Are Pro-Life Laws Harming Iowa Women? An Examination of Claims Against Iowa
Co-authored with Sara Smith
This is Issue 9 of the On Women’s Health Series.
Executive Summary
- Iowa’s abortion law allows for timely and necessary care for pregnant women in a medical emergency. The law permits physicians to use their reasonable medical judgment to determine if a medical emergency exists and what interventions are necessary.
- There is no good reason to think that limiting access to abortion will, in itself, cause overall maternal mortality in Iowa to worsen. In fact, abortion may contribute to the problem of maternal mortality in certain cases.
- Iowa’s abortion law should not impact maternity care providers or make it more difficult to recruit new doctors.
- Iowa has an ecosystem of support for moms and babies. State funding for alternatives to abortion programs, as well as the compassionate work of pregnancy centers in Iowa, can empower women to choose life and prevent coerced and unwanted abortions.
Introduction
Many concerning narratives have arisen in the wake of the U.S. Supreme Court’s Dobbs decision overturning Roe v. Wade, which allowed legislatures to express the will of their citizens by regulating the practice of abortion. While the topic of elective induced abortion is polarizing, with many Americans expressing strong views and nearly everyone having a personal opinion about the morality and legality of the action, presumably all agree that the health of women considering abortion should be prioritized. Thus, it is critical to examine claims alleging harm to women resulting from abortion limitations, so the truth can be uncovered. Although claims abound criticizing obstetric care in most pro-life states, and we have previously addressed claims directed against Texas,[1] this paper will specifically address claims attacking Iowa.
False Claim #1: Abortion laws will prevent quality care in obstetric emergencies, causing Iowa women to suffer severe health consequences.
Amid the changing legal landscape, pro-abortion advocates claim that pro-life laws will prevent women from accessing critical medical care. According to one article published in the Iowa magazine Little Village, “One year after the U.S. Supreme Court overturned Roe v. Wade in the 2022 Dobbs decision, Iowa Gov. Kim Reynolds signed a law prohibiting most abortions except in the earliest weeks of pregnancy. This measure makes getting an abortion in Iowa illegal after six weeks without a special exception. But the permissibility of such exceptions may not always be clear.”[2] Similarly, an article titled “Reckless abortion ruling will harm Iowa women” in The Gazette quoted Chief Justice of the Iowa Supreme Court Susan Christensen saying, “[T]his statute forces pregnant women (and young girls) to endure and suffer through life altering health consequences that range from severe sepsis requiring a limb amputation to a hysterectomy so long as those women are not at death’s door.”[3]
The aforementioned articles claim that the exceptions outlined are unclear and insufficient for protecting the health of the mother. However, a closer examination of the law in question reveals a different reality.
Iowa’s House File 732 states, “A physician shall not perform an abortion upon a pregnant woman when it has been determined that the unborn child has a detectable fetal heartbeat, unless, in the physician’s reasonable medical judgment, a medical emergency or fetal heartbeat exception exists.” Abortion is defined as “the termination of a human pregnancy with the intent other than to produce a live birth or to remove a dead fetus.” Fetal heartbeat is defined as “cardiac activity, the steady and repetitive rhythmic contraction of the fetal heart.” Exceptions are allowed when “the pregnancy is the result of a rape which is reported within forty-five days of the incident the pregnancy, … is the result of incest which is reported within one hundred forty days of the incident … [or] the fetus has a fetal abnormality that in the physician’s reasonable medical judgment is incompatible with life.” The law plainly states that it does not apply when a spontaneous abortion (miscarriage) occurs. Reasonable medical judgment is defined as “a medical judgment made by a reasonably prudent physician who is knowledgeable about the case and the treatment possibilities with respect to the medical conditions involved.”[4]
Elsewhere, Iowa Code 2025, Section 146B.1 defines medical emergency as “a situation in which an abortion is performed to preserve the life of the pregnant woman whose life is endangered by a physical disorder, physical illness, or physical injury, including a life-endangering physical condition caused by or arising from the pregnancy, or when continuation of the pregnancy will create a serious risk of substantial and irreversible impairment of a major bodily function of the pregnant woman.”[5]
Nowhere in the Iowa law is there a requirement that the threat to the mother’s life or substantial impairment of a major bodily function be “immediate” or “certain.” Although the Iowa Supreme Court has not addressed this question, the Supreme Courts of Idaho and Texas have ruled that the risk to a mother need not be immediate, nor a doctor certain that she will die or suffer substantial impairment.[6] Obstetricians do not have a crystal ball that enables them to predict with certainty the outcome of a medical emergency in pregnancy, but they do know which complications could cause a woman to become seriously ill or die. They also cannot predict how quickly she may get sick or whether they can save her life if she does “reach death’s door,” as the Chief Justice of the Iowa Supreme Court, Susan Christensen, stated, promoting fear while failing to clarify the law as other state supreme courts have done. Yet, the law clearly allows a physician to use common sense and clinical experience (another way of saying “reasonable medical judgment”), to determine when and how to intervene.
