Mr. President, this bill ensures all life is protected when a heartbeat is detected,” Sen. Amy Sinclair, R-Allerton, said in opening remarks on the bill. “The child in her mother’s womb has her own heartbeat, her own DNA. She’s a baby, and she deserves the same protections as any other baby in the state.”

Democrats in both chambers offered amendments and argued in favor of broadening the exceptions, without success.

Republicans defeated amendments to eliminate the requirement that rape or incest must be reported to authorities and to create an exception for pregnant patients age 12 or younger or with mental health conditions or a developmental disability.

Although the bill does include exceptions for rape and incest, the bill specifies a 45-day limit for a rape to be reported or 140 days for incest to be reported for the crime to qualify as an exception to the abortion prohibition.

Democrats in both chambers tried to eliminate the reporting limit.

“I am appreciative that the current bill acknowledges that the survivors of rape and incest have an option, I would just like it to be a little less restrictive,” House Minority Leader Jennifer Konfrst D-Polk, said during floor debate.

Women who become pregnant as a result of rape or incest often do not feel safe reporting it, lawmakers said.

“We know, folks, that women who are the survivors of rape and incest, for a myriad of reasons, including fear for their own safety, are not able to safely report rape or incest and therefore, the law as it is currently written, would be forcing these women to carry out their pregnancy because they were not able to safely report what happened,” Rep. Austin Baeth, D-Des Moines, a physician, said. 

Democrats in both chambers also attempted, unsuccessfully, to include mental health concerns as an exception.

“The number one cause of pregnancy-related death in the United States is related to mental health, suicide or substance overdose,” Baeth said. 

Rep. Shannon Lundgren, R-Dubuque, the bill’s floor manager, responded by saying, “I would like to recognize that abortion isn’t a treatment for mental illness. Obviously if we have someone whose life is in danger, a doctor should take an approach to make sure they immediately refer them to inpatient care.”

Debate in the Senate was contentious almost from the beginning.

“Senator Sinclair, don’t piss down my back and tell me it’s raining,” Sen. Liz Bennett, D-Cedar Rapids, said at one point during debate, prompting a call for decorum from Sen. Brad Zaun, who was presiding.

At another point, a Democratic senator objected to Sinclair repeatedly referring to their talking points as “lies.”

“I would love to not use the word ‘lie,’” Sinclair responded, to derisive laughter from the opposite side of the chamber.

Later, Zaun threatened to remove anyone causing a disturbance in the public gallery.

In the House, Speaker Pat Grassley, R-New Hampton, said he was impressed with the camaraderie shown by the representatives. Even so, Rep. Jeff Cooling, D-Cedar Rapids, drew an objection when he suggested on the House floor that the session was a result of special interests. 

“We’re here today because special interests, some would say, are running the state and controlling the governor, some would say that. So this special interest session…,” Cooling said before a point of order was called.

“So it’s my belief that our time here today is neither fiscally responsible to the taxpayer, nor will the result of what we do here today lead to responsible government,” Cooling continued. “I believe that this session is all about power and politics, and I believe I was elected to represent people, not special interests.”

 

Lawmakers get personal

 

Lawmakers of both parties brought their personal stories to the debate. 

Rep. Luana Stoltenberg, R-Davenport, said she was standing up for mothers who have died or are infertile as a result of an abortion.

“I’d like to speak up for my three children who lost their life and died by abortion,” Stoltenberg said. “I’d like to speak up for the 65 million plus other children that died by abortion and will never get to speak. I’d like to speak up for the women who have been hurt by abortion and are too ashamed and too filled with guilt to be able to speak.

“I was told that it was just a blob of tissue, that it was easy and it was safe. That was a lie. Those abortions caused me not to be able to have children. Every day I live with the reality that I killed the only children I would ever have,” she said.

Stoltenberg said uterine damage and infertility can happen as a result of abortions and shared stories of other mothers who have been harmed by abortions. “We do not have a constitutional right in the state of Iowa to kill our children,” she concluded.

Weiner, arguing that exceptions should be expanded to include mental health conditions, said she is raising her 5-year-old grandchild because her daughter has a mental health condition.

“She’s an addict, and she has serious mental health challenges and diagnosis so the irony is that right now under this bill, based on her addiction, based on her purposely and knowingly ingesting or injecting something, she would have a choice. Based on the mental health challenges that most likely led to and exacerbated her addiction, she would not have a choice,” Weiner said.

Senate Minority Leader Pam Jochum, D-Dubuque, whose late daughter had developmental disabilities, offered an amendment seeking to expand the exceptions under the bill to pregnant patients with a developmental disability. She said sexual abuse victims with developmental disabilities are taught to trust their abusers.

