Iowa Supreme Court justices poised to rule on halted abortion law (2024)

DES MOINES — Iowa’s Supreme Court is set to decide this week whether to allow a strict abortion restriction to take effect, potentially delivering a dramatic shake-up to Iowa’s abortion laws.

The court will rule on a law that would outlaw abortion when cardiac activity is detected in an embryo or fetus, which can be as early as six weeks, often before a woman knows she is pregnant. There are exceptions for rape, incest and to protect the life of the mother or for medical abnormalities.

The decision will be the latest to change the legal landscape for abortion in the state, as Republican lawmakers have sought through multiple laws and court cases over six years to restrict it.

Abortion currently is legal in Iowa up to roughly 20 weeks into pregnancy.

“Six years later, with the so-called right to abortion overturned at both the state and federal levels, the stage is set for Iowa to take the lead once again in the battle for life, and that's exactly what we’ve set out to do,” Republican Gov. Kim Reynolds said, according to her submitted remarks that were read Saturday at a “Right to Life” rally at the Iowa Capitol.

Iowa Republican lawmakers passed House File 732 in 2023 during a rare special session after the state Supreme Court declined to reinstate a nearly identical 2018 law.

In that decision, an evenly split court declined to set a new standard by which to judge abortion laws, meaning the “undue burden” standard in place at the federal level before 2022.

Friday is the last day of the court’s current term and the last chance to issue a ruling in the law. The court’s decision Friday will likely set a clear standard by which courts should judge abortion laws.

Abortion rights advocates suing the state argued before the court in April that it should keep the “undue burden” standard that would likely find the “heartbeat” law unconstitutional, or to set up another level of intermediate scrutiny.

But the state argued that the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, which overturned the federal right to an abortion, made that standard untenable. Republican Iowa Attorney General Brenna Bird’s office is arguing the court should employ the lower-level “rational basis” test that is now in place at the federal level and allow the state law to take effect.

“Keep praying, because we expect that decision to come out any day now from our Iowa Supreme Court. So I ask you to pray for this: pray for justice,” Bird said Saturday at the “Right to Life” rally. “We know the law is on our side. We absolutely do.”

Possible outcomes

If the court agrees with the state that the rational basis test should be applied, it would likely allow the law to take effect, said Drake University law professor Sally Frank. But if the court decides to keep the undue burden standard, the law would likely remain blocked.

The court could also declare a standard without ruling on the merits of the law, sending the case back to the lower courts to decide with new binding guidance, Frank said. In that case, it would likely end up back at the state Supreme Court next term.

“I don't think it's likely they'll send it back, but certainly the lawyers for Planned Parenthood suggested that option to the court,” Frank said. “But if they do, they just know it's going to come back to them again in a year.”

In April, a lawyer for Planned Parenthood said, if given the option, the organization is prepared to argue against the law in court under either the rational basis or the undue burden standard.

“We would hope for an opportunity to go back down to the District Court, and explain to the District Court why this ban is so awful and why it’s unconstitutional,” said Peter Im, a lawyer for Planned Parenthood.

What does the law do?

If allowed to take effect, the law would ban abortion once cardiac activity can be detected in an embryo or fetus using a transabdominal ultrasound. That can happen as early as six weeks, but it is often eight to 10 weeks into a pregnancy.

The law is crafted around the detection of a “fetal heartbeat,” which is not easily translated to medical science. While advanced technology can detect a flutter of cardiac activity as early as six weeks gestation, medical experts say the embryo at that point is not yet a fetus and does not have a heart.

There are exceptions in the law for rape, incest and medical abnormalities and emergencies. The state medical board adopted rules for the law earlier this year as the court weighed the challenge.

A rape must be reported within 45 days to qualify for the exception, and an act of incest must be reported within 140 days. The report can be made to the doctor overseeing the procedure and does not need to be reported to law enforcement authorities.

Doctors would need to perform documented diagnostic tests and procedures to determine if a pregnancy is “incompatible with life” and qualifies for a medical exception. An abortion also can be performed in a medical emergency, if the pregnant woman faces major physical health risks.

