Many patients seeking abortion care in Iowa in the past few weeks were unaware that the state has banned most abortions beginning Monday, Planned Parenthood staff said.

More than six years after the Legislature first attempted to pass the law, abortion became illegal in Iowa, with narrow exceptions, at 8 a.m. Monday.

Kristina Remus, a Planned Parenthood patient services associate, said Friday that many people she is working with are unaware that Iowa’s abortion law was changing.

“To say the last few weeks have been hard is an understatement,” Remus said. “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’re pregnant set to take effect so soon on Monday. We are having extremely difficult conversations in my department with patients.”

The Iowa law bans abortions after cardiac activity is detectable in an embryo, something that can occur as early as six weeks of gestation. There are some exceptions to the ban, including for rape, incest and to save the life of the mother.

The so-called “fetal heartbeat” law was blocked from enforcement shortly after it was passed in July 2023. It was signed by Gov. Kim Reynolds in a special session after the Iowa Supreme Court ruled to uphold an injunction on a similar 2018 law. But in this June, the state Supreme Court ruled that a district court judge should lift the injunction on the 2023 measure, in addition to setting a lower legal standard for testing the constitutionality of Iowa abortion laws.

Dr. Sarah Traxler, chief medical officer for Planned Parenthood North Central States, said the law will have major negative impacts on health care in Iowa — especially maternal and reproductive health care, areas of care that the state already faces care shortages.

“We now live in a reality where politicians have control over Iowans’ bodies and futures,” Traxler said. “Its impact will be widespread and generational. We are tired, of course, but we are not defeated. Instead, we stand strong with Iowans in this moment.”

Following the district judge’s announcement of the law taking effect Monday, Reynolds said in a statement that “our work will continue to strengthen a culture of life in Iowa,” in supporting expectant parents, encouraging adoption and ensuring legal access to in vitro fertilization treatments. She also celebrated the six-week abortion ban becoming enforceable after many years of being enjoined in the legal system.

“Today is a victory for life,” Reynolds said. “There is nothing more sacred and no cause more worthy than protecting innocent unborn lives.”

Remus said that in the week before enforcement of the law began, Planned Parenthood locations were “overbooking our schedules” in Iowa facilities trying to get patients access to legal abortion care.

“But I would say 30% of the people I talked to on the phone told me that, ‘Well, I can’t get off work this week, you know, I’m already scheduled for work this week, and I can’t find day care, I can’t get off work — I have it for next week,’” she said. “So unfortunately, those people, I was able to connect them with a navigator, and they will have to go out of state, because they are already above the (gestational age) of six weeks. So I would say we were able to get in maybe 50 percent of the people that were scheduled for next week, but the rest of them, the fact is that it was too it was too late of notice for them to rearrange their schedules to be able to come sooner.”

Here’s what to know about the law, and how abortion care providers plan to assist Iowans seeking the medical procedure beginning Monday.

What changes are being made to abortion law in Iowa?

Before Monday, abortions were legal up to 20 weeks of pregnancy in Iowa. With the injunction lifting, abortion will be illegal when embryonic cardiac activity can be detected. Cardiac activity can become detectable as early as six weeks of gestation.

There are multiple exceptions to the law:

• In cases of rape resulting in pregnancy, if reported within 45 days to law enforcement or a public health agency or doctor.
• In cases of incest, if reported within 140 days to law enforcement or a public health agency or doctor.
• When an abortion is necessary to save the life of the pregnant person.

Planned Parenthood advocates say the standards for medical providers to determine when an abortion is necessary to prevent the death of a patient are unclear. Lawsuits against in other states with abortion bans, including similar exceptions to save the life of the mother, have called for clarification on this exception. Five women filed a lawsuit in Texas in 2023 saying they were denied abortion despite having medical problems that endangered their lives during pregnancy. The Texas Supreme Court rejected the lawsuit in May.

