The number of abortions in Iowa fell last year, after two years of increases

There were fewer Iowa abortions in 2021 than in 2020, marking the first time in three years that the annual number of abortions has decreased in the state. 

Iowa Department of Public Health spokesperson Sarah Ekstrand said there were 3,761 abortions in Iowa in 2021, according to preliminary data. That's down about 7% compared to 2020, when 4,058 abortions were performed in the state. 

Annual reports show the number of Iowa abortions increased from the previous years in both 2019 and 2020. However, these days, abortions are less frequent than they were in the mid-2000s, when pregnancy terminations numbered more than 6,000 per year.

Iowa mirrors national trends on abortion. Data compiled by the Centers for Disease Control and the Guttmacher Institute show legal abortions declined overall over the past several decades, then increased in the late 2010s. 

Ekstrand said the official count for 2021 is subject to change when the state releases its full Vital Statistics of Iowa Report in the fall. But she said she does not expect the number to "shift drastically."

Why have abortion numbers declined since the mid-2000s? 

Sheena Dooley, communications manager for Planned Parenthood North Central States, attributed the long-term decrease in abortions to several factors: the increased use of long-term birth control, and new laws restricting abortion in Iowa and across the U.S.

"Any and all restrictions to abortion access result in a decrease in abortion care," Dooley wrote in an email. "These additional barriers make it much more difficult to access care and patients are sometimes forced into pregnancy because they cannot access safe and legal abortion."

Several Iowa Planned Parenthood clinics closed in 2017, Dooley said, "as a result of the policies of Iowa politicians who want to ban abortion in the state," as well as health care worker shortages and retiring physicians. 

Planned Parenthood is the largest provider of abortions in Iowa.

Kristi Judkins, executive director of the anti-abortion group Iowa Right to Life, suggested abortions were decreasing due to more individuals choosing to carry their pregnancies to term — including "the positive influence that pregnancy resource centers and the information on fetal development is having with regard to women choosing life affirming options."

However, Judkins raised concerns that the 2021 data may not accurately reflect the number of medication abortions performed in the state, as some Iowans access abortion pills online. Dooley said there's been an increase in self-managed abortion in recent years.

"There is no way to say how much this has contributed to the decrease, but they will certainly play a larger role in the future," Dooley said.

Ekstrand confirmed that the state does not track self-managed medication abortions. 

As abortions rose in 2019 and 2020, groups on either side of the issue disagreed about what was driving the trend.

Democratic lawmakers and Planned Parenthood representatives pointed to a 2017 decision to withdraw from a federal family planning program. Instead, the state introduced its own family planning program — and barred Planned Parenthood from participating.

Opponents of abortion argued that a 2018 Supreme Court decision was behind the increase. The court ruled that abortion was a fundamental right under the Iowa Constitution. That decision, however, was overturned in June.

Maggie DeWitte, executive director of the anti-abortion group Pulse Life Advocates, said Tuesday that people tend to "follow the laws."

"I think that that had an impact on how people were looking at abortion law in Iowa... and I think we were seeing the results of that in our abortion numbers," DeWitte said.

Abortion remains legal, but further restrictions may be imminent

Abortion is legal in Iowa until about 20 weeks of pregnancy. But it may not be legal for long.

Recent state and federal court decisions cleared the way for anti-abortion lawmakers to adopt new restrictions on the procedure. Gov. Kim Reynolds has called on the courts to reinstate a 2018 law that would ban most abortions after about six weeks of pregnancy. 

Plus, lawmakers are working on a constitutional amendment that would state Iowa does not recognize the right to an abortion.

However, a spokesperson for the anti-abortion Family Leader group cautioned that Iowa may see an increase in abortions until the state passes more restrictions on the procedure.

"Because Iowa’s abortion laws are significantly more lax than our neighboring states, such as South Dakota and Wisconsin, we should expect Iowa to become an abortion destination state for women traveling to abort their children," said Drew Zahn, communications director for the group.

A July Des Moines Register/Mediacom Iowa Poll found a majority of Iowans, 60%, believe abortion should be legal in most or all cases. A majority of Iowans also object to the proposed constitutional amendment, and they oppose a six-week ban.

Katie Akin is a politics reporter for the Register. Reach her at kakin@registermedia.com or at 410-340-3440. Follow her on Twitter at @katie_akin.