Iowa judge lifts injunction blocking state's 6-week abortion ban

DES MOINES, Iowa — An Iowa judge has ruled the state's hotly contested six-week abortion ban will officially take effect on July 29, just over a year after Republican Gov. Kim Reynolds signed it into law.

The state's "fetal heartbeat" law bans abortion after fetal cardiac activity can be detected by ultrasound, typically around six weeks of pregnancy, with exceptions in some cases for rape, incest, fatal fetal abnormalities and to protect the mother's life. It was passed in a 2023 special session after a divided Supreme Court allowed a previous version of the law to remain blocked, but it was enjoined by a district judge last year before it could take effect.

On June 28, a divided Iowa Supreme Court ruled that the law was constitutional, setting a lower legal bar for future abortion restrictions, and ordered the district court to lift its injunction and let the law take effect. On July 22, after several procedural delays, the district court formally regained jurisdiction over the case.

The case is assigned to Judge Jeffrey Farrell, who said in an order posted online Tuesday that the injunction will end at 8 a.m. on July 29.

Attorneys for Planned Parenthood, which sued to challenge the ban, had asked for the order to build in some lead time to ensure no medical procedures were disrupted, and Farrell wrote that "plaintiffs' proposal is reasonable to ensure that everyone is on fair notice as to when enforcement of the statute may begin."

Reynolds, who has worked to enact a six-week ban since 2018, called the decision "a victory for life."

“As the fetal heartbeat law finally takes effect, our work will continue to strengthen a culture of life in Iowa," Reynolds said. "I remain deeply committed to supporting women in planning for motherhood, promoting the importance of fatherhood, elevating adoption, and protecting in vitro fertilization (IVF). Families are the foundation of society, and policies that encourage strong families will make our state and country strong for generations to come.” 

Iowa will join more than a dozen other states that have near-complete bans on abortions with limited exceptions. After the U.S. Supreme Court overturned Roe V. Wade in 2022, Republican lawmakers across the country have introduced and passed a sweep of abortion restrictions.

Fourteen states currently have near-complete bans while seven states ban abortion at or before 18 weeks of gestation, according to The Guttmacher Institute, which tracks abortion data. Three other states, including Florida, Georgia, and South Carolina, have similar six-week abortion bans.

"Nearly all of these bans include exceptions, which generally fall into four categories: to prevent the death of the pregnant person, when there is risk to the health of the pregnant person, when the pregnancy is the result of rape or incest, and when there is a lethal fetal anomaly," according to non-profit organization KFF.

What is Iowa's 'fetal heartbeat' law?

Once in effect, the new law will replace Iowa's current ban that prohibits abortions at 20 weeks gestation.

The so-called "fetal heartbeat ban" prohibits an abortion once the first sights of cardiac activity can be detected in a pregnancy. That can occur as early as six weeks of pregnancy — or just two weeks after the first missed period.

Clinicians have said calling this activity a "heartbeat" is a misnomer. At six weeks gestation, the embryo has developed a cluster of cells that generate sporadic electrical impulses. These cells will eventually form different structures of the heart, but the organ is not developed until later in pregnancy.

The law does allow for abortions to be performed in cases of rape, incest, and if the fetus has an abnormality that is "incompatible with life."

The ban also includes exceptions for miscarriage care and in cases of a "medical emergency" to "preserve the life of the pregnant woman" if her life is endangered by "physical disorder, physical illness, or physical injury, including a life-endangering physical condition caused by or arising from the pregnancy" or "when continuation of the pregnancy will create a serious risk of substantial and irreversible impairment of a major bodily function of the pregnant woman."

How many patients could be affected by the ban?

Planned Parenthood North Central States CEO and President Ruth Richardson recently said her organization estimates 97 percent to 98 percent of abortions performed in Iowa would be banned once the law goes into effect.

The Guttmacher Institute estimates that 4,200 abortions were performed in Iowa in 2023. The vast majority of those patients were Iowans, researchers said.

The most recent state data shows the vast majority of abortions in Iowa were performed before 14 weeks gestation. Of the 4,062 abortions performed in 2022, 93% took place between zero and 13 weeks gestation.

Most abortions nationwide happen after six weeks of gestation, according to data from the Centers for Disease Control and Prevention for 2021. Forty-nine percent happened from seven to 13 weeks’ gestation and 7% at 14 weeks or later. Meanwhile, 45% were obtained at six weeks or earlier.

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How will this law be enforced?

The Iowa Board of Medicine, the state's top medical board that licenses and regulates physicians practicing in the state, is the enforcing agency of the new six-week ban.

However, it's still unclear what penalties doctors could face under the law. The board has not offered additional insight on punishment it would issue to those who violate the law, but existing administrative rules give the Iowa Board of Medicine to place a doctor on probation, issue civil fines, or suspend or revoke a physician's license, among other actions.

Administrative rules approved by the board earlier this year include guidelines for physicians to comply with the law, including the requirement that doctors must perform an ultrasound on patients seeking an abortion. If cardiac activity is detected, an abortion is prohibited unless it applies under one of the law's narrow exceptions.

The rules dictate steps doctors must take to comply with the exceptions for rape, incest and fetal abnormality that is incompatible with life. However, these rules do not offer any insight on how to comply in cases of a medical emergency. The law states an abortion can be performed to preserve the life of the mother.

Doctors have criticized the board's administrative rules, saying they fail to provide clarity on when a provider is allowed to intervene when a patient's life is at risk. The threat of losing their medical license could further amplify that hesitance to act, some critics have speculated. They say they worry doctors may put off performing abortions and put a patient's life further at risk.

Planned Parenthood and the Emma Goldman Clinic, the plaintiff abortion providers, have said they intend to continue providing abortion services under the ban, although the six-week limit comes before many women even know they're pregnant.

They also have raised several constitutional arguments against the law not addressed in last month's Supreme Court decision, and have suggested they may continue to litigate on those grounds.

Contributing: Thao Nguyen, USA TODAY

William Morris can be contacted at [email protected]. Michaela Ramm can be reached at [email protected], or on X at @Michaela_Ramm.