Iowa doesn’t have enough maternal health care specialists, and that long-standing problem could get worse if the recently passed six-week abortion ban goes into effect.
The ban penalizes doctors for performing abortions if electrical impulses are detected in the fetus. There are limited, vague exceptions for rape, incest, fetal abnormalities that will result in death and exceptions for the life of the mother, but the barriers to get those exceptions are high and ineffective, according to Iowa OB-GYNs.
Ultimately, that could cost Iowa in the number and quality of OB-GYNs the state is able to attract.
“Nobody wants to come in and practice medicine with this government looking over your shoulder, where you feel like you can’t protect your patients and care for them and worry about threats on your own medical license,” said Dr. Amy Bingaman, an OB-GYN at Broadlawns Medical Center in Des Moines.
Across the country, medical students are saying they’re less likely to do their residencies in states with abortion restrictions, and states that have passed restrictions have seen OB-GYNs leave.
Ending a pregnancy can be necessary for a number of reasons, including treating miscarriages where the body doesn’t expel all fetal tissue, starting chemotherapy, and when emergencies happen. Some women also choose to abort if they learn their baby has an abnormality that means they won’t live that long, rather than watch their baby suffer after it’s born.
OB-GYNs are, for the most part, the only doctors who can provide that care.
“If you had a physician who was highly interested [in abortion care], they could seek out additional training. But I will be very honest, I’ve never heard of such a thing. There’s just not a lot of people trained,” said Dr. Emily Boevers, an OB-GYN at Waverly Health Center.
Training in abortion care, or access to abortion training, is required only for OB-GYN residencies as part of the full scope of care they provide. And Boevers said obstetrics and gynecology is a small field.
“The number of people who have training in abortion care in Iowa are the number of OB-GYNs here in Iowa,” Boevers said.
And Iowa doesn’t have very many OB-GYNs. Iowa has the lowest number of OB-GYNs per capita in the entire US, and a third of Iowa’s 99 counties don’t have a single provider.
Small, rural communities are the hardest hit by those deficiencies, with several birthing centers in Iowa closing as of late.
OB-GYNs do much more than abortion care, too: They treat conditions related to reproductive organs and those that affect menstruation, pregnancy, childbirth, and the pelvic floor. That involves screening for cancer, monitoring pregnancies, and more.
In communities without labor and delivery units, delivery outcomes worsen, according to a study conducted by the University of Iowa and published this year in the Journal of Rural Health.
Pregnancy is complicated, even without emergency complications, because a lot of underlying conditions are exacerbated by pregnancy.
“That decision [when to act] will fall to the patient’s physician, ultimately, to have enough information to justify performing an abortion for a patient whose life is at risk,” Boevers said, adding there’s never a clear-cut moment when the scale has tipped toward a woman’s life being in danger. “People need to be prepared to watch women die in early pregnancy because Iowa does not have the medical personnel across the state to deal with emergencies in early pregnancy for everyone.”
Bingaman said Broadlawns is doing a grant-approved, year-long fellowship program with the goal of training people to be OB-GYNs and then having them practice in rural Iowa.
“We have 10 applicants, but a lot of them want to incorporate abortion care into their practice,” Bingaman said. “And so they may not even apply here, interview here, once they learn of the potential legislation happening in Iowa.”
Medical school and residencies are the best ways to recruit and retain qualified workers said Bingaman, who went to medical school at the University of Iowa.
“That’s how I ended up here,” she said.
Nikoel Hytrek
8/29/23
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