What potentially life-threatening obstetric complications may require an abortion? Fortunately, most severe pregnancy complications occur in the second half of pregnancy, usually after the unborn child can survive separation from his or her mother. In those circumstances when the pregnancy needs to end, it can end through induced delivery or c-section, allowing pediatricians and neonatologists to care for the baby after delivery, usually protecting the lives of both mother and baby. Rarely, a serious hypertensive emergency,[7] previable rupture of membranes,[8] life-threatening maternal cardiac disease,[9] or other rare emergency[10] may require maternal-fetal separation prior to a gestational age when the unborn child can survive delivery. As we have written and discussed above and elsewhere, Iowa law clearly allows intervention in those circumstances.[11]
Notably, although Iowa’s law does not mention the treatment of an ectopic pregnancy, obstetricians recognize that this abnormal and potentially dangerous pregnancy implanted outside of the normal location in the uterus would be covered under the “life of the mother” exception. Failure to treat an ectopic pregnancy can result in continued growth, possibly leading to catastrophic hemorrhage and even maternal death.[12]
Similar exceptions for the “life of the mother” existed in abortion legislation prior to Roe, but the fearmongering narrative surrounding physician confusion about the exceptions in Iowa and other states’ laws is new. Why are physicians confused? As noted above, pro-abortion media sources have promoted this false narrative. They have then used anecdotal stories of poor medical care unrelated to abortion laws to deceptively imply that the laws prevented intervention, when in fact, it is unclear why physicians delayed care in emergencies.[13] At the same time, professional medical organizations, such as the American College of Obstetricians and Gynecologists (ACOG),[14] both within Iowa and nationally, have failed to provide clarification for their members regarding how to comply with the laws, leaving physicians fearful and hesitant to provide necessary obstetric care in pregnancy emergencies.
Although some doctors fear prosecution if they misinterpret the law, an extensive review of U.S. court decisions reveals that there has not been a physician prosecuted or disciplined for an abortion performed to protect the “life of the mother” from a physical obstetric emergency in over 100 years.[15] Guidance and reassurance for the few physicians who remain fearful or confused will empower them to provide quality medical care and improve the care of Iowa women experiencing pregnancy emergencies. We encourage and welcome future clarification from Iowa professional medical organizations for Iowa physicians who look to them for guidance.
False Claim #2: Limiting access to abortion will cause overall maternal mortality in Iowa to worsen.
An independent news network in Iowa articulated some common fearmongering points:
…pregnancy is not a low-risk condition. Existing medical conditions are often exaggerated, and multiple bodily systems are affected, even without complications such as preeclampsia or the water breaking early … the United States’ maternal mortality risk is higher than any other industrialized country. The problem has only worsened over time. By 2019, 16 in 100,000 live births in Iowa ended in death, according to the Iowa Department of Public Health. In 1999, it was eight in 100,000. For women of color in Iowa, the rate of pregnancy-related death was much higher than for white women. Black women died at a rate of 36.9 per 100,000 live births … For white women, the rate was six deaths per 100,000 live births … Many doctors say this rate will increase as reproductive health care decisions are restricted in the United States. One study published last year found that pregnancy-related deaths would increase by 21% overall and 33% among Black women.[16]
Similarly, a Des Moines Register guest columnist worried, “I am speaking out because I worry about the future my daughter faces. What if she becomes pregnant and is denied life-saving medical care because of a state law? I have seen firsthand the life-threatening dangers women must navigate when religion and politics come before women’s health. I fear we are on that path, heading backward into the world of maternal and infant death I escaped.”[17]
An Iowa Public Radio report stoked more concern by noting, “Nearly all pregnancy-related deaths of Iowa residents between 2019 and 2021 were preventable, according to the most recent state Maternal Mortality Review Committee report.” Although the MMRCs report encompassed years prior to the overturn of Roe v. Wade (2022), the reporter nonetheless concluded with concerns about how abortion restrictions may worsen the problem of maternal mortality.[18]
Further examination of the most recent Iowa Maternal Morbidity and Mortality Review (IMMRC) Committee’s report gives additional information. Twenty pregnancy-related maternal deaths of Iowa women were reported over the three-year time period (2019-2021) when there were approximately 110,598 live births[19]: 30% resulted from infection (often due to COVID-19), 20% from hemorrhage, 20% from embolism, and 30% from other conditions, including mental health conditions. Obesity was the most common contributing circumstance, documented in 40% of the women who died. Notably, 80% occurred postpartum with 25% occurring more than six weeks postpartum.[20] As noted by IMMRC, 19 of the 20 (95%) of the deaths were considered preventable. Iowa’s pregnancy-related mortality ratio (PRMR) was 18.1 deaths per 100,000 live births, up from 9.5 deaths per 100,000 live births between 2016 and 2018 (this increasing trend was seen nationwide during the COVID-19 pandemic).[21] Women of color were disproportionately affected. They made up 21% of the pregnant population yet represented 35% of the pregnancy-related deaths (a trend that has also been noted nationally).[22]
The U.S.’ abysmal maternal mortality rates are horrifying to those of who love women, children, and families.[23] What could be more devastating than for a child to lose his or her mother at birth? For a husband to lose his wife or family members and friends to lose a loved one at what should be one of life’s happiest occasions, the birth of a child? The allegation that Iowa’s legislation could worsen this problem is alarming and needs to be addressed with accuracy and compassion.
It appears the U.S. leads the developed world in maternal mortality[24] despite our affluence and medical advances. This has been the case for decades, including when abortion was readily available in every state. This paradox is a frequently discussed, though often politicized, topic of conversation. But what does this really signify? How is maternal mortality detected, defined, and measured? What events are leading to the deaths of women in proximity to childbirth, and most importantly, how can we impact this crisis?