If the law takes effect

Republican lawmakers and supporters of the law say the exceptions allow medical providers to exercise judgment and provide abortions if they believe an exception applies. Opponents contend the uncertainty and worry among physicians of potentially losing their license could prompt providers to avoid abortions.

Iowans for Health Liberty, a political action committee founded by a group of female physicians united in their advocacy for their patients and reproductive health care, says highly trained obstetrician-gynecologists and other medical experts would be compelled to withhold treatment for life-altering pregnancy complications until a woman's life is critically threatened.

“As a physician I’m trained, and it’s my aim, to provide the right medical treatment to patients when I’ve identified what medical treatment they need,” said Dr. Emily Boevers, an obstetrician-gynecologist in Waverly. “… Not wait for them to become unstable.

“But the way the law is written, the actual implementation for an exception for the life of the mother forces health care providers to withhold medically appropriate care until they’re unstable. And we’ve seen how it’s played out in other states, where patients are waiting in parking lots or ER bathrooms to bleed more because they are considered too stable to provide treatment,” she said.

“This isn’t hyperbole. This is actually happening to patients. What’s sad is these are real women whose lives are impacted by this bill.”

Iowans for Health Liberty said child victims of rape and incest, who rely on adults for transportation, pregnancy recognition and reporting, would find it nearly impossible to seek timely care. Individuals with irregular or unpredictable menstrual cycles could also face significant delays in recognizing pregnancy, severely limiting their access to abortion care, the group says.

Iowa physicians have also raised concerns the law would prevent the full scope of medical training necessary to practice in Iowa, impacting the ability to recruit and retain providers.

Iowa has among the fewest OB-GYN specialists per capita of any state in the country, according to data from the American College of Obstetrics and Gynecology. One-third of Iowa counties are considered “maternity care deserts” without a hospital or birth center offering obstetric care and without any obstetric providers, according to a 2022 report by the March of Dimes, a nonprofit focused on maternal and infant health.

According to a report by the Idaho Physician Well-Being Action Collaborative, more than 1 in 5 Idaho obstetricians stopped practicing in that state since a near-total abortion ban took effect there in August 2022.

Boevers said Iowa can expect to see a similar exodus, if the state law takes effect. “And we can continue to expect to see an decrease in applicants to our one obstetrics and gynecology residency program in the state (at the University of Iowa), because educated physicians don’t want to train in a restricted place,” she said.

Some advocates opposed to abortion rights say they will push for the state to further restrict abortion if the court clears the way for the “heartbeat” law to take effect.

Maggie DeWitte, executive director of the anti-abortion rights group Pulse Life Advocates, said the state law was a good first step, but the organization wants a total abortion ban at any point.

“We will not stop until all abortion is eliminated in the state of Iowa,” she said. “So we’re going to move forward for that gold standard, which of course is life at conception.”

If law remains blocked

Republican leaders in Iowa have said they expect to win the case, but they have not committed to any further action if justices rule in favor of abortion providers and keep the law blocked.

Republicans passed a proposed state constitutional amendment in 2021 that would specify there is no right to an abortion in Iowa. Lawmakers could pass that resolution again, which would send it to a vote of the public to ratify it as part of the constitution.

That resolution would need to pass before the next general assembly convenes in January, so it could be passed in a special session this year. Leaders have not committed to passing it if they fail in court, but they said they would pursue other options.

“The legal recourse would be to go back and discuss what new laws might come into the realm of being constitutional,” Senate President Amy Sinclair, R-Allerton, said last month on “Iowa Press” on Iowa PBS. “But again, I have full faith that what we have passed is indeed constitutional, it's regulation of a medical procedure, there are no criminal penalties attached.”

Senate Minority Leader Pam Jochum, D-Dubuque, said in an appearance last week on “Iowa Press” that a special session is possible if the court rules against the law. She said Democrats would continue advocating for laws to protect abortion access and other reproductive health care measures.

“I think that you will see Democrats be very active in trying to pass that package through in the next General Assembly and make sure that voters are very aware of what we're attempting to accomplish,” Jochum said.