"The walls are closing in": States under strain as Iowa abortion ban goes into effect

This week, Iowa’s “detectable fetal heartbeat” law went into effect. Previously, Iowa permitted abortions until 22 weeks of pregnancy, although there were still barriers to accessing care. Now, abortions are illegal once fetal cardiac activity has been detected on an ultrasound — usually between six to eight weeks of pregnancy, frequently before many people know they are pregnant. 

While the law technically has exceptions for rape, incest, life of the mother and fatal fetal anomalies, they have been vaguely written and will to be difficult to implement, experts caution. For example, in the rape exception, survivors must adhere to specific rules for reporting the attack, like having exactly 45 days to report the attack to police or a doctor. As the Des Moines Register explains, the fatal fetal anomaly exception permits abortion when a fetal abnormality “is incompatible with life,” which is vague. 

Iowa’s new law was expected, but the fallout comes as access to abortion care continues to tighten across the country in a darkening post-Roe landscape. This means the effects won’t only impact Iowans, but people across the country. Isaac Maddow-Zimet, a data scientist at Guttmacher Institute, told Salon in general that as more states pass six-week bans, it leads to an increase in travel across state lines. In 2023, Guttmacher Institute estimated that around 171,000 people traveled to access abortion care, which is more than double the number who traveled across state lines in 2019 or 2020.

“Any ban in one state has impacts on many others, because many folks are often looking to see where they can get care in neighboring states,” Maddow-Zimet said. “Often they're traveling, sometimes from very far distances to access that care, and that care often comes with a lot of costs.”

Such costs can be financial, but also put strain on patients via upticks in wait times and appointment availability. 

When Florida’s six-week abortion went into effect, it created almost a “wall in the south," according to Serra Sippel, interim executive director of The Brigid Alliance, an organization that helps facilitate abortion travel and logistical support for people who are 15 weeks pregnant or more. Sippel told Salon that since the Florida ban, the Brigid Alliance has helped more than 56 people travel out of the state for abortion care, with the average itinerary costing $2,842. It’s estimated that only one in three Americans can comfortably cover a $400 emergency expense.

“With what’s happening in the Midwest, it's almost like the walls are closing in,” Sippel said. “There is not enough support and help out there, abortion funds are strained in terms of resources, and not having enough resources.” 

Lyz Lenz, board co-chair of the Iowa Abortion Access Fund, told Salon the abortion fund had long been preparing for the detectable heartbeat bill to go into effect. She emphasized the fund is operating and available to help Iowans seeking access to abortion care. It partnered with the Chicago Abortion Fund (CAF), a non-profit organization that provides medical referrals and funds to people who are facing barriers to access abortion services, to better connect patients with clinics and providers. However, like other abortion funds across the country, money is tight. 

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“We’re just trying to tell Iowans who we are, that we're still here, that we're still operating and then fundraising to meet that need,” Lenz said. “It's also important for people to know that this has ripple effects, that this is going to affect every single Iowan no matter what.” 

Chelsea Souder, the co-owner of Hope Clinic in Granite City, Illinois, said while they are expecting a surge in patients from Iowa shortly, the clinic has already seen one over the last year from Iowa. 

“We already saw in 2024 about a 400 percent increase in patients from Iowa, and that was before this ban took effect,” Souder said. “I think that's for a lot of reasons, there's a lot of confusion, many states around Iowa have also lost access, and Iowa had access, but it also a lot of hurdles for people to jump through to be able to get that access, like multi-day appointments.” 

On average, Souder said, a patient travels to Hope Clinic at least 225 miles one way. 

“If you're coming to Hope Clinic from even the far east side of Iowa, that's at least a three-and-a-half hour drive,” Souder said. “We've already seen sort of the ripple effect happen with Iowans, and I think we'll definitely see a larger increase now since Monday.”

The effects of Iowa’s ban will especially be felt in its neighbor, Illinois. Since Dobbs overturned Roe, Illinois has already seen an influx in patients from the south. Data from the Society of Family Planning #WeCount found that after Dobbs, Illinois saw the biggest increase in out-of-state abortions. Florida, a state that now also has a six-week ban, saw the second biggest increase. The bordering states of Florida, Alabama and Georgia, also face near-total bans. California saw the third biggest increase in out-of-state abortions.

“Any time there is a new ban, no matter where it is, it sends the whole kind of system out of whack,” Megan Jeyifo, executive director of Chicago Abortion Fund told Salon. “We are no longer seeing a regional implication of a ban, but it pretty quickly has national implications as the service area for getting an abortion shrinks.” 

That’s because, Jeyifo elaborated, every state that has a ban or gestational limit was not just serving their own community, but also a community from another state. 

“We would routinely support people going from Nebraska to Iowa," Jeyifo said. “So it’s not just Iowans who are losing access, but people around the Midwest, that may have been depending on Iowa, will also lose that access."

Illinois has built a robust infrastructure to handle the surge, and its state legislature is supportive. Most recently, Democratic Governor J.B. Pritzker signed the Birth Equity Act, a legislation aimed to ensure reproductive health care access, including abortion care, across the state. As part of the act, Illinois-based health insurance must cover abortion care without extra costs like co-pays or deductibles. Still, many in the abortion fund space wonder how much more Illinois can handle. 

“We’ve had a 165% increase in callers from Iowa in the first three weeks of July, when abortion was still legal, and so that was just a response to the chaos, misinformation and fear,” Jeyifo said. “I do remain optimistic about our state and optimistic about what our state can teach other receiving states, but Illinois cannot carry the entire country or the entire Deep South, or even the entire Midwest.”