To begin to unpack this complex topic, we must understand the terms used to describe these deaths. There is no standard definition of “maternal mortality.” Definitions differ depending on the organization compiling the data, how the deaths are investigated (whether relying upon death certificate coding[25] or in-depth analysis of a woman’s medical record[26]) and the length of time (six weeks[27] vs. one year[28]) after the end of pregnancy during which the death is measured. The death of a woman while pregnant or within a given time frame after the end of pregnancy from any cause (even if unrelated to pregnancy) is called a “pregnancy-associated death.” When the death has been determined to be caused by an obstetric complication of pregnancy (direct death), or preexisting disease that was aggravated by the effects of pregnancy or disease that developed during pregnancy (indirect death), it is called a “pregnancy-related death.”[29] Maternal mortality review committees will then make an additional determination, whether the death was “preventable” or might have been avoided with one or more reasonable changes to factors related to the patient, provider, facility, community, or systems, and the MMRCs will then provide recommendations on how deaths might be avoided in the future.[30]
The U.S. Centers for Disease Control and Prevention (CDC) supervises the collection of maternal mortality data, but it relies primarily upon death certificate documentation to identify deaths related to pregnancy for analysis. Unfortunately, many maternal deaths are not documented on death certificates, causing many of these deaths to remain unknown and unexamined. This is especially true for deaths related to early pregnancy events such as induced abortion or miscarriage, for which linkage of death certificates in reproductive-aged women with birth certificates (assigned after 20 weeks of gestation) can’t be performed.[31] Due to numerous data deficiencies related to induced abortion in the U.S., a direct comparison cannot reliably be made of the likelihood of death resulting from childbirth compared to death from induced abortion, although ideologically motivated abortion advocates sometimes advance this false proposition,[32] promoting abortion to high-risk women as a way to protect themselves from maternal mortality.[33]
While it may be commonly assumed that maternal mortality usually occurs due to catastrophic events at childbirth, the good news is that direct obstetric deaths from hemorrhage, sepsis, embolism, and hypertensive crises are improving, accounting for less than half of maternal deaths between 2017-2019. According to data from 46 Maternal Mortality Review Committees in 2021, only 23.2% of maternal deaths occurred on the day the pregnancy ended or within a week of delivery. An additional 29.2% of deaths occurred between 7 and 42 days postpartum. Late maternal deaths, often due to mental health conditions or complications of chronic illnesses, are increasingly documented, accounting for 28.1% of deaths between six weeks and one year after the end of the pregnancy in 2021.[34] Most hospitals employ safety-bundle protocols and implement emergency drills to improve the physicians’ and staff’s detection and response to obstetric emergencies.[35]
Unfortunately, there is a rising incidence of deaths related to chronic medical conditions such as obesity,[36] diabetes,[37] and hypertension,[38] reflecting the poor preconceptual health and advanced maternal age of many American mothers. Additionally, mental health conditions leading to “deaths of despair” from suicide, substance overdose, and intimate partner homicide are adding to the toll. A study examining pregnancy-associated deaths from 2010 to 2019 in 33 states plus the District of Columbia found that drugs, suicide, and homicide contributed to almost ¼ of pregnancy-associated deaths.[39] Indirect contributions from “upstream determinants of health” also impact maternal mortality, including factors such as single motherhood, poor family and community support, poverty, rural location, or difficulties in accessing quality obstetric care.[40]
Although induced abortion is sometimes promoted as a solution to this heartbreaking problem, as the preceding articles implied, very few abortions occur in response to medical factors. In fact, about 96% of U.S. abortions are due to social, economic, or other elective and unspecified reasons.[41]
With these facts in mind, one recognizes that far from being a solution, abortion may contribute to the problem of maternal mortality in certain cases.[42] As mentioned above, every state allows an exception in the exceedingly rare situation that a life-threatening complication requires ending a pregnancy.[43] Contrary to the narrative that abortion is safer than childbirth, records-linkage studies demonstrate that a woman is much more likely to be alive a year following childbirth than following a pregnancy loss, including abortion.[44] It is notable that the racial population most affected by maternal mortality, Black women, is also the population with the highest rates of abortion.[45] High rates of abortions are not protecting these unfortunate women from harm.
Limitations on abortion will prevent later abortions which are more likely to result in a mother’s death. A 2015 analysis of data from the Pregnancy Mortality Surveillance System, for example, found that abortion-related deaths increased from 0.3 per 100,000 abortions at eight weeks of gestation or earlier to 6.7 per 100,000 abortions at 18 weeks or later.[46] Other high-risk abortions may be prevented, such as those that are coerced or unwanted by the woman, multiple repeat abortions, and abortions in women with preexisting mental health disorders, all subgroups of women who are at higher risk of mental health complications following abortion, possibly leading to “deaths of despair.”[47] Hopefully, the lack of easy access to abortion as a “back-up” if contraception is not used or fails will encourage couples to safeguard their sexuality and avoid promiscuous behavior. Modifying sexual behavior and encouraging healthy relationships may eventually lead to fewer single mothers and healthier families, something that we all should applaud for the good of society.
On a final note, surveys indicate the majority of women with a history of abortion would have preferred to give birth if they only had more relationship, material, or financial support.[48] Thus, through the work of this country’s almost 3,000 pregnancy centers (including over 50 in Iowa[49]), many advocates for women are uniquely positioned to impact the heartbreaking problem of maternal mortality by protecting women from the mental health harms of unwanted abortions and helping mothers to access the support they really need in order to give birth to their children.[50]
False Claim #3: Constraints placed on OB-GYNs by the new abortion law will drive the remaining maternity care providers out of the state and make it difficult to recruit new doctors.
