Allison Bierman, 31, of Iowa City and her husband underwent three rounds of in vitro fertilization, or IVF treatments, before she had a positive pregnancy test. When she found out she was pregnant three years into the process, Bierman told her family and began planning to take time off of work so she could be home with the baby.
At a check-up with her doctor, the couple discovered the pregnancy was ectopic, meaning the baby was growing outside of the uterus.
Bierman received an abortion and experienced a months-long depressive state. The couple went through three more rounds of IVF treatments, and Bierman suffered three miscarriages, all of which were treated with abortion pills.
An Iowa law took effect July 29 barring almost all abortions after six weeks, causing Bierman to question if the state legislature would pursue further legislation regarding IVF.
“It’s mostly frustrating for me, selfishly, because I want to know what the plans, what my options are, and what I’m able to do,” Bierman said.
Iowa’s law bans abortions after fetal cardiac activity is detected, which can be as soon as six weeks into a pregnancy — a timeframe in which most women are unaware they are pregnant. The law includes exceptions for the life of the mother, rape, and incest. Experts say the language is unclear about what constitutes an emergency.
Many outcomes of the law have yet to be seen, but critics fear impacts on women’s health care, retention for OBGYNs in the state, and, in Bierman’s case, IVF treatments.
Since the U.S. Supreme Court overturned Roe v. Wade in 2022, the landmark case that protected the right to abortion since 1973, more than a dozen states have restricted abortion access across the country. Iowa abortion providers filed a lawsuit against the law but dropped the challenge on Aug. 15, ending the legal battle.
Now, Iowa’s abortion providers must alter how they provide care. Drawing on lessons learned in states where bans took effect sooner, Iowa abortion providers and abortion funds are partnering with out-of-state resources including the Chicago Abortion Fund to continue providing care.
The Biermans said they have struggled and fought to have a biological child for six years. They don’t plan to stop even with Iowa’s six-week abortion ban adding more stressors to the process.
Abortion care providers adjust to new law
Iowa’s two abortion care providers, the Emma Goldman Clinic for Women, located in Iowa City, and Planned Parenthood, located in six cities around the state including Iowa City and Cedar Rapids, are shifting resources to continue to support those seeking abortion care.
Before the law took effect, abortion was legal in Iowa up to 20 weeks of pregnancy.
Francine Thompson, director of the Emma Goldman Clinic, said the ban reduces the number of people the clinic is able to provide abortion care for, but it offers an opportunity to provide support in other ways.
The clinic will increase focus on community outreach and education and access to wellness and preventative services, Thompson said.
The Emma Goldman Clinic plans to pivot its resources and energy to educate Iowans about the limitations of the six-week ban, allowing them to make decisions about their own health care. The clinic will also increase access to contraceptives and encourage routine checkups or regular pregnancy tests.
Thompson said being able to control reproductive health care is paramount to controlling destiny and the ability to live and thrive as a family.
“When that’s restricted, your bodily autonomy is restricted,” Thompson said.
Planned Parenthood will continue providing abortion care in Iowa in compliance with the law. The organization created a network of patient navigators to help Iowans determine if they can receive care in the state or must travel out-of-state for care, according to a July 29 news release.
Ruth Richardson, president and CEO of Planned Parenthood North Central States, said in the release that the ban will impact Iowans for generations, and the organization has spent months planning for the possibility of the ban.
Allison Bierman said Iowa’s ban will make the process of trying to have a baby more harrowing, especially because of the stress it puts on doctors as they try to navigate how to care for patients while complying with the law. Doctors and providers risk facing up to $10,000 fines or losing their medical licenses if they break the law.
“You want to be able to turn to your doctors to have them tell you what to do,” Bierman said.
Support to seek out-of-state abortion care
After enacting the six-week ban, Iowa became one of 22 states with abortion restrictions. Florida, Georgia, and South Carolina enforce a similar ban on abortion after around six weeks.
Iowa’s abortion providers and abortion funds are dedicated to helping those who cannot receive care in the state find out-of-state help.
Iowa’s border states offer broader regulations than Iowa.
Under Nebraska law, abortion is legal up to 12 weeks, and Minnesota does not enforce any restrictions based on gestational age or cardiac activity. Illinois has no restrictions on abortion up until fetal viability, which occurs around 24-26 weeks into a pregnancy.
Before the ban was enacted in Iowa, the Iowa Abortion Access Fund reached out to partnering clinics in Minnesota, Kansas, and Illinois to ensure they were prepared for the influx of Iowans who would inevitably seek out-of-state care.