“That was one of my biggest fears as a mom – biggest fear — that so many of the adults with disabilities are such trusting people,” Jochum said. “And no, they don’t understand what’s going on. And yes, we have a duty to protect them.”

Sinclair said because people with severe developmental disabilities are unable to consent to sex, they would be covered under the exception for rape. But Jochum said that was a “flimsy excuse.”

She said the abuse is unlikely to be reported. “If you can’t consent, how can you report?”

One Republican, Sen. Carrie Koelker of Dyersville, voted in favor of the amendment, which failed on a vote of 17-32.

 

What’s the penalty?

 

The bill specifies that women who obtain an abortion in violation of the law would face no civil or criminal penalties. But lawmakers in both chambers argued over whether the bill was clear or vague and what might happen to doctors who violate the law.

Baeth said, as a doctor, he does not know where to draw the line on the definition of “medical emergency.” The law is not specific enough to give doctors confidence they will be free from punishment from the Board of Medicine, he said.

Baeth said he was worried a patient would have to be already in critical condition to receive an abortion, because doctors are concerned they will break the law if they provide care too soon. 

“I have great concerns that the current exceptions are actually extremely narrow and strict because they only apply to somebody in whom because of pregnancy they would develop potentially, and quickly,” Baeth said. “It’s critical illness and death, actually they must be in critical illness and near death to receive those services.”

The bill states the Board of Medicine is directed to adopt administrative rules to administer the bill. Normally, administrative rules have to be enacted within 90 days after a bill is signed into law. Since the bill is effective immediately upon enactment, rules are not yet established. 

Rep. Brian Meyer, D-Des Moines, asked Lundgren multiple times how the bill will be enforced, considering its quick passage.

In multiple instances, Lundgren was asked what would happen to a doctor if the law is violated. 

Lundgren responded each time that “the Board of Medicine will determine those rules,” providing no more information to the body.

In the Senate, Sinclair said repeatedly she could not predict what rules the board would enact, but said she believes the bill text is clear enough that rules may not be needed. “Rules are not necessary for this bill to go into effect,” she said.

Rep. John Forbes, D-Urbandale, a pharmacist, said the Board of Medicine will have a hard time creating rules. 

“I think they’re [the Board of Medicine] going to have a difficult time interpreting really what type of action should be taken if a physician does make a mistake and not make the right decision he thinks is proper for that patient,” Forbes said.

 

Iowans pack the Capitol

 

Hundreds of Iowans packed the State Capitol on Tuesday to express their views on the legislation.

The Iowa House Health and Human Services Committee hosted a public hearing on House Study Bill 255 and the Senate State Government Committee heard public comments during a subcommittee meeting on its identical version of the bill, Senate Study Bill 1223.

As hearings were underway in two meeting rooms, hundreds gathered in the Capitol rotunda with signs and participated in chants, muffling the voices of those speaking inside. Chants of “Vote them out” and “Hey hey, ho ho, abortion bans have got to go” rang in the halls outside of the room. 

Republican presidential candidate Vivek Ramaswamy joined the crowd after meeting with Reynolds.

“The judicial branch here got it wrong but the people of this country – people of this state – put Kim Reynolds in office and put those legislators in both chambers of the Legislature to actually reflect the will of the people. And that’s what we’re celebrating,” Ramaswamy said.

 Lori Van Lo of West Des Moines, who was standing nearby, interjected that 60% of Iowans don’t agree with an abortion ban.

“So, look, if you want to vote for somebody else, you have the power to do that,” Ramaswamy responded.

During both hearings, advocates from both sides of the issue shared their stories, citing religion, bodily autonomy and clarity of the bill’s enforcement. 

Maggie DeWitte, executive director of Pulse Life Advocates, said during the House hearing that she testified in front of legislators to prevent abortions in 2018. 

“This has been a long time coming,” DeWitte said. “I testified at our heartbeat bill in 2018, and here we are again. It is beyond time to once and for all have this heartbeat law passed, for the second time, signed into law for the second time, but now will be able to be enforced.”

Advocates that have spoken out against the passing of this bill have threatened to take the law to court if enacted. 

Francesca Turner, a doctor of osteopathic medicine, asked lawmakers for better guidance from the bill.  

“Using medically inaccurate language is confusing and dangerous,” Turner said. “The words in the bill should be very specific and accurate. These words matter and facts are important.”