According to one article published by CNN, “Health care leaders are sounding the alarm that the constraints placed on them by the new abortion law could drive maternity care providers out of state and deter new ones from coming in, at a time when Iowa desperately needs them.”[51] Similarly, the League of Women Voters published an article written by Dr. Deborah Turner saying:
Earlier this month, I testified alongside two OB-GYN residency students at a hearing around Iowa’s new six-week abortion ban. Understandably, the residents were devastated by the Iowa Supreme Court’s decision to uphold the ban … They had initially planned to provide OB-GYN and reproductive care in Iowa, but because of the Iowa Supreme Court’s ruling, they will leave the state when their training is complete. Their stories show how anti-abortion restrictions are creating reproductive care deserts across the country; Iowans will now be deprived of two practitioners who not only would have provided abortion care but also all other types of obstetric, gynecological care.[52]
One 2023 analysis by the Association of American Medical Colleges (AAMC) seems to support the predictions made above citing data that “fewer new graduates of U.S. medical schools applied to residency programs in states that banned or restricted access to abortion than to residency programs in states where abortion remained legal.”[53] Subsequently, however, a 2025 study of 60,085 OB-GYNs found that “the number of OBGYNs did not significantly change across policy environments, increasing by 8.3% in states where abortion is banned, 10.5% in states where it is threatened, and 7.7% in states where it is protected after the Dobbs decision.”[54] Therefore, the evidence that pro-life laws will drive maternity care providers out of state and deter new ones from coming in is inconclusive at best.
According to another article, published in November 2025, “rural hospitals in Iowa have been struggling to find more OB/GYNs.” The article cites Karla Solheim, chair of the Iowa section of the American College of Obstetricians and Gynecologists, who claims that “the state’s abortion restrictions are still a red flag for some OB-GYNs when deciding whether to practice in Iowa.” However, the article concludes by citing the aforementioned conflicting studies, saying, “It’s still unclear whether abortion bans are driving doctors out of state.”[55]
The above article highlights the burnout that many OB-GYNs experience, perhaps especially those practicing in rural hospitals where it is difficult to recruit and retain physicians. It is important to note that this is not a new phenomenon. Evidence shows high burnout rates and a shortage in OB-GYNs long before the Dobbs decision. According to a 2017 report by ACOG, “The pace of life and its stresses, impact from multitasking, overwhelming information exposure, and electronic medical record expectations have led to some degree of physical or emotional exhaustion or lack of motivation. Physicians have burnout rates that are twice the rate of other working adults, and no area of medicine is immune. [It is] estimated that 40–75 percent of Ob-Gyns experience some form of professional burnout (e.g., losing control, conflicting demands on time, or diminishing sense of worth).”[56]
Another article, published by the Association of American Medical Colleges, cites a variety of reasons for the shortage in OB-GYNs, including the high number of OB-GYNs who are nearing retirement; an inadequate number of residency slots; a higher likelihood of being sued as compared to other medical professions; and the fact that OB-GYNs are among the least compensated of all surgical specialties.[57] Another concerning trend that may contribute to OB-GYN burnout is the number of rural hospital closures across the United States. Based on data compiled by the University of North Carolina, there have been 195 rural hospital closures and conversions since January 2005.[58] As more rural hospitals close, pressure is placed on the remaining hospitals[59] and the number of patients per provider increases.[60] According to the aforementioned article published by the AAMC, “The growing OB-GYN shortage is mostly a matter of demand exceeding supply. In recent decades, the number of U.S. women over age 18 has increased by 33 million — yet OB-GYN first-year residency positions grew by less than 200 between 1992 and 2016.”[61]
Another possible reason for the distribution of residencies across the country is based on medical students’ state ties. At the University of Iowa’s medical school, for example, two-thirds of current students are Iowa residents.[62] This ratio will increase to 80% in future years due to Iowa Legislative House File 516, a bill that went into effect in July 2025 and requires four-fifths of University of Iowa medical and dental students to be state residents.[63] Iowa’s second medical school, the Des Moines University College of Osteopathic Medicine, has a much lower number of students with state ties due to its private status and lack of residency requirements. In fact, the Des Moines University Class of 2028 profile listed that only 16% of students were from Iowa.[64] Between Iowa’s two medical schools, only about 40% of recent classes are Iowa residents, so it is no surprise that most medical students leave the state for residency or to practice.[65]
In the state of Iowa, there are only six OB-GYN residency slots, all located at the University of Iowa. Two of these slots are part of a rural track intended to prepare OB-GYN physicians for the unique challenges present in rural communities with critical access hospitals. Although Iowa has pro-life legislation, the University of Iowa cites the Accrediting Council on Graduate Medical Education (ACGME) as requiring that abortion training be offered as part of the curriculum.[66] Additionally, the University of Iowa OB-GYN residency program is part of the Ryan Program,[67] which requires participating locations to facilitate education and training in abortion.[68]
On Match Day, March 20, 2026, it was announced that all six OB-GYN residency positions had been filled.[69]
In addition to the limited six OB-GYN residency slots, Iowa also offers one single-year OB fellowship for board-certified family medicine physicians. This fellowship is offered through Broadlawns Medical Center in Des Moines and only takes one fellow per year.[70]
Iowa offers many incentive programs for physicians looking to practice in rural areas. The Rural Iowa Primary Care Loan Repayment Program offers up to $200,000 of loan forgiveness, paid out in five increments for every year spent working in cities with a population of less than 26,000 that is more than 20 miles from a city of 50,000 or more people.[71] Additionally, the Health Care Professional Incentive Program, administered through the Iowa Department of Education, works similarly to recruit and retain physicians in high-need areas. This financial award is paid to physicians who agree to practice full-time in a rural area for five years.[72] Finally, the University of Iowa offers a unique rural track for medical students known as the CCOM Rural Iowa Scholars Program, or CRISP. This program operates similarly to the Rural Iowa Primary Care Loan Repayment Program and offers up to $100,000 of loan reimbursement for physicians who agree to work in a rural area for five years.[73]
Restricting abortion will in no way affect the care provided by most obstetricians, as most do not perform elective abortions,[74] and it is unlikely that the restrictions, understood correctly, will cause obstetricians to become reluctant to practice in these states. In fact, it’s possible that the opposite will be the case, as the births of more babies will give obstetricians more opportunities to practice their profession.[75] Most obstetricians enter this specialty because they love to care for two patients, and to help safely bring a new child into the world.
