A bill making moves in the Iowa legislature would restrict access to medications that induce abortion.
Senate Study Bill 3115 would require an in-person exam with a physician for abortion medications. Those medications include mifepristone, misoprostol, as well as any other Food and Drug Administration-approved measure used to intentionally terminate a pregnancy.
The bill also mandates that healthcare providers inform the patient about potential risks and outcomes of the abortion inducing drug, including a health advisory of trauma associated with the medication’s administration and the possibility to reverse the procedure.
The bill passed out of subcommittee Feb. 9. It needs to be voted on in committee by Friday, Feb. 20, or it will die.
Republican Sen. Jason Schultz is the chair of the subcommittee overseeing this bill. Schultz is in favor of it to address what some proponents are calling a “black market” system of obtaining abortion medications.
“Out of state dispensers — some of them based off of websites, none of them being licensed in Iowa — are sending products into Iowa that we have no basis of knowing the dosage, whether it’s even the proper compound,” Schultz said. “The intent is if you are going to use these drugs, it is in person with a licensed medical professional in a licensed facility.”
Tom Chapman, executive director and lobbyist for the Iowa Catholic Conference, said the organization has worked on this issue for more than 10 years and “is not supportive of abortion rights in general.”
However, he agreed that the bill’s primary strength is ensuring abortion medications have an in-person consultation with a physician.
“If abortion drugs are going to be provided, we think they should be provided in a medical setting,” Chapman said. “Our concern is [that] right now, if people go to a website, they can order the pills without a subscription or without a prescription. It’s very affordable, and they show up in a baggie. And so what we’re trying to do is at least get the medical people involved.”
Anna Wilson, the president of Students for Reproductive Justice at Drake University, believes the bill intentionally targets accessibility.
“They’re banning it from being distributed virtually because that is the most accessible and safe way for a lot of people,” Wilson said. “And that is taking this possibility away from a lot of individuals out there.”
Supporters of the bill are citing safety concerns in their rationale for mandating in-person doctors’ visits for abortion medications. Opponents of the bill argue that such a requirement unfairly limits healthcare access by obstructing telehealth and mail-in options.
Iowa Democratic Rep. Austin Baeth, who is an internal medicine physician, said he voted “No” on the bill because it’s harmful.
“We, first of all, live in a state that has the poorest access to OB [obstetrics] providers in the country,” Baeth said. “And to require women to have an in-person exam before receiving this medication further hampers a woman’s ability to access care.”
Given access concerns, Chapman said that his organization’s objective in supporting this bill is not to impede on virtual options that widen healthcare reach.
“We’re definitely not trying to get rid of telehealth. That’s a big deal in the medical world now,” Chapman said. “I know Catholic Charities, for example, use it for mental health counseling in rural areas. So our goal is definitely not to get rid of telehealth. … But our preference would be an in-person visit for sure on this [abortion medication] issue.”
However, Baeth said the bill eliminates telemedicine options, which rural Iowa relies on.
“In Iowa, there are only three OB-GYNs per 10,000 women,” Baeth said. “If we’re going to eliminate the ability for these women to receive care through telehealth, it’s going to further exacerbate our healthcare deserts.”
Critics of the bill are concerned by the wording of the two warnings about these medications in lines 24-28 in the bill:
- “That women using abortion-inducing drugs have suffered trauma from seeing the remains of the unborn child in the process of a chemical abortion.”
- “That it may be possible to reverse the intended effects … but time is of the essence.”
Wilson said the specific language chosen for the trauma warning “perpetuates very harmful rhetoric” that is not scientifically sound.
“These drugs are only FDA approved for up to 10 weeks [of] gestation when the fetus is about the size of a strawberry,” Wilson said. “The language … invokes an image of a fully gestated and viable fetus being born and expelled, and that’s not the case at all.”
Regarding the reversal counseling piece of the bill, Schultz is “not totally sure where we’ll end up on that.” While the product the bill refers to, progesterone, “is shown to work in many cases, it’s off-label,” Schultz said.
The FDA has approved progesterone for preventing preterm birth or treating menstrual cycles, but it’s never been approved for “reversing” a chemical abortion. The American College of Obstetrics and Gynecologists says medication abortion reversal is not scientifically supported, and “represent[s] dangerous political interference and compromise[s] patient care and safety.”
Like Schultz, Chapman acknowledged concerns about the lack of medical credibility to support promoting abortion reversal.
“Definitely, there are actual medical clinics who are doing the reversals … and there’s real life babies that result after … it can’t always be reversed, depending on the timing. But to us, that’s a reality. And I know there might be some changes to the bill in that regard,” Chapman said. “But we think it’s legitimate enough that people should find out about it, and then they can make their decision.”
Baeth said that those success numbers are not statistically representative.
“That legitimacy is based on a case series of six human patients, and then a couple [of] studies involving rats,” Baeth said. “It’s just laughable from the point of medical science that there would be any sort of mandate for doctors to declare that this is any sort of possible treatment based on such [a] little, minuscule amount of data.”
Being a legislator with a medical background is particularly frustrating, Baeth said.
“I’ve witnessed so many lawmakers pretending that they are doctors, and people are getting hurt because of it,” Baeth said. “My advice to people is to develop a close and trusted relationship with a good doctor. And listen to their opinion. And go with that instead of whatever laws come out of this state capitol that is currently run by amateur, wannabe medical professionals.”