Turner asked the committee members: “At what point will your wife or your daughter, who is having a medical emergency related to pregnancy, do I get to save her life? At what point do I get to intervene? It is unclear in this bill.”

“Pregnancy is too complicated to legislate,” Turner said. “I support the rights of patients to choose medical care that is best for them, and help them access care without government interference.”

Speakers cite religion

A majority of speakers in favor of the bill referred to their religion. John Lamb, a pastor speaking for Lutheran Family Service, emphasized during the Senate hearing that he believes life begins at conception. “A new and unique human being comes into existence,” he said. “… So I want to remind everyone that when we talk about heartbeat, we’re not talking about the heartbeat of something, but the heartbeat of someone.”

 Some who opposed the bill also cited their religion. 

Sally Frank, who said she was an active member of the Jewish community, said that the law does not allow her to practice religion. 

“Under Jewish life, human life begins at birth. While the fetus has value, its value is far below the human lives of the living people, including those who are pregnant.”

“Abortion is part of good health care and forced birth is not,” Frank said.

Rev. Brigit Stevens, a regional minister for the United Church of Christ, spoke on behalf of Black, indigenous people of color and LGBTQ Iowans. 

“Abortion will not go away, it will go underground, and let’s be frank, straight white men with money will still be able to get abortions for their wives, their daughters and their girlfriends,” Stevens said. “And other people of color, Black, indigenous folks and LGBTQ Iowans will continue to die at exponentially higher rates than white Iowans. Mothers will die and babies will die.”

Loras College student Grace Van Petten said she used to be pro-choice and she now believes women her age are misinformed about abortion. “We have many young women like my younger self convinced that abortion is needed or necessary,” she said, and that abortion is “the removal of just a clump of cells.”

House Democrats presented four amendments in committee regarding extending postpartum Medicaid, testing and treatment for sexually transmitted infections and access to contraception and accessibility to child care. They all failed on party-line votes. Both bills passed their respective committees on party-line votes.

Both the House and Senate majority parties passed rules for the special session that limited debate in committees and on the floor. House leadership planned to halt debate at 10 p.m. and move immediately to a vote. The Senate’s debate was set to end at 11 p.m.

Democrats in the House and Senate objected to limiting debate on the legislation.

“When you make a decision, Senator Whitver, to change the rules and democracy, to cut and muzzle the voices of Iowa women and those who love them and stand for them, you’re showing what Iowa looks like. That’s a dictatorship,” Sen. Janet Petersen, D-Des Moines, said, addressing Senate Majority Leader Jack Whitver during debate of chamber rules for the special session.

Sinclair pushed back at the criticism that the process has been rushed, saying during the subcommittee meeting the language was identical to the legislation debated at length and passed in 2018. “We are not here for one day, we are here for five years,” she said during opening comments of the Senate’s subcommittee meeting on the bill. “In fact, I would suggest that perhaps this has gone on too long, given the nature of the contents of the law.”

 

( Iowa Capital Dispatch ) – Jennifer Adkins’ first pregnancy was near-perfect.

 She sailed through her appointments and screenings with no complications, ticking every box and making lists of all the right questions to ask her medical professionals. By the time her unmedicated labor was over and the nurses placed her newborn son on her chest, Adkins felt like a superhero.

 So when she discovered she was pregnant again the day after Valentine’s Day, she was ready for another home run. The baby would be due on Halloween, and she and her husband affectionately referred to it as “Baby Spooky.” Maybe they’d find out the sex beforehand, maybe it would be a surprise. They hadn’t decided yet.  

 On April 21, Adkins saw her doctor for a routine screening by ultrasound to measure the collection of fluid behind the fetus’ neck. And even without a medical degree, she could tell by the picture on the ultrasound that something was wrong.

Sitting in the genetic counselor’s office that afternoon, Adkins learned her 12-week-old developing fetus likely had Turner syndrome, a chromosomal abnormality that ends in miscarriage in 99% of cases. Turner’s occurs when one of two X-chromosomes for a female is deleted, often from all cells. The few babies that do survive still have deletions in some cells that cause significant heart defects, fertility issues, kidney abnormalities and a range of other disabilities.

 The normal measurement is less than 3 millimeters, according to Dr. Maria Palmquist, a maternal-fetal medicine specialist at Saint Alphonsus Regional Medical Center in Boise, Idaho. Palmquist said Adkins’ fluid measured at 11.7 millimeters, with additional fluid accumulating under the skin and around the body of the fetus, known as edema. The combination of increased fluid and skin edema is a condition known as hydrops fetalis, a severe form of swelling that is often fatal.

