Iowa’s fetal heartbeat law, House File 732, which was signed into law by Governor Kim Reynolds in 2023, will go into effect on Monday, July 29. The law has been temporarily enjoined from enforcement since last July, however a 4-3 decision from the Iowa Supreme Court last week, and a subsequent motion from District Court Judge Jeffrey Farrell dissolving the temporary injunction, will allow the law to go into effect on July 29.
The law bans abortions, with exceptions for rape, incest, non-viability of the fetus and for medical emergencies, after a fetal heartbeat can be detected, which occurs as early as six weeks into a pregnancy. The rape and incest exceptions require reporting to law enforcement, a public health agency, or doctor within 45 days for rape, and 140 days for incest.
The Iowa Supreme Court reads the fetal heartbeat law to employ a narrower medical emergency exception than Iowa’s existing 20 week abortion ban, carving out both “psychological conditions, emotional conditions, familial conditions, or the woman’s age” and “when continuation of the pregnancy will create a serious risk of substantial and irreversible impairment of a major bodily function of the pregnant woman” from the definition of medical emergency. Planned Parenthood of the Heartland, Inc. v. Reynolds ex rel. State, 2024 Iowa Sup. LEXIS 74, 2024 WL 3209943, at 64.
Iowa Code Chapter 146A includes a number of prerequisites that a physician performing an abortion must complete, including a written certification from the pregnant woman 24 hours prior to the abortion that she has undergone an ultrasound, an opportunity to view the ultrasound and hear a description of the ultrasound and heartbeat, and has been provided information regarding alternative options to abortion, risks associated with abortion and materials developed by the State. The Iowa Code Chapter 146A abortion prerequisites do not apply in the event of an abortion performed in a medical emergency.
Iowa providers should be aware that they are still obligated to comply with the Emergency Medical Treatment and Labor Act (EMTALA) mandate to provide necessary stabilizing treatment to patients presenting with emergency medical conditions. EMTALA preempts Iowa law to the extent that it conflicts with EMTALA. The issue of EMTALA pre-emption was addressed in June, 2024 by the U.S. Supreme Court which allowed an order by a federal judge in Idaho to remain in place that temporarily blocks the state from enforcing a similar abortion ban, to the extent that it conflicts with EMTALA. Hospitals and physicians should review the CMS guidance which addresses the EMTALA obligations of hospitals and physicians in light of new state laws prohibiting or restricting access to abortion.
