It’s quiet over the lunch hour on a recent Friday at the Planned Parenthood clinic in Mankato, Minn.
Brooke Zahnle, the health center manager, steps into the southern Minnesota clinic’s small hallway to point out the clinic’s lab and five exam rooms, including an ultrasound room.
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Iowa Clinics
The clinic is tucked away in a strip mall close to Minnesota State University, Mankato. It’s about an hour from the Iowa border. “We’re set up to see 14 patients a day here in Mankato, and we’re looking to increase that to up to 22,” Zahnle said.
As Iowa’s so-called “heartbeat law” worked its way through the courts, she said the clinic has been getting ready for more Iowa patients. It moved into a new location last November, which added an exam room, and it recently started offering abortion services, she said. “We started providing medication abortion services in January,” she said. “And we’re actually looking at cross training staff right now to increase access on Wednesdays when we do provide that service.”
The Iowa law bans abortion when cardiac activity is detected, which can be as early as six weeks of pregnancy – or before some people know they’re pregnant. The law is set to go into effect July 29. Planned Parenthood estimates it will block nearly all abortions in the state. The ban will likely affect abortion access not only in Iowa, but in the entire Midwest region. “The protections of Roe have just been chipped away at slowly through time,” she told The Associated Press.
At 8 a.m. Monday in Iowa, the state will join more than a dozen others where abortion access has been sharply curbed in the roughly two years since the Supreme Court overturned Roe v. Wade.
It’s an outcome Iowa’s abortion providers have been fighting but still prepared for, shoring up abortion access in neighboring states and drawing on the lessons learned where bans went into effect more swiftly.
States with restrictive laws are “glimpses of our future,” Traxler said. Even with the ability to prepare, she told reporters Friday, “this transition is devastating and tragic for the people of Iowa.”
Iowa’s Republican-controlled Legislature approved the law last year, but a judge blocked it from being enforced shortly after the measure went into effect because of a lawsuit from the American Civil Liberties Union of Iowa, Planned Parenthood and the Emma Goldman Clinic in Iowa City.
The Iowa Supreme Court reiterated in June that there is no constitutional right to an abortion in the state and ordered the hold to be lifted. The district court judge’s July 22 orders set July 29 as the first day of enforcement.
The law prohibits abortions after cardiac activity can be detected, which is roughly at six weeks of pregnancy and before many know they are pregnant. There are limited exceptions in cases of rape, incest, fetal abnormality or when the life of the mother is in danger. Previously, abortion in Iowa was legal up to 20 weeks of pregnancy. Alex Sharp, senior health center manager who runs the Planned Parenthood abortion clinic closest to Des Moines, said staff members overbooked schedules this week, moving up appointments for people seeking abortions who likely would be past the legal limit as of Monday.
Still, that wasn’t an option for everyone. Almost a third of the people Sharp spoke to said they couldn’t get off work or find daycare before next week. Those patients could work with staff members to find appointments out of state, she said.
Across the country, the status of abortion has changed constantly since the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, with trigger laws immediately going into effect, states passing new restrictions or expansions of access and court battles putting those on hold.
In states with restrictions, the main abortion options are getting pills via telehealth or underground networks and traveling, vastly driving up demand in states with more access.
The Guttmacher Institute, which supports abortion rights, projected last month that about 20,000 abortions were performed in Kansas in 2023, or 152% more than in 2020. Near Iowa, Illinois saw a 71% increase and Minnesota went up 49%. Providers there expect to see more influx after Monday.
When the first restrictive laws went into effect, like in Texas, providers had to essentially “figure it out as we went,” said Amy Hagstrom Miller, founder of Whole Woman’s Health. And even though providers across the country have learned how to work within the limits, “I don’t ever want us to have this seem normal.”
‘They feel crushed’
Shira Klane, a nurse practitioner who works at Planned Parenthood clinics across Minnesota, is already seeing Iowa patients traveling as far as three or four hours to get to the nearest Minnesota clinic. “They feel crushed,” she said. “It feels like such a heaviness that they’re forced to carry, and then extreme gratitude that they’re able to find care through us. “Last year, an estimated 940 Iowans sought abortions in Nebraska, Minnesota and Illinois, according to data from the Guttmacher Institute, which supports abortion rights.
A similar law from 2018 was blocked by the state Supreme Court. The justices remained deadlocked, preventing the law from taking effect. Then during a special session in July 2023, a nearly identical bill was passed by the legislature. The new version was also put on hold until June 28 when the justices ruled the injunction should be lifted.
Even without the so-called “heartbeat law” in effect, Iowa still has many more abortion restrictions compared to neighboring Minnesota and Illinois, said Candace Gibson, the director of state policy at the Guttmacher Institute.
“You have a forced 24-hour waiting period after the [required in-person] counseling, forced ultrasound, there’s parental notice requirements in Iowa. And so, all of those restrictions add up in terms of obstacles for a person to get care,” she said. Gibson said with Iowa’s new law, the number of Iowans seeking abortion care in another state will likely increase significantly.
A surge in out-of-state patients
Since the U.S. Supreme Court’s Dobbs decision more than two years ago, which ended the constitutional right to abortion, Planned Parenthood has expanded abortion services in states like Minnesota, Nebraska, Kansas and Illinois. That’s to accommodate the increase in people coming from states like South Dakota, North Dakota, Missouri, Indiana, Kentucky – and now Iowa – that have severely restricted or nearly eliminated the procedure. This influx of abortion seekers can put a strain on clinics and providers, Gibson said.
“As states think through policies to protect and meet the need that’s coming from other states, they also have to make sure that residents within their respective state can continue to get that care,” she said.
‘Where’s that line?’
Meanwhile in Iowa, health care providers are still trying to figure out what they can and can’t do under the new law. Francesca Turner, an OB-GYN in Des Moines and co-founder of Iowans for Health Liberty, which supports abortion rights, said, for example, the rules approved by the Iowa Board of Medicine say you can provide an abortion for someone having miscarriage who has not expelled all the tissue from their uterus.
“But it doesn’t explicitly say if that embryo has a heartbeat or fetus has a heartbeat, would you still be able to provide them with emergency medical care? Where’s that line?” she said. Even though the law has exceptions for rape, incest and life-threatening conditions, Turner said properly documenting them can be complicated, requiring doctors to collect information they normally wouldn’t, such as the date the “sex act” occurred and whether it “constituted a rape” or happened with a “closely related person.”
Doctors worry a misstep could affect their medical licenses, she said.
“If I see something that I can’t take care of, I can call my high risk OB colleagues and specialists and get their opinion from their experiences and make those decisions in real time,” Turner said. “I don’t want to stop after we make some decisions and say, ‘Well, maybe I should call my hospital attorney and get some more information if I can act now or not.’” She said this means many of those Iowa patients will still end up crossing borders for abortion care –– or won’t get it at all.
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