“The doctor said basically, lightning struck this pregnancy, there’s nothing you can do,” Adkins said. “This just happens in 1% of all pregnancies.”

Following the U.S. Supreme Court’s decision in June 2022 to overturn Roe v. Wade and allow states to regulate abortion access, 14 states have enacted near-total or total abortion bans, while others continue to pass abortion ban laws that become tied up in state and federal court. The patchwork laws create reproductive health care deserts that can force pregnant people to travel as far as an eight-hour drive or a flight across the country.

That can bring great financial and often emotional costs, even if the termination of the pregnancy would prevent severe or potentially fatal health effects.

There are no abortion bans yet that criminalize the pregnant person. Instead, criminal penalties are focused on medical providers or others who help someone obtain an abortion. The charges in most states are felonies, with punishment ranging between two years and life in prison, and physicians face suspension or revocation of their medical licenses. 

Because Adkins lives in a state with an abortion ban, she faced one of two options: Either continue carrying the pregnancy knowing it would almost certainly end in miscarriage or stillbirth and jeopardize her own health in the process — or make a trip out of state for termination.

 

‘Do we try? But for what purpose?’

 

Idaho has a near-total ban on abortions that applies to any stage of pregnancy, with exceptions for cases of rape and incest with an accompanying police report during the first trimester or to save a patient’s life. Health care providers who violate the statute put their medical licenses at risk and face between two and five years in prison, along with civil penalties of $20,000 against individual providers if family members decide to sue.

Since Roe fell, residents in states with bans like Texas have to travel much farther to obtain an abortion. The Texas Observer reported the average number of miles a resident must travel increased from 44 miles to 497 miles. Texans often go to New Mexico, where some abortion providers fled and opened new clinics. Washington abortion providers have reported seeing patients from seven states around the country within one day.  

In the Southeast, where nearly every state has a highly restrictive ban, states such as Louisiana and Mississippi are hours away from the nearest abortion clinic. For many, the closest state is Florida, and the outcome of a Florida Supreme Court case over a law banning abortion at 15 weeks could determine whether a six-week ban signed in April by Republican Gov. Ron DeSantis will go into effect. If it does, the distance to access abortion for many residents in that region of the country will become much greater.

A study released in April conducted by international reproductive health care journal Contraception found that women who were forced to travel for abortion care described it as emotionally burdensome, saying it caused distress, anxiety and shame. 

“Because they had to travel, they were compelled to disclose their abortion to others and obtain care in an unfamiliar place and away from usual networks of support, which engendered emotional costs,” the study said. “Additionally, travel induced feelings of shame and exclusion because it stemmed from a law-based denial of in-state abortion care, which some experienced as marking them as deviant or abnormal.”

Photo by Devon Divine on Unsplash

Adkins said seeking care in another state made her feel like a criminal and a medical refugee of sorts, and she worried about what others would think of her for terminating her pregnancy. Another physician she saw for a separate issue wanted to keep the pregnancy out of her record, entirely as a precaution.

“They make this out to be like people that seek abortions are horrible, horrible people, and murderers, and all this stuff, and I’m like, that could not be further from the truth. This is a baby that we love with all of our heart and soul. And because we are loving parents, we are choosing this route, not only to be loving parents to that baby, but also to our living son, because I have to think about what’s in my best interest so that I can still be here and be healthy enough to take care of my son who needs me,” Adkins said.  

Idaho physicians have also stopped making referrals for patients in situations similar to Adkins’ in the wake of a legal opinion sent by Attorney General Raúl Labrador at the end of March. Until there is a decision in a lawsuit over the opinion, physicians and Planned Parenthood facilities in Idaho have said they will not make any referrals for abortion-related care outside of the state.

Adkins said if she wasn’t as informed about the state’s laws, she wouldn’t have understood what doctors were saying about her options.

“They said that I was welcome to leave the state on my own accord and seek health care outside of the state,” Adkins said. “It was a very odd experience because we were talking basically in code. … I understood the nuance, and I understood what they were implying, but it was a very surreal experience.”

A brief filed in the lawsuit on behalf of a health system in Idaho detailed a scenario nearly identical to Adkins’ on the same day she was diagnosed at a different facility. Like the case outlined in the brief, Adkins would be at risk for developing a condition called mirror syndrome, which causes the pregnant person to experience similar symptoms to that of the fetus. Dr. Palmquist told States Newsroom that it can lead to preeclampsia, a life-threatening state of high blood pressure in pregnant people that can cause seizures and organ damage.

 Knowing all of this, Adkins decided it was in the best interests of her family, including the nearly 2-year-old son she already had and the daughter she would never get to hold, to terminate the pregnancy.

