The number of abortions performed in Iowa has been dropping despite access to abortion services within a two-and-a-half hour drive for most Iowans and through telemedicine.
The number of induced abortions in Iowa dropped from 5,399 in 2010 to 4,020 in 2014, the last year for which the Iowa Department of Public Health has data.
Ten abortions were performed in 2014 for every 100 births in the state, down from 16 abortions for every 100 births in 2006 through 2008, data reviewed by IowaWatch shows.
Reasons for fewer abortions vary. They include:
? An increase in contraception use, including among low-income women with access to contraceptives through Medicaid expansion.
? Reproductive health care education, in schools but by both organizations opposed to legal abortion and those supporting it.
? A decrease in the number of intended pregnancies.
? Fewer teen pregnancies. A study by The National Campaign to Prevent Teen and Unplanned Pregnancy, a Washington-based group whose stated goal is to reduce unplanned pregnancies, showed that Iowa’s teen birth rate of 19.8 births per 1,000 teen girls was down 10 percent from 2013 to 2014 and 53 percent since 1991.
Attention to Iowa’s abortion access comes during several high profile events dealing with abortion rights, most notably the June 27 U.S. Supreme Court ruling that struck down regulations in Texas that made getting an abortion more difficult than in other states.
The ruling was significant because some states have attempted to emulate Texas’ restrictions. The Supreme Court majority opinion written by Justice Stephen Breyer criticized Texas’ laws for forcing women to travel long distances to receive an abortion.
“Really, compared to other states, Iowa is in much better shape in terms of access to abortion,” said Laura McGraw, director of communication for the Iowa Abortion Access Fund, an organization started in 1978 offering women $100 to $200, depending on economic standing to help pay for abortions.
Nine of Planned Parenthood’s 12 clinics in Iowa offer abortion services, mainly through telemedicine. Iowa is one of only three states allowing teledicine abortion. Moreover, clinics like the Emma Goldman Clinic for Women in Iowa City, which opened in 1973 immediately after the U.S. Supreme Court declared abortion rights to be legal, also provide abortion services.
“We don’t have the things to fight like they do in Texas,” Clare Smith-Larson, a Des Moines woman favoring abortion rights, said.
Abortion access also has been under fire in Iowa from those opposed to abortion trying to defund Planned Parenthood, which provides abortion as one of its reproductive health care services, and which has closed clinics in Iowa.
PLANNED PARENTHOOD’S LARGE ROLE
The closures were a business decision, Penny Dickey, Planned Parenthood of the Heartland’s chief clinical officer, said.
“As good stewards of our resources, we chose to move staff and equipment to the locations where demand was higher,” Dickey said. “This sometimes means that we have decided to close an under utilized center in one location in order to better meet the needs in another location.”
Planned Parenthood of Iowa is part of Planned Parenthood of the Heartland that covers Iowa, Nebraska, Eastern Oklahoma and Arkansas. Clinics closed in the other states, too. The organization’s annual reports show a decline in the number of people who have used clinics in the four states:
? Fiscal 2015: 48,072 people.
? Fiscal 2014: 59,989 people.
? Fiscal 2013: 72,948 people.
? Fiscal 2012: 64,095 people.
In fiscal 2012, when seven Planned Parenthood clinics in Iowa closed, Planned Parenthood of the Heartland operated with a $4.3 million deficit, financial documents inspected for IowaWatch in a Simpson College journalism class reporting project showed.
|Planned Parenthood of the Heartland Funding for Fiscals 2012-2015|
|Source: 990 IRS tax forms|
The list of closed Planned Parenthood clinics since 2011 in Iowa includes rural areas or area served by Iowa’s smaller cities, such as Creston, Red Oak, Mount Pleasant, Washington, Spencer, Fort Madison, Storm Lake, Newton and Knoxville. Clinics also were closed in Ankeny, Fort Dodge, Dubuque and Des Moines and another facility, The Family Practice in Des Moines, was relocated to the existing Rosenfield center in the city, Planned Parenthood officials said.
“We closed our programs in Red Oak and Creston so we can serve people where there is greater population density,” Dickey said. “Medical providers are hard to come by. Being able to staff clinics were we travel two hours in one direction versus where we can have them some place where there is a higher demand.”
While the Emma Goldman Clinic in Iowa City and the University of Iowa Hospitals and Clinics offer abortion services, Planned Parenthood is the nation’s number one abortion provider. The organization points out that 80 percent of its clients receive pregnancy prevention services and that abortion comprises 3 percent of its business.
Abortion opponents have focused on Planned Parenthood, attempting to defund the organization. The Republican-controlled Iowa House passed a bill this year that would have eliminated state funding of Planned Parenthood but Democrats in the Senate were able to strike a compromise. While state funds may not be used directly for abortions Planned Parenthood may receive state funds under the compromise.
TWO WOMEN, TWO ABORTIONS, TWO VIEWPOINTS
The views Clare Smith-Larson and Jocelyn Fry have about abortion rights are about as wide as the three decades that separate the abortions they had. Smith-Larson had an abortion in 1975, Fry in 2004, both in Des Moines.
Smith-Larson, a then-married mother of two, struggling to pay her bills while in a distant relationship with her then-spouse, sought her abortion two years after the 1973 U.S. Supreme Court Roe v. Wade decision that legalized abortion.