Abortions can still legally be provided in Iowa before cardiac activity is detectable. Planned Parenthood staff said they plan to continue to provide abortions in Iowa in adherence with the law.

What abortion care looks like in Iowa, starting Monday

If a pregnant Iowan goes to a health care facility seeking an abortion, they are required to have two appointments — with a 24-hour waiting period before an abortion can be performed — in addition to having an ultrasound performed. The health care provider must also assess whether embryonic cardiac activity is detectable.

If there is no observable cardiac activity, the patient can legally access an abortion in Iowa.

If cardiac activity is detected, an abortion cannot be performed in Iowa — outside of the law’s exemptions for rape, incest when reported in specified timeframes, and when an abortion is required to save the life of the patient.

Alex Sharp, senior health care manager at Planned Parenthood North Central States, said if a person seeking an abortion comes to one of the organization’s Iowa clinics and cardiac activity is found, they will “have that conversation with the patient” about Iowa restrictions on the procedure, and connect them with a patient navigator for assistance seeking care in other states where they can legally have an abortion performed.

Remus, on the Planned Parenthood patient services team, said navigators will then help the person setting up an appointment in a nearby state where abortion is legal.

Navigators will also assist patients in seeing if they have access to financial aid — through programs like the Planned Parenthood Justice Fund, or outside sources like the Iowa Abortion Access Fund — to see if they qualify for funding to help cover the cost of the procedure, as well as associated expenses like transportation and lodging.

Planned Parenthood has expanded patient capacity at health centers in Omaha, Nebraska, and Mankato, Minnesota in recent months as the organization prepared for abortion law to change in Iowa.

Will there be future legal challenges to Iowa’s abortion law?

Peter Im, staff attorney at Planned Parenthood Federation of America, said earlier in July that reproductive health care advocates are “exploring all of our options right now” for challenging Iowa’s law restricting abortion. That includes a potential challenge to the Iowa Board of Medicine rules on the law, Im said.

However, the 4-3 Iowa Supreme Court decision sets a high standard for finding state abortion laws unconstitutional. The Supreme Court majority ruled that the “rational basis” test will be used to assess Iowa abortion laws constitutionality. This means that if the state has a legitimate reason to enact a law restricting abortion, the measure can stand.

“Employing that test here, we conclude that the fetal heartbeat statute is rationally related to the state’s legitimate interest in protecting unborn life,” Justice Matthew McDermott wrote in the June majority opinion.

Sally Frank, a law professor at Drake University, said in June there may be “applied challenges” to the law, similar to the Texas lawsuit, in the future. These challenges could be made by women who have their life endangered and families of people who died due to the law, as medical professionals may not be willing to perform an abortion when necessary because of a lack of clarity on what qualifies a “medical emergency” that would make the procedure legal, she said.

Will there be further restrictions on abortion in Iowa?

Iowa Democrats and reproductive health care advocates have said Iowa Republicans — who control both chambers of the Legislature, in addition to holding the governorship — may pursue further restrictions on abortion in future legislative sessions following the state Supreme Court ruling. Frank said she expects Iowa to pass measures restricting travel or assistance for out-of-state abortions similar to those passed by conservatives in other states, like an Idaho law that criminalized the act of assisting a pregnant minor seeking an abortion in another state.

While top Iowa Republican leaders have not commented on future abortion legislation, other conservative figures have said they are aiming for further restrictions. Chuck Hurley, vice president of the conservative Christian organization the Family Leader and lobbyist at the Iowa Legislature, told the crowd at the Family Leadership Summit earlier in July that “we aren’t done” on the issue of abortion in Iowa.

“Fourteen states now protect babies from the moment of conception, and Iowa should be the 15th,” Hurley said.

Iowa Capital Dispatch is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Iowa Capital Dispatch maintains editorial independence. Contact Editor Kathie Obradovich for questions: info@iowacapitaldispatch.com. Follow Iowa Capital Dispatch on Facebook and X.