Truth: Iowa has an ecosystem of support for moms and babies.
Iowa has prioritized providing support for pregnant women. Additionally, at least 50 pregnancy centers exist to walk with women through difficult pregnancies.[76]
Iowa is one of 19 states that has authorized some form of alternatives to abortion (A2A) funding to life-affirming Pregnancy Help Organizations (PHOs).[77] These organizations which offer services such as STI testing, parenting classes, post-abortion healing, pregnancy tests, options counseling, and ultrasounds, can be found by women through a helpful map at iowapregnancysupport.com.[78] Additionally, Iowa Health and Human Services has a page titled “Pregnancy Resources” containing a map of Healthy Pregnancy Program Contacts.[79]
The More Options for Maternal Support (MOMS) program, Iowa’s alternatives-to-abortion program, was created in June 2022 by a law signed by Gov. Kim Reynolds. In fiscal year 2024-25, $1 million was allocated for the program.[80] It seeks to promote healthy pregnancies and childbirth by providing funding to pregnancy help organizations and reducing the number of abortions through financial, prenatal, and medical support for mothers in need.[81]
Through their support of women, pregnancy centers in Iowa empower women to choose life and prevent coerced and unwanted abortions.
Conclusions
- Properly understood, Iowa’s laws do not prevent quality medical care in obstetric emergencies.
- There are some reasons to suggest that abortion limitations may improve issues related to maternal mortality in certain respects.
- Most OB-GYNs do not perform elective abortions, so these laws should not impact their practices.
- Pregnancy resource centers are available to help.
Ingrid Skop, M.D., F.A.C.O.G., is Vice President and Director of Medical Affairs for the Charlotte Lozier Institute.
Sara Smith is a research assistant with the Charlotte Lozier Institute. She holds a BA in Public Policy from Anderson University and is pursuing a graduate degree in Applied Ethics and Science Policy from Duke University
[1] Ingrid Skop, “Are Pro-Life Laws Harming Women and Children? An Examination of Claims Against Texas,” Charlotte Lozier Institute, February 12, 2025, https://lozierinstitute.org/are-pro-life-laws-harming-women-and-children-an-examination-of-claims-against-texas/.
[2] Alice Cruse, “Iowa’s Abortion Law Is Dangerously Vague, Iowa Health Providers, Advocates and Democrats Warn,” Little Village, February 17, 2025, https://littlevillagemag.com/iowas-abortion-law-is-dangerously-vague-iowa-health-providers-advocates-and-democrats-warn/.
[3] Editorial Staff, “Reckless Abortion Ruling Will Harm Iowa Women,” The Gazette, June 29, 2024, https://web.archive.org/web/20250726095719/https://www.thegazette.com/staff-editorials/reckless-abortion-ruling-will-harm-iowa-women/; quotation from Planned Parenthood of the Heartland, Inc., Emma Goldman Clinic, and Sarah Traxler vs. Kim Reynolds Ex Rel. State of Iowa, and Iowa Board of Medicine, 23-1145 (Supreme Court of Iowa June 28, 2024), https://www.iowacourts.gov/courtcases/20698/embed/SupremeCourtOpinion.
[4] House File 732, General Assembly of the State of Iowa, https://www.legis.iowa.gov/docs/publications/LGE/90/HF732.pdf.
[5] Abortion – Postfertilization Age, 146B.1 Definitions, https://www.legis.iowa.gov/docs/code/146B.1.pdf.
[6] Tessa Cox et al., “Fact Sheet: Are Pro-Life State Laws Preventing Pregnant Women from Receiving Emergency Care?,” Charlotte Lozier Institute, September 13, 2024, https://lozierinstitute.org/fact-sheet-are-pro-life-state-laws-preventing-pregnant-women-from-receiving-emergency-care/.
[7] ACOG Practice Bulletin 222: Gestational Hypertension and Preeclampsia. Obstet Gynecol 2020;135(6):237-260; ACOG Practice Bulletin 203: Chronic Hypertension in Pregnancy. Obstet Gynecol 2019;133(1):26-50.
[8] ACOG Practice Bulletin 217: Prelabor Rupture of Membranes. Obstet Gynecol 2020;135(3):80-97.
[9] ACOG Practice Bulletin 212: Pregnancy and Heart Disease. Obstet Gynecol 2019;133(5):320-356.
[10] Mary Harned and Ingrid Skop, “Pro-Life Laws Protect Mom and Baby: Pregnant Women’s Lives Are Protected in All States,” Charlotte Lozier Institute, September 11, 2023, https://lozierinstitute.org/pro-life-laws-protect-mom-and-baby-pregnant-womens-lives-are-protected-in-all-states/.
