Iowa’s top medical board hears opposition, support for state’s 6-week abortion ban

Physicians, advocates and other concerned Iowans made their appeals to the Iowa Board of Medicine Thursday as the state medical regulatory body moves forward with its rulemaking effort for the state’s 6-week abortion ban.

Nearly a dozen individuals spoke in opposition of the proposed rules crafted by the state board to enforce Iowa’s so-called “fetal heartbeat” law, which would ban abortion in Iowa when fetal cardiac activity can be detected, or at about six weeks of pregnancy.

Only one attendee in support of the abortion ban — a representative from the pro-life organization Iowa Right to Life — spoke during the meeting this week.

Thursday’s public comment session is the last step before the Iowa Board of Medicine takes a final vote on the administrative rules to enact the abortion ban, should it go into effect. The vote is scheduled during the board’s next meeting on Jan. 12.

Enforcement of the law has been temporarily blocked by a Polk County court, and abortion remains legal in Iowa up to 20 weeks of pregnancy. The Iowa Supreme Court is expected to hear arguments over enforcement the abortion ban sometime this year, with a decision expected by the end of June 2024.

Though the ban remains tied up in the courts, the Iowa Board of Medicine, which is the sole state entity with authority to enforce the law, is still required to craft rules to administer the ban. That includes guidance on how physicians may be expected to comply with the law’s narrow exceptions, and how doctors could be subject to licensure discipline should they violate the rules.

More:Iowa’s top medical officials consider rules for 6-week abortion ban. Here’s what they say:

Opponents raise concerns about impact on physician workforce

Several speakers voiced concerns on how the abortion ban would impact Iowa’s ability to recruit and retain physicians, particularly those that specialize in obstetrics-gynecology.

The state has long struggled to maintain an adequate maternal health care workforce, especially in rural areas of the state. A third of Iowa’s 99 counties are considered maternity care deserts, meaning there are no OB-GYNs practicing in that county and no birthing hospitals or birthing centers for patients to receive care, according to the March of Dimes.

Dr. Emily Boever, an OB-GYN practicing in Waverly, said during Thursday’s meeting that she is the sole provider offering pregnancy care at her hospital because the facility has struggled to hire another OB-GYN.

“Obstetrician-gynecologists are already rare in Iowa, and we are one of the states with the least number of obstetrician-gynecologists per capita for our patients,” she said. “I do anticipate that adopting rules like these will make that situation even harder.”

Dr. Rebecca Shaw, an OB-GYN and associate professor at Des Moines University’s medical school, raised similar concerns, saying she expects this could affect medical students’ decision whether to continue their training in Iowa. Following the passage of Iowa’s law, medical students studying in the state have said they would be less likely to apply for residency spots within the state because of Iowa’s strict ban.

“Some of the rules that have been considered in other states and are being applied have caused significant problems with retaining physicians for those states,” Shaw told representatives of the board. “… Iowa already has a very significant problem with workforce, especially as it applies to women’s health. I would hope that we do not do something that further sets us back with regard to our workforce.”

Nationwide, the Association of American Medical Colleges has found 13 states that enacted total abortion bans saw a 10.5% drop in applicants for OB-GYN residency programs in 2023 compared with the previous year. That’s double the 5.2% drop in applicants in states without restrictions.

Dr. Steven Wahle, a Cedar Rapids-based urologist who has previously trained residents at the University of Iowa, said the ban would create dilemmas for doctors because they would be uncertain whether they can make clinic decisions for their patients without facing repercussions.

“I would recommend that this board strongly work with the state government to find some clarity in terms of these clinical issues,” he said during the public hearing.

Proponents ask for public data on physicians that violate law

John Strathman, president of the board of directors for the Iowa Right to Life, asked the Iowa Board of Medicine to consider establishing a reporting system on any disciplinary action taken against physicians who violate the rules. The identity of the physician as well as the compliance failure should be made public, he added.

Iowa Right to Life Executive Director Kristi Judkins told the Register after the meeting that her organization believes providing this information to the public is an important step to ensure Iowans have unbiased information about which physicians may not be adhering to the board’s regulations.

“What we would want is that data reported and that data available to folks,” she said.

The proposed rules say failure to comply with the law or the proposed requirements “may constitute grounds for discipline,” but do not offer clear insight on what specific penalties doctors could face.

The Iowa Board of Medicine does have the authority to revoke or suspend a physician’s license, impose civil fine and enact other disciplinary action for these medical professionals.

Doctors would not face criminal or civic penalties under the proposed rules before the Board of Medicine.

Iowa abortion access fund says requests for help increased last year

The Iowa Abortion Access Fund, a nonprofit organization that provides grant funding to Iowans seeking abortion care, has said the need for their services has increased over the past year. The group served 666 clients as of November 2023, already an increase from the 607 clients served in 2022.

Typical cost of obtaining abortion care in Iowa totals more than $700, including the cost for medication-based abortion and pre-procedure ultrasound required by state law, according to fund officials. Surgical abortions are often double the cost, they say.

State data shows there were a total of 4,062 abortions performed in Iowa in 2022, an 8% increase compared to the 3,761 abortions in 2021.

While Iowa has seen increases in the number of pregnancies terminated over the past five years, recent totals are still far below abortion totals from two decades ago, when abortions numbered more than 6,000 per year.

A March Des Moines Register/Mediacom Iowa Poll found a majority of Iowans ― 61% ― believe abortion should be legal in all or most cases. Thirty-five percent believe the procedure should be illegal in most or all cases.

Michaela Ramm covers health care for the Des Moines Register. She can be reached at mramm@registermedia.com, at (319) 339-7354 or on Twitter at @Michaela_Ramm

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