On June 28^th of last year, when the Iowa Supreme Court reversed and remanded the prior permanent injunction on a 6-week ban on pregnancy termination they utilized the rational basis test, which means the fact that this law inflicts harm on individual rights doesn’t matter. The court held the law is constitutional if it is rationally related to a legitimate government interest.

And so, when the law went into effect July 29, 2024, women in Iowa were taken back in time, relegated to lesser citizens by the state, and placed squarely behind men and fetuses in their rights.

Now, only 2 of 5 clinics previously providing abortion remain open for care. Of note, this is a barrier to women, particularly low-resourced women, receiving cancer screenings, contraception, treatment for infections and a safe place to seek information, not only abortion care. Very pro-life, and especially poignant to reduce care for women that are already struggling to make ends meet.

As these clinics close, women travel further for care, spending more time and more money, gathering additional childcare resources, spending resources on lodging and missing time furthering their own careers and educations. The financial stress caused by these restrictions has caused more women to seek assistance.

In 2023, 194 women sought support from abortion funds. In 2024, that number swelled to 625.

The challenges to recruitment that medical professionals warned of – that OB/GYNs would not want to practice in a state where their license could be at risk by providing life-saving (or patient-affirming) care, remain. Iowa’s position of weakness in women’s healthcare persists. Burnout levels are high, and moral injury is heavy. Rural healthcare is struggling, and metro healthcare is not much different.

This law does not eliminate abortion as an act, as a need, or as a choice. It simply punishes Iowa’s women for making personal health and family choices by forcing them to confront barriers, costs and arbitrary timelines. It diminishes their own lived experience and bodily expertise - to the ongoing detriment of our families and communities.

In 1846 when Iowa was admitted to the Union, and its first constitution adopted, women comprised approximately 5% of the workforce. At that time, even married women could not own property, much less make reproductive decisions.

But now, 79% of Iowan women are in the workforce, surviving and supporting their families in a state economy that is worst in the nation.

A recent Government Accountability Report confirmed that abortion restrictions negatively affect educational attainment, labor force and career trajectories, and where people choose to live.

Well, Chief Justice Susan Christensen, in her dissent, gave us our rallying cry. “We didn’t come this far to say, ‘Our work is done.’”

We know that Iowa deserves better. There are better ways to protect women; keeping women safe involves allowing them to exercise bodily autonomy, live by their own mores, and access healthcare with privacy and dignity.

Let me be clear: barriers to abortion access are barriers to equity, freedom and liberty in Iowa. They shape the way that young girls see themselves in our state society, which is in fact a society that transfers the value of women’s lives to their unborn children. No family is exempt from an impossible pregnancy decision, and as an OB/GYN I’ve seen these go every way. Seeking adoption, seeking abortion for an unplanned pregnancy, seeking abortion for a planned but incurably ill pregnancy, and seeking emergent care for a desperately ill mother. In each of these heart wrenching situations, I can assure you our legislature, our governor, our AG and our Justices did not hold these patients’ hand as they weighed the risks, benefits and alternatives to their unique medical conditions – but I have.

Whether a young women struggling with infertility who is deciding whether to freeze embryos in Iowa or a neighboring state; a pregnant teenager who has been shunned by her boyfriends’ family with little support; a young family who is struggling to remain in their rented apartment and cannot support another child; or a woman coping with the devastating news of a fetal anomaly – I have held space with these patients and seen the toll of this legislation. I have counseledIowan fathers on where their daughters can access abortion care, conversations that demonstrate that dignified choices should be available to even those who never imagined themselves in these situations. I have wondered how to improve rural Iowan’s healthcare during a moment when few physicians will choose to work here.

Yesterday, a patient told me that her partner and father of her unborn child had ‘dipped’. A choice that only a man in Iowa has when a pregnancy does not serve his best interests. Women shoulder the weight of this bill and now bear pregnancies according to the will of the government.

Our work remains vital. In no other life changing, life altering decision do we insist that a condition be specifically enumerated by a document written nearly 200 years ago.

But we know what is right – patients deserve “the fundamental right to make medical decisions affecting their health and bodily integrity... free from government interference”, language our own Chief Justice gave us in her dissent. We must continue to demand it.