[11] Ingrid Skop, “Abortion Policy Allows Physicians to Intervene to Protect a Mother’s Life,” Charlotte Lozier Institute, May 16, 2023, https://lozierinstitute.org/abortion-policy-allows-physicians-to-intervene-to-protect-a-mothers-life/.
[12] ACOG Practice Bulletin 193: Tubal Ectopic Pregnancy. Obstet Gynecol. 2018;131(3):91-103.
[13] Kavitha Surana, “Abortion Bans Have Delayed Emergency Medical Care. In Georgia, Experts Say This Mother’s Death Was Preventable.,” ProPublica, September 16, 2024, https://www.propublica.org/article/georgia-abortion-ban-amber-thurman-death; Cassandra Jaramillo & Kavitha Surana, “A Woman Died After Being Told it Would be a ‘Crime’ to Intervene in her Miscarriage at a Texas Hospital,” ProPublica, Oct. 30, 2024, https://www.propublica.org/article/josseli-barnica-death-miscarriage-texas-abortion-ban; Lizzie Presser & Kavitha Surana, “A Pregnant Teenager Died After trying to Get Care in Three Visits to Texas Emergency Rooms,” ProPublica, Nov. 1, 2024, https://www.propublica.org/article/nevaeh-crain-death-texas-abortion-ban-emtala; Lizzie Presser & Kavitha Surana, “A Third Woman Died Under Texas’ Abortion Ban. Doctor are Avoiding D&Cs and Reaching for Riskier Miscarriage Treatments,” ProPublica, Nov. 25, 2024, https://www.propublica.org/article/porsha-ngumezi-miscarriage-death-texas-abortion-ban.
[14] Ingrid Skop, “ACOG Peddles Disinformation About Pro-Life Laws, Plays Politics With Women’s Lives,” Townhall, October 11, 2024, https://townhall.com/columnists/ingridskop/2024/10/11/acog-peddles-disinformation-about-pro-life-laws-plays-politics-with-womens-lives-n2646033.
[15] Maura Quinlan and Paul Linton. Medically Necessary Abortions after Dobbs: What, If Anything, Has Changed? Notre Dame Journal of Law, Ethics & Public Policy. 2025;39(1):87-147.
[16] Nikoel Hytrek, “’Life Of The Mother’ Abortion Exceptions Aren’t As Clear-Cut As They Sound,” Iowa Starting Line, May 26, 2022, https://iowastartingline.com/2022/05/26/life-of-the-mother-abortion-exceptions-arent-as-clear-cut-as-they-sound/.
[17] Abby Collins, “I’ve Seen the Horrors Women Endure When Denied Health Care. Iowa’s Abortion Law Scares Me.,” The Des Moines Register, June 9, 2024, https://www.desmoinesregister.com/story/opinion/columnists/iowa-view/2024/06/09/iowa-abortion-laws-dangerous-pregnancy-women-healthcare/73990287007/.
[18] Natalie Krebs, “State Report Finds Majority of Maternal Deaths Were Preventable,” Iowa Public Radio, April 11, 2025, https://www.iowapublicradio.org/health/2025-04-11/state-report-finds-majority-maternal-pregnancy-deaths-preventable.
[19] “Natality Information: Live Births,” CDC Wonder, accessed February 19, 2026, https://wonder.cdc.gov/natality.html; Maternal Mortality Review Committee, “Iowa 2024 Maternal Mortality Report, 2019-2021 Deaths,” 2025, https://publications.iowa.gov/52367/1/MMRC%20Report%202025%20-%20Abridged%20FINAL.pdf.
[20] Maternal Mortality Review Committee, “Iowa 2024 Maternal Mortality Report, 2019-2021 Deaths.”
[21] Ibid.
[22] Ibid.
[23] All text from here through to the end of this section is taken with permission, and with minor changes, from the following previously published blog on the American Association of Pro-Life OBGYNs (AAPLOG) website: Ingrid Skop, “How Can Pro-Life OB/GYNs Impact Maternal Mortality?,” AAPLOG Action, accessed February 20, 2026, https://aaplogaction.org/how-can-pro-life-ob-gyns-impact-maternal-mortality/.
[24] Steven Ross Johnson, “Maternal Mortality: How the U.S. Compares to Other Rich Countries,” U.S. News, June 4, 2024, https://www.usnews.com/news/best-countries/articles/2024-06-04/how-the-u-s-compares-to-other-rich-countries-in-maternal-mortality.
[25] “Maternal Deaths,” World Health Organization, accessed February 19, 2026, https://www.who.int/data/gho/indicator-metadata-registry/imr-details/4622.
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[28] CDC, “Data from the Pregnancy Mortality Surveillance System,” CDC Maternal Mortality Prevention, December 11, 2025, https://www.cdc.gov/maternal-mortality/php/pregnancy-mortality-surveillance-data/index.html.
[29] Ingrid Skop, “Fact Sheet: Introduction to Maternal Mortality,” Charlotte Lozier Institute, December 3, 2025, https://lozierinstitute.org/fact-sheet-introduction-to-maternal-mortality/.
[30] Susanna Trost et al., “Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017-2019,” CDC National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, https://www.suicideinfo.ca/wp-content/uploads/2024/03/Pregnancy-Related-Deaths.pdf.