 She hoped to miscarry within the following week so they wouldn’t have to make the emotional three-day trip. So she scheduled another ultrasound, but there was still a heartbeat. She was desperate to fix it — desperate to stop being a walking coffin for a dying dream. 

 “It’s hard knowing that my body and the fetus are trying so hard to hang on,” Adkins said. “And we had to make a really hard decision. Do we try? But for what purpose? There’s no sense in bringing a child into this world that’s not going to survive anyway or have severe complications. And it’s not fair to any of us.”

Maternal-fetal medicine doctors continue fleeing to other states

Idaho legislators made minor changes to the state’s abortion law toward the end of the legislative session in March to clarify that certain instances where the fetus has already died or ectopic or molar pregnancies would not fall under Idaho’s abortion ban, declining to proceed with an earlier iteration of the bill that included a clause exempting medical professionals from criminal liability. In that version, providers had to determine if an abortion was necessary “to prevent the death of the pregnant woman or to treat a physical condition of the woman that, if left untreated, would be life-threatening.” 

 Dr. John Werdel, an obstetrician-gynecologist at St. Luke’s in Boise, said he wasn’t sure if Adkins’ situation would have qualified under the health language in the original bill. She likely would have had to wait until the health effects were more severe, he said.

Many reproductive care physicians in states where abortions are banned have left to practice in other states in recent months, including one maternal-fetal medicine doctor in Tennessee who moved to Colorado in January after starting what she described as a dream job in Tennessee in August. 

 Idaho’s abortion laws caused Palmquist, one of three maternal-fetal medicine physicians at Saint Alphonsus, to take a job at Desert Perinatal in Las Vegas, Nevada. She is one of several specialists in the state to leave over the new laws since January. She was packing her belongings on Thursday, hoping the laws change soon and allow her to return. 

 “Since June, it’s just become so complicated to take care of pregnancy complications. Things before that were so straightforward now make us take an extra four to six hours and multiple meetings,” Palmquist said. “Making sure we’re protected by EMTALA, making sure this is an emergency medical condition. Does the hospital administration agree, does legal counsel agree? All of that.”

A recent study published in the Journal of General Internal Medicine found from a survey of more than 2,000 current and future physicians on social media that 82% preferred to work or train in states with preserved abortion access. More than 76% of respondents said they wouldn’t even apply to states with legal consequences for providing abortion care.

“At least monthly, we are faced with caring for moms with significant complications, and there’s no chance of a viable outcome. But with Idaho’s restrictions, there’s a lot of anxiety about essentially practicing the standard of care,” Palmquist said. “A year ago, it would’ve been just so straightforward, and now there’s all this caution and hesitancy.”

 The mounting costs

Adkins and her husband left their son with grandparents to make the trip to Oregon on a Thursday for her appointment the following morning. The Northwest Abortion Access Fund and Cascade Abortion Support Collective helped pay for a hotel room, a rental car and the surgical procedure, which was $850 by itself without insurance. Friends and family sent her Venmo donations for other expenses.

“I just started calling organizations because I was like, I don’t know what to do. And they said, ‘We’re here to help you.’ And it was so relieving but also absolutely heartbreaking to hear multiple times from multiple people, ‘You are not the only one. We get stories like yours all the time, every day,” Adkins said. “Every day.”

The Planned Parenthood clinic was supportive and professional, she said, and they honored her request to be deeply sedated for the procedure. When she told them why she needed to terminate the pregnancy, they offered to take ultrasound photos beforehand.

 “Everybody was like, ‘Oh my god, I’m so sorry you had to come all this way for this,’” Adkins said. “And they’re right. I shouldn’t have had to leave my son and travel hundreds of miles to do this.”

Since the procedure was performed in another state and at a Planned Parenthood clinic, Adkins had to ask the doctor to collect the remains of the fetus, the pregnancy tissue and the placenta and package them properly to be sent to a genetic testing clinic. She was also faced with rushing the package of remains to FedEx herself that same day.

 While she doesn’t regret the decision, Adkins said it was a painful experience that could have been much easier if she had been able to access care in her own state.

“I deserve better, and so does everybody else,” she said. “We can’t stop things from happening in pregnancy. That’s why we have modern medicine, to help guide us and protect the things we do have control over. So if we can’t stop those horrible things from happening … why make it even worse by making the worst experience someone has to go through — learning that they will not give birth to a happy, healthy baby — why do we make that even worse by saying, ‘We don’t value your life enough to try to save it or prevent something bad from happening to you in the meantime?’”