As a result of the ban, the organization partnered with the Chicago Abortion Fund to connect Iowans with a broader network of resources and continue to provide support. The Iowa Abortion Access Fund is still operating, but now all calls are directed to the Chicago Abortion Fund.
Lyz Lenz, board co-chair of the Iowa Abortion Access Fund, said abortion funds across the nation are experiencing a financial strain because more states are enacting abortion bans, which drives up demand for support from states with fewer restrictions.
Lenz said partnering with the Chicago Abortion Fund costs more than operating independently, but the partnership is necessary to provide care for Iowans.
“We are one of the oldest abortion funds in the nation, and we have no intention of going anywhere,” Lenz said. “We’re going to have to keep up because this is essential. Iowans need care, and if we don’t help them, who else will?”
The organization has increased fundraising efforts to cover costs created by the ban.
The Chicago Abortion Fund provides one-on-one case management for those seeking abortion care. Case managers help connect people with the care that works best for their unique needs and situations. The fund covers transportation, lodging, child care costs, and meals.
Partnering with four major hospitals in Chicago to provide for Iowans seeking out-of-state care, the program streamlines the referral process between an Iowa provider and a hospital.
Other states experience influx of Iowans seeking care
With the ban in effect, an increasing number of Iowans are seeking out-of-state abortion care. In 2023, 390 Iowans traveled to Minnesota, 370 traveled to Illinois, and 180 traveled to Nebraska to seek abortion care, according to the Guttmacher Institute. In the same year, a total of 37,300 people from states with restrictions on abortion care traveled to Illinois for abortion care, according to The New York Times.
Since the Supreme Court’s Dobbs v. Jackson ruling in June 2022, the Chicago Abortion Fund has received requests for financial assistance from 465 Iowans. The organization expects this number to rise due to the six-week ban.
In the first three weeks of July before the ban went into effect, the fund received 60 support requests from Iowans — a 165 percent increase from previous months.
In July alone, the organization received a record number of calls, with over 1,500 people calling for financial assistance, and it dispersed over $750,000 to support people seeking an abortion nationwide, Eleanor Grano, Chicago Abortion Fund communications manager, said.
Fund officials anticipated this influx and prepared by upping their staff. The organization is in the process of hiring three individualized case managers to help reduce strain from the additional workload.
Grano said the ban also impacts people with varied pregnancy-related needs, including delays in miscarriage management because of confusion amongst doctors and unnecessary C-sections.
Future legislation takes aim at birth control and IVF
Iowa Republicans have tried in past legislation to define life as beginning at fertilization and enact a total abortion ban, which have been unsuccessful.
Groups such as The Family Leader and Pulse Life Advocates have pushed for a total abortion ban, birth control and IVF restrictions, and formal declarations labeling an embryo as a child.
Maggie DeWitte, executive director of Pulse Life Advocates and spokesperson for Iowa’s Coalition of Pro-Life Leaders — an alliance of multiple pro-life groups in the states, including The Family Leader — said the anti-abortion advocacy group was one of the main groups to push for Iowa’s six-week abortion ban, and the organization was thrilled to see the law go through.
The organization was involved in 2018 when the fetal heartbeat bill was first passed in Iowa, and the group continued to advocate until the law was enacted on July 29.
“Certainly our mission is to educate Iowans on the sanctity of human life,” DeWitte said. “The heartbeat bill is very important, and we are very glad that it was passed. It will save women from the harm of abortion, and, of course, save the lives of innocent unborn children, but it is not our end goal.”
DeWitte said the organization is laying the groundwork with Iowa legislators to bring forward a life at conception act next legislative session.
Iowa Democrats warn that a total abortion ban would risk birth control and fertility treatments, such as IVF. Democrats’ fears about IVF were increased after Alabama’s state Supreme Court ruled that embryos frozen as part of the IVF process were legally protected as children, causing clinics to halt services.
Iowa Rep. Beth Wessel-Kroeschell, D-Ames, ranking member on the House Health and Human Services Committee, is adamantly opposed to the ban and has worked strongly against it.
“It’s just plain dangerous for pregnant Iowans, the six-week ban,” Wessel-Kroeschell said. “The legislature and the governor should not be determining what access Iowans have to health care, and that’s what this does, and it’s absolutely dangerous, and there will be women who die.”
Wessel-Kroeschell said ensuring reproductive freedom will be difficult until Democrats are in control of the Iowa legislature, and the most important proposal introduced by the party is an amendment to the Iowa constitution that would guarantee a right to full reproductive health care.
Despite added worries created by Iowa’s six-week abortion ban, Allison Bierman and her husband will continue fertility treatments.
“We’ve waited so long,” she said. “I’m not going to let politics dictate us trying to start a family.”