Initially denied an abortion by her general practitioner due to his moral reservations about the operation and what Larson-Smith said was the unsettled nature of her marriage, Larson-Smith eventually found an avenue for her then-$150 operation with Planned Parenthood.
“That was the toughest decision I had to ever make,” Smith-Larson, now 71, said. “I had two teenage kids and a husband who was unreliable, this I was taking care of the bills on my own. I had an intake interview with Planned Parenthood and they scheduled me pretty quickly.”
Fry was in different circumstances in 2004.
Twenty years old, homeless, unmarried and already providing for one child, Fry found herself pregnant again. Fry said she received pressure from her boyfriend to get an abortion.
Together they went from house to house and made phone calls to family members to raise enough money to fund the abortion.
“I didn’t find it to be difficult whatsoever in terms of access,” Fry recalled. “I was well acquainted with Planned Parenthood by being a gynecologist client previously.”
Since then Larson-Smith, who has not had any more children, has become a staunch supporter of Planned Parenthood and the movement to keep abortion legal.
Fry, who has had given birth to five more children, is a volunteer speaker and advocate for Iowa Right to Life.
|ABORTIONS IN IOWA 2004-2014|
|Year||Surgically induced||Medically induced||Other induced||Spontaneous||Total induced Abortions||Total births||Induced abortion rate / per 100 births|
|Source: Iowa Department of Health annual Vital Statistics of Iowa reports|
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WHY THE DOWNWARD TREND?
Nationally, 9.7 abortions were performed for every 1,000 women of reproductive ages of 15 to 44 in 2011, a 14 percent decrease since 2008 when it was 11.3, the Guttmacher Institute reported in 2015.
Pregnancy numbers, overall, decreased significantly from 40,835 in 2007 to 39,685 in 2014, Iowa Department of Public Health statistics show.
The study, led by M. Antonia Biggs of the Bixby Center for Global Reproductive Health at the University of California, San Francisco, found that the number of family planning clients using long-term reversible contraception increased from 539 in 2005 to 8,603 in 2012.
Dickey, with Planned Parenthood of the Heartland, said access to contraceptive methods such as injections and intrauterine devices has improved as insurance providers cover their costs.
Fry said she looks at education from the standpoint of having been pregnant. She said she doesn’t think she would have had her abortion if she had been educated on fetal development and the status of her child during ultrasound testing.
“The biggest regret that I had in regards to my abortion is that I had a lack of education,” Fry said. “I was a high school dropout and didn’t have that information.”
A Guttmacher Institute study, “Abortion Incidence and Service Availability in the United States”, concluded that reduced demand for abortions has forced the closing of abortion clinics, not the other way around. The “national abortion rate has resumed its decline, and no evidence was found that the overall drop in abortion incidence was related to the decrease in providers or restrictions implemented between 2008 and 2011,” the study’s authors wrote.
ACCESS TO TELEMEDICAL ABORTIONS
Planned Parenthood clinics in Ames, Bettendorf, Burlington, Cedar Falls, Council Bluffs, Dubuque and Sioux City offer telemedicine abortions while Des Moines’ Rosenfield Center and Iowa City offer both surgical and medication abortions.
Telemedicine has changed the playing field for rural residents in Iowa.
In 2008, Iowa was the first state to offer telemedical abortions to aid residents in rural Iowa who cannot make a trip for a physical meeting. Two other states, Minnesota and Maine, offer this option at clinics.
Earlier this year, Gynuity Health Services announced a study in four states — Hawaii, Oregon, New York and Washington — to test a mail-order abortion drug for women in the first nine weeks of pregnancy. The patients are able to consult with a doctor via video on taking the drug. The study was announced after researchers led by Gynuity senior medical associate Dr. Elizabeth Raymond wrote in a JAMA Internal Medicine article that telemedicine would improve access to abortions, especially in states where access is difficult to obtain.
In telemedical abortions, doctors remotely supervise medical professionals who give clients medication that induces an abortion. This is open to women who are less than 10 weeks into pregnancy.
Planned Parenthood of the Heartland leaders argue that telemedicine is needed to rural Iowans.
The Iowa Board of Medicine had reservations about the practice, claiming it was unsafe, but the Iowa Supreme Court disagreed, allowing the practice to continue.
“The Iowa Supreme Court looked at our rules and laws and decided that there are things like women’s rights that are greater than our laws,” Iowa Board of Medicine Executive Director Mark Bowden said. “Telemedical abortions are something that would be very hard to make illegal in Iowa.”
An American Journal of Public Health study has concluded that “telemedicine could improve access to medical abortion, especially for women living in remote areas, and reduce second-trimester abortion.”
The reasoning for this, according to the study’s authors, was thathad their odds of obtaining both medical abortion and abortion before 13 weeks’ gestation and “women living farther than 50 miles from the nearest clinic offering surgical abortion were more likely to obtain an abortion after telemedicine introduction.”
Brock Borgeson reported and wrote this story as part of an IowaWatch/Simpson College journalism reporting project in spring and summer 2016. IowaWatch’s Lyle Muller and Brittany Robb, who was a member of the IowaWatch/Simpson journalism class project in spring 2016, contributed to this report.