Reproductive health care in Iowa ‘not going anywhere’

While the abortion landscape across the country has changed dramatically since the overturn of Roe v Wade, Francine Thompson is confident abortion care isn’t going anywhere.

“I’ve been here for 36 years, and there’s been a number of challenges—and a number of potential threats—to not being able to provide abortion over those years,” Thompson said.

Thompson is the executive director of the Emma Goldman Clinic, a reproductive health clinic in Iowa City that has been around since 1973. It offers OBGYN services, performs surgical abortions once a week, and provides medication abortion through a participating pharmacy.

The threats Thompson mentioned have included legal restrictions but also the availability of doctors. Nonetheless, she said the clinic has always been able to continue services.

Dobbs decision and Iowa’s temporary 6-week ban

Even the 2022 overturn of Roe—the long-standing Supreme Court ruling that overturned Americans’ constitutional right to abortion—hasn’t had as big an impact on the Emma Goldman Clinic as it could have.

That’s partly because abortion is still legal in Iowa until around 20 weeks of pregnancy, while the legality of a six-week ban passed by Iowa Republicans this year is decided by the Iowa Supreme Court. The six-week ban was active for only three days, none of which were when the clinic normally provided abortions anyway.

“The 24-hour wait period happened right about the same time [as Dobbs]. And so we were implementing that,” Thompson said.

The 24-hour waiting period was passed in 2020 and the Iowa Supreme Court ruled it enforceable in 2022. It requires patients to wait at least 24 hours between their abortion consultation and actually ending their pregnancy. Thompson said adjusting to that has been one of the largest changes in the last year.

“Not the things that we do during the visit, because those are unchanged,” she said. “But just that they need to be done 24 hours before a person can actually have a surgical abortion done or get medications for a non-surgical procedure.”

Traveling from out of state

The biggest changes, Thompson said, are the anger and confusion people feel and the higher number of people who are now forced to travel out of state to get the care they need.

People were already coming to Iowa for abortions because, even prior to 2022, multiple states had restrictive abortion bans. Now those numbers have increased.

“We are seeing folks who are just confused and challenged by the different regulations in the different states,” Thompson said. “That also creates an atmosphere of frustration and anger. And so often the clients we see for appointments come in already frustrated that they had to travel to another state, or they had to travel 4-6 hours or sometimes even longer.”

‘Folks will do what they need to do’

Thompson said navigating restrictions is one more stressor for patients on top of an unwanted, unplanned pregnancy. The clinic often sees patients from rural areas and from far away, and they’re increasingly performing surgical abortions because appointment wait times are too long for medication to be effective.

That hasn’t stopped patients from coming, and Thompson knows it won’t.

“It’s been shown that folks will do what they need to do in order to seek abortion services, whether it’s [to] find funding or travel, or have a method that’s based on the length of their pregnancy—even though that might not be the initial method that they might have preferred,” she said.

And the clinic is determined to treat everyone they can, even if they have to set up two appointments to comply with the 24-hour waiting period.

Care will continue

Thompson said she isn’t hopeful exactly, but she’s realistic and practical that abortion care will continue in Iowa.

As a small, independent clinic, Emma Goldman Clinic is able to adapt to changes in the law, even if they’d rather not have to, Thompson said. Election results across the country showing Americans support abortion rights also give her hope.

“We figure out what we need to do to continue to offer the service with as little disruption and changes as possible, but still in compliance with the law,” Thompson said. “Even if we have a total ban in Iowa, people will still seek abortions.

“People will still need reproductive health care that abortion is a part of,” she continued. “The clinic’s not going anywhere. Abortion isn’t going anywhere, [even] if there’s a total ban. We [wouldn’t] be able to provide those services, but [we would] be able to continue to stay open and serve the folks of the Midwest with high-quality reproductive health care.”