Doctors say new abortion rules might limit women’s access to health care

New proposed rules for Iowa doctors who perform abortions might further reduce the state’s number of women’s health care providers — which is already the lowest per-capita in the country — according to several doctors.

“As a obstetrician-gynecologist practicing in a rural area, I consider myself scarce — I’m a rarity,” said Dr. Emily Boevers, an OB-GYN at the Waverly Health Center in northeast Iowa. “I think it’s very important that the board consider the impact of these rules on physicians that are out in practice, attempting to care for patients that are in the maternal health deserts and the underserved areas in Iowa.”

Boevers provided the comments to the Iowa Board of Medicine on Thursday during a public hearing that was meant to elicit feedback on new rules it is considering for the state’s physicians. No one testified Thursday in support of the rules as written. The board is expected to discuss the rules and feedback at a meeting next week.

Those rules are the result of a restrictive abortion law adopted last year by state lawmakers that would bar most abortions after about six weeks of gestation. A judge temporarily blocked the law from taking effect shortly after its passage, and the Iowa Supreme Court is considering the law’s constitutionality.

The proposed rules would require a physician who intends to perform or induce an abortion to make a “bona fide” attempt to detect a “fetal heartbeat” using an abdominal ultrasound before proceeding.

“This effort must be made in good faith and according to standard medical practice and reasonable medical judgment,” the proposed rule says.

Opponents of the new law say the phrase “fetal heartbeat” is a misnomer when it refers to the earliest detectable cardiac activity of a developing embryo. Embryos become fetuses at the end of the 10th week of pregnancy, according to the National Library of Medicine.

The rules also use the term “woman” to describe the person who is seeking an abortion, while in practice the person might be younger than 18.

“I would recommend this board strongly work with the state government to find some clarity in terms of these clinical issues,” said Dr. Steven Wahle, of Cedar Rapids. He did not specifically say what parts of the new rules need clarification.

Wahle helps lead the UnityPoint Health – St. Luke’s Hospital and said ambiguity in the new rules might make it more difficult to retain and recruit medical specialists.

“This does affect some of our residents coming out of training, where they’re going to practice,” he said. “Physicians are very risk averse.”

A doctor who fails to comply with the new rules or the new law might be subject to fines of up to $10,000 and license revocation.

Dr. Rebecca Shaw, a long-time OB-GYN who teaches at Des Moines University, said her medical students might choose to work in another state because of the new rules.

“Iowa already has a significant problem with workforce, especially as it applies to women’s health,” she said. “I would hope that we do not do something that further sets us back in time with regard to our workforce and patient care.”

The law has exceptions for pregnancies that result from rape and incest, and for pregnancies that threaten the life of the patient.

The proposed rules require doctors to query their patients who seek a rape or incest exception, part of a “good-faith assessment that the woman is being truthful.”

“The physician … may require the woman to sign a certification form attesting that the information she gave was true and accurate to the best of the woman’s understanding,” the proposed rules say.

Dr. Boevers, the OB-GYN in Waverly, said those requirements might hinder doctors’ abilities to foster trusting relationships with their patients.

“Treating our patients as people that need to be interrogated about their traumas and treating providers as extensions of the government … is going to jeopardize our ability to form a bond with our patients and provide them good care,” Boevers said. “It’s also going to jeopardize our ability to recruit and retain providers in the state.”

The Board of Medicine is set to meet Jan. 11 and 12.