[31] Ingrid Skop, “Handbook of Maternal Mortality: Addressing the U.S. Maternal Mortality Crisis, Looking Beyond Ideology,” Charlotte Lozier Institute, January 6, 2023, https://lozierinstitute.org/handbook-of-maternal-mortality-addressing-the-u-s-maternal-mortality-crisis-looking-beyond-ideology/.
[32] Ingrid Skop, “Fact Check: ‘Abortion Is 14 Times Safer than Childbirth,’” Charlotte Lozier Institute, April 25, 2024, https://lozierinstitute.org/fact-check-abortion-is-14-times-safer-than-childbirth/.
[33] Ingrid Skop, “Response to Media Allegations That Abortion Restrictions Cause Maternal Mortality and Female Suicides,” Charlotte Lozier Institute, March 21, 2023, https://lozierinstitute.org/response-to-media-allegations-that-abortion-restrictions-cause-maternal-mortality-and-female-suicides/.
[34] CDC, “Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees,” Maternal Mortality Prevention, August 28, 2025, https://www.cdc.gov/maternal-mortality/php/data-research/mmrc/index.html.
[35] Ingrid Skop, “Handbook of Maternal Mortality: Addressing the U.S. Maternal Mortality Crisis, Looking Beyond Ideology,” Charlotte Lozier Institute, January 6, 2023, https://lozierinstitute.org/handbook-of-maternal-mortality-addressing-the-u-s-maternal-mortality-crisis-looking-beyond-ideology/.
[36] Kosisochi E. Achara et al., “Trends and Patterns in Obesity-Related Deaths in the US (2010–2020): A Comprehensive Analysis Using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Data,” Cureus 16, no. 9 (2024): e68376, https://doi.org/10.7759/cureus.68376.
[37] Mushood Ahmed et al., “Type 2 Diabetes Mellitus–Related Mortality in the United States, 1999 to 2023,” JACC: Advances 4, no. 7 (2025): 2, https://doi.org/10.1016/j.jacadv.2025.101882.
[38] Oyinlola O. Fasehun et al., “Trends and Patterns in Hypertension-Related Deaths: A Comprehensive Analysis Using Center for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Data,” Cureus 16, no. 10 (2024): e70754, https://doi.org/10.7759/cureus.70754.
[39] Authors note that the true percentage of pregnancy-associated deaths that suicide, drugs, and homicide account for is likely much higher than their estimate due to the under-use of the pregnancy checkbox when reporting these causes of death. Authors estimated these deaths may contribute to over 40% of pregnancy-associated deaths after accounting for underreporting. Claire E. Margerison et al., “Pregnancy-Associated Deaths Due to Drugs, Suicide, and Homicide in the United States, 2010–2019,” Obstetrics and Gynecology 139, no. 2 (2022): 172–80, https://doi.org/10.1097/AOG.0000000000004649.
[40] Skop, “Handbook of Maternal Mortality.”
[41] Elyse Gaitan et al., “Fact Sheet: Reasons for Abortion,” Charlotte Lozier Institute, May 24, 2024, https://lozierinstitute.org/fact-sheet-reasons-for-abortion/.
[42] Ingrid Skop, “Twelve Reasons Women’s Health and Maternal Mortality Will Not Worsen, and May Improve, in States with Abortion Limits,” Charlotte Lozier Institute, September 22, 2023, https://lozierinstitute.org/twelve-reasons-womens-health-and-maternal-mortality-will-not-worsen-and-may-improve-in-states-with-abortion-limitations/.
[43] Harned and Skop, “Pro-Life Laws Protect Mom and Baby.”
[44] David C. Reardon and John M. Thorp, “Pregnancy Associated Death in Record Linkage Studies Relative to Delivery, Termination of Pregnancy, and Natural Losses: A Systematic Review with a Narrative Synthesis and Meta-Analysis,” SAGE Open Medicine 5 (2017): 2050312117740490, https://doi.org/10.1177/2050312117740490.
[45] James Studnicki et al., “Perceiving and Addressing the Pervasive Racial Disparity in Abortion,” Health Services Research and Managerial Epidemiology 7 (August 2020): 2333392820949743, https://doi.org/10.1177/2333392820949743.
[46] Zane S, Creanga AA, Berg CJ, et al. Abortion-Related Mortality in the United States: 1998-2010. Obstet Gynecol. 2015;126(2):258-265. doi:10.1097/AOG.0000000000000945
[47] Charlotte Lozier Institute, “Fact Sheet: Abortion and Mental Health,” Charlotte Lozier Institute, September 18, 2025, https://lozierinstitute.org/fact-sheet-abortion-and-mental-health/.
[48] David C. Reardon et al., “The Effects of Abortion Decision Rightness and Decision Type on Women’s Satisfaction and Mental Health,” Cureus 15, no. 5 (2023), https://doi.org/10.7759/cureus.38882.
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[50] “NEW: Pregnancy Centers Provided Over $452 Million in Services and Goods to Families,” Charlotte Lozier Institute, November 17, 2025, https://lozierinstitute.org/new-pregnancy-centers-provided-over-452-million-in-services-and-goods-to-families/.
[51] Lauren Mascarenhas, “As Iowa’s Maternity Care Deserts Continue to Grow, Doctors Say the State’s New Abortion Ban Will Only Make Matters Worse,” CNN, August 5, 2024, https://www.cnn.com/2024/08/05/us/iowa-abortion-ban-maternity-care.
[52] Deborah Turner, “One Year After Dobbs: The Emotional Impact of Anti-Abortion Laws,” League of Women Voters, July 26, 2023, https://www.lwv.org/blog/one-year-after-dobbs-emotional-impact-anti-abortion-laws.
