In a trial that begins Monday, Planned Parenthood of the Heartland is taking on a reproductive justice issue that could have national implications. The health care giant is partnering with the American Civil Liberties Union to sue the state of Iowa — alleging the three-day waiting period it imposes on abortion constitutes an undue burden on women seeking to end their pregnancies.
While 27 states enforce some mandatory wait time between abortion counseling and procedure, Iowa is one of six states — others include Missouri, North Carolina, Oklahoma, South Dakota and Utah — with a three-day waiting period. Iowa’s law would require a person seeking an abortion to make two appointments: One where the patient submits to an ultrasound and receives informational materials, and another three days later, when she undergoes the actual procedure.
In states with waiting periods like Iowa’s, the extra days don’t seem to sway women away from abortion — they only drive up its cost.
“This abortion restriction takes us back decades,” Suzanna de Baca, Planned Parenthood of the Heartland President and CEO, said in a statement. “It is among the harshest in the nation and will strip access away from the most vulnerable women who need abortion care.”
“This proposed law puts women’s health at risk by forcing a woman to have an abortion later in pregnancy and risk her health solely for political — not medical — reasons.”
In early May, then-Gov. Terry Branstad signed a bill introducing the 72-hour waiting period and limiting the legal window for abortion to 20 weeks, pregnancies resulting from rape or incest and pregnancies showing life-threatening fetal anomalies excepted.
Planned Parenthood and the ACLU moved to block the law’s enforcement in early May, and if it goes into effect, it won’t do so until the case is decided. But Branstad, who recently resigned his post to accept a U.S. ambassadorship to China, had another parting gift for Iowans: He declined federal Medicaid funds for the state’s family planning program, striking another blow against Planned Parenthood of the Heartlands. The organization shuttered four of its 12 clinics June 30.
Despite the closures, Planned Parenthood remains the foremost reproductive health care provider in Iowa, particularly for low-income women and women living in remote areas. For them, having to make two trips is no small thing: Traveling longer distances to a clinic may mean taking time off work, and scraping together money for gas, meals and accommodations on top of the cost of the procedure. Many abortion patients already have children, which means they may need to find child care, as well.
“Especially in a rural state like Iowa, requiring a three-day waiting period and medically unjustified second visit makes it difficult for women who may have to drive hours to a health center,” ACLU-Iowa legal director Rita Bettis told the Des Moines Register in May, when her organization and Planned Parenthood filed their lawsuit.
The undue burden argument recalls the U.S. Supreme Court’s Whole Woman’s Health v. Hellerstedt decision from June 2016. That case struck down two provisions in Texas abortion law — the requirement that physicians maintain admitting privileges with a local hospital and the requirement that clinics meet the same standards as ambulatory surgical centers — on the basis that they posed no medical advantage, making the legal procedure unnecessarily difficult to access.
As Iowa Public Radio pointed out, a ruling issued in a district court is likely to face appeal in the Iowa Supreme Court. It’s impossible to know what the case’s trajectory could be from there, but if it were to make its way all the way to the U.S. Supreme Court, a decision in Planned Parenthood’s favor could have implications comparable to the Whole Woman’s Health decision, reinforcing abortion’s status as a safe and legal procedure that cannot be regulated without medically valid reason.
Bringing abortion in front of the Supreme Court is not without its risks, however: With the addition of Justice Neil Gorsuch to the bench, President Donald Trump restored the court’s conservative bias. A ruling in Iowa’s favor would undercut Roe v. Wade’s provision that states cannot restrict abortion in the first and second trimesters unless the mother’s health is at risk.
But that’s all hypothetical for now. At the moment, Planned Parenthood is focused solely on advocating for Iowans’ health and choice. According to de Baca, though, Planned Parenthood “will continue to exhaust every avenue to fight back against these extreme legislative attacks on Iowa women.”