[53] Orgera, Kendal, and Atul Grover. “States with Abortion Bans See Continued Decrease in U.S. MD Senior Residency Applicants.” AAMC, May 9, 2024. https://www.aamc.org/about-us/mission-areas/health-care/post-dobbs-2024.
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[56] “Why Ob-Gyns Are Burning Out,” ACOG, October 28, 2019, https://www.acog.org/news/news-articles/2019/10/why-ob-gyns-are-burning-out.
[57] Linda Marsa, “Labor Pains: The OB-GYN Shortage,” AAMC, November 15, 2018, https://www.aamc.org/news/labor-pains-ob-gyn-shortage.
[58] Rural Hospital Closures. University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research. https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/.
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[60] Vaughan L, Edwards N. The problems of smaller, rural and remote hospitals: Separating facts from fiction. Future Healthc J. 2020;7(1):38-45. doi:10.7861/fhj.2019-0066
[61] Ibid.
[62] “2025 Current Class Profile,” Iowa Carver College of Medicine: MD Program, accessed February 20, 2026, https://md.medicine.uiowa.edu/admissions/application-process/current-class-profile.
[63] House File 516, State of Iowa General Assembly, 516, https://www.legis.iowa.gov/legislation/BillBook?ga=91&ba=hf516.
[64] “Class Profile — D.O.,” Des Moines University Medicine & Health Sciences, June 16, 2025, https://web.archive.org/web/20250616135052/https://www.dmu.edu/do/class-profile/.
[65] The Iowa Carver College of Medicine reports that 103 out of the 152 members of the 2025 entering class are Iowa residents: https://web.archive.org/web/20250616135052/https://www.dmu.edu/do/class-profile/; Des Moines University reports that 16% of the 232 members of the class of 2028 are Iowa residents: https://web.archive.org/web/20250616135052/https://www.dmu.edu/do/class-profile/.
[66] Roxy Ekberg, “OB-GYN Students Opt for Residency Programs in States without Abortion Bans,” Politics, The Daily Iowan, October 8, 2024, https://dailyiowan.com/2024/10/08/ob-gyn-students-opt-for-residency-programs-in-states-without-abortion-bans/; Robin Opsahl, “Iowa OB-GYN Future Unclear as Abortion Training Standards Changes,” Iowa Capital Dispatch, August 3, 2022, https://iowacapitaldispatch.com/2022/08/03/iowa-obgyn-education-abortion-unclear/.
[67] “Ryan Program Locations,” Ryan Program, accessed March 5, 2026, https://ryanprogram.org/home/overview/ryan-program-locations/.
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[71] “Budget Unit Brief – FY 2026: Rural Iowa Primary Care Loan Repayment Program,” Legislative Services Agency, July 1, 2025, https://www.legis.iowa.gov/docs/publications/FT/1540888.pdf.
[72] “Health Care Professional Incentive Program,” Iowa Department of Education, accessed February 20, 2026, https://educate.iowa.gov/higher-ed/financial-aid/loan-repayment/health-care-professional-incentive-program.
[73] “CRISP Program Description,” Iowa Carver College of Medicine: MD Program, accessed February 20, 2026, https://md.medicine.uiowa.edu/curriculum/educational-opportunities/ccom-rural-iowa-scholars-program-crisp/crisp-program; Celine Robins, “Building a Rural Health Care Pipeline,” Medicine Iowa, August 22, 2023, https://medicineiowa.org/fall-2023/building-rural-health-care-pipeline.
[74] Sheila Desai, Rachel K. Jones, and Kate Castle, “Estimating Abortion Provision and Abortion Referrals among United States Obstetrician-Gynecologists in Private Practice,” Contraception 97, no. 4 (April 2018): 297–302, https://doi.org/10.1016/j.contraception.2017.11.004; Debra B. Stulberg et al., “Abortion Provision Among Practicing Obstetrician–Gynecologists,” Obstetrics and Gynecology 118, no. 3 (September 2011): 609–14, https://doi.org/10.1097/AOG.0b013e31822ad973.
[75] Tessa Cox and Ingrid Skop, “Dobbs and Medical Deserts: Will Pro-Life Laws Drive Away Doctors and Lead to Hospital Closures?,” Charlotte Lozier Institute, August 27, 2024, https://lozierinstitute.org/dobbs-and-medical-deserts-will-pro-life-laws-drive-away-doctors-and-lead-to-hospital-closures/.
[76] Iowa Pregnancy Support, “Pregnancy Resource Centers.”
[77] Jeanneane Maxon, “Fact Sheet: State Alternatives to Abortion Funding,” Charlotte Lozier Institute, December 18, 2025, https://lozierinstitute.org/fact-sheet-state-alternatives-to-abortion-funding/.
[78] Iowa Pregnancy Support, “Pregnancy Resource Centers.”
[79] “Healthy Pregnancy Program Contacts,” State of Iowa Department of Health and Human Services, August 2023, https://hhs.iowa.gov/media/12716/download?inline.
[80] Maxon, “Fact Sheet: State Alternatives to Abortion Funding.”
[81] Natalie Krebs, “Iowa HHS Contracts with Four Crisis Pregnancy Centers under MOMS Program,” Iowa Public Radio, May 7, 2024, https://www.iowapublicradio.org/state-government-news/2024-05-07/iowa-hhs-contracts-with-four-crisis-pregnancy-centers-under-moms-program.
