The Joseph F. Rosenfield Reproductive Health Clinic in Des Moines is like a domino that is still standing but could fall at any moment. Abortion is still legal in Iowa until 20 weeks after fertilization, but the state’s Governor, Republican Kim Reynolds, announced last week that she will do everything she can to end it. She is racing to bring the state’s abortion policies into line with the recent Supreme Court ruling that overturned Roe v. Wade, the 1973 decision that gave constitutional status to this right. Her decision does not coincide with the majority opinion reflected in the polls, but with the Supreme Court’s decision to give states back the power to regulate abortion. In fact, an estimated 26 out of 50 states will ban it.
While Washington is still in a political-judicial stalemate, the war for women’s reproductive health is now being fought from state to state. Last week, organizations advocating “the right to choose” challenged the legislation in 11 states and managed to detain them in four. Among this confusion is the vast and predominantly conservative Midwest region, where some of the fiercest battles are being fought between the two sides.
In Iowa there is a law, blocked by judges, that would reduce the limit to six weeks, which in practice looks a lot like a ban. Reynolds, who is fighting for her seat in the November election, has already managed to pass a law that requires women, for both surgical abortions and pill-taking, to attend two doctor’s appointments at least 24 hours apart. In the first, the patient must sign a consent form, receive information about alternatives to discontinuation, have an ultrasound and have the option to see it. In the second, the procedure can be performed or the woman can be given pills. This proposal aims to urge pregnant women to reconsider their decision. But Elizabeth Nash, from the Guttmacher Institute, an independent research organization in the United States, warns that, according to her studies, “92% don’t need to think twice: they made their decision in advance”.
Megan Amato, a registered nurse who has worked in downtown Des Moines for 15 years, explained last week that the legislative reform presented a logistical nightmare for workers to relocate patients who had already made an appointment. Like most sexual and reproductive health clinics in the United States, the Des Moines center belongs to the Planned Parenthood network. “It’s just another way to keep us from doing our jobs,” she said. Director Jordawn Williams added that the victims of this reform will largely be those women who are forced to travel miles to receive the attention they are denied at home. Iowa borders three of the seven states (Wisconsin, South Dakota and Missouri) that have already banned abortion in the last week, so the Rosenfield clinic (one of seven Planned Parenthood centers in Iowa, of which only two, this one included, provide surgical abortions) became a test case in the Midwest.
Women are coming here from all over the country. An anonymous doctor at the center spoke to EL PAÍS and revealed that she had just seen a patient from New Orleans who had traveled about 1,500 kilometers. How this woman could afford it, she asked at clinics state by state, until she received the first available consultation in Iowa.
The women traveled from states like Texas and Oklahoma – where restrictive laws began to take effect – to downtown Des Moines and others across the country. The center’s director calculated that in a single day last week they treated a record 42 patients. “Those who don’t have the resources and can’t afford a hotel drive for hours,” she explained. She gave the example of a woman, who represents many people in the US, forced to travel long distances: this woman lives in Dubuque (Iowa) and traveled three hours for her first appointment (and another three hours for her return trip). Two days later, she had to travel another six hours for her second appointment.
If the Des Moines domino falls, the pressure the center is now under will shift to places where abortion remains legal, Illinois in particular. Neighboring to the east, it has become an island of tolerance in post-Roe America, surrounded by states where abortion is already banned, soon to be banned, or where restrictions are about to be imposed.
A five-hour road separates Des Moines from Flossmoor, south of Chicago, where one of Illinois’ 29 abortion clinics is located. Employees there are working 24 hours a day, EL PAÍS was informed by the Mary Jane Maharry health center, an affiliate of Planned Parenthood in that state. The peace in this quiet suburb is disturbed every morning by anti-abortion activists who protest “in groups of at least five,” says pregnant assistant Beatriz González, who posed for a photo in the recovery room, where patients rest for 45 minutes after surgery. quick intervention.
Planned Parenthood has 17 centers in Illinois, where abortion has been covered by Social Security (Medicaid) since 2017. They see about 60,000 patients annually and have been preparing, says Maharry, “since 2016, when Donald Trump came to power.” what they hoped for: that the most conservative Supreme Court in eight decades, created by the former president and in collaboration with Senate Republican leader Mitch McConnell, would work to remove a right that women in the United States had exercised through century. In the past, they have seen about 1,000 out-of-state patients, according to Maharry. Now they expect “between 20,000 and 30,000 a year”. “We’ve started to see a dramatic increase since Texas passed this law in September,” she explains. “Our online search went crazy between Friday and Saturday. And on decision day [June 24] we get twice as many calls as usual.”
The Flossmoor center opened in 2018. In 2020, they opened another one up north in Waukegan to accommodate women from neighboring Wisconsin, where abortion is prohibited. The clinic receiving the most pressure in the state of Illinois belongs to Planned Parenthood’s affiliate for Southwest Missouri. Located in Fairview Heights, it is 20 km from St. Louis, across the border from the Mississippi River.
Yamelsie Rodríguez, president of the clinic, explained that before the Missouri attorney general rushed to ban abortion after the ruling (it took about 20 minutes), the Saint Louis clinic had seen about 1.3 million women. in reproductive age. Now these women will be served on the other side of the border, in facilities that “opened in 2019 in a strategic and discreet way”. During the legislative period that is ending, Rodríguez recalls, Missouri tried to pass a law that would prohibit patients from traveling to another state for intervention. “They didn’t make it, but they warned that they will try again in due course,” she adds.
And they are certainly not the only ones: preventing this exodus is one of the goals of the anti-abortion movement in the United States. A story last week in The Washington Post states that a conservative Chicago law firm, the Thomas More Society, has prepared model legislation that will be made available to states that require it. Inspired by Texas law, he invites citizens to sue anyone who helps a woman travel for a termination. The Justice Department has confirmed that it will challenge these regulations, and the issue was addressed in the Supreme Court’s decision to overturn abortion. Conservative Justice Brett Kavanaugh called this an obscure controversy. He wondered if these bans were legitimate. “In my opinion,” he said, “based on the constitutional right to travel interstate, the answer is no.” Of the 52,780 abortions that the Guttmacher Institute claims were performed in 2020 in Illinois, about one in five women traveled from another state.
Rodríguez does not, however, intend to sit back and wait for more restrictions to be imposed, as Republicans no longer hide their aspiration to pass a bill that would ban abortion at the federal level. The clinic she runs expects an additional 14,000 patients this year (on top of the 8,000 seen on average). “Now we open six days a week, but to meet demand we will expand to seven days; We also plan to increase the number of service providers and are working with the Governor of Illinois [Democrat J. B. Pritzker] pass a law that would allow qualified nurses to prescribe medication for abortion,” he warns.
As for abortion pills, which were used on half of terminations in 2020 in the United States (again, according to the Guttmacher Institute) – there is also a war going on. Compared to places like Illinois, where a remote consultation is sufficient (although to receive medications by mail you must order them from a phone or a computer whose IP is registered within the state), in Iowa the entire process must be face-to-face. . to stare. Pills are banned in places like Missouri and South Dakota, where a law came into effect on Friday that threatens severe penalties for prescribing abortifacient drugs without a license from local authorities. This rule was created to prevent doctors in other states from treating South Dakota patients. In response to this move, Planned Parenthood clinics in Montana, a neighbor to the north, announced that they will require applicants to prove residency, to avoid putting their doctors in legal trouble.
Des Moines’ anonymous doctor explained that they too are under enormous pressure. In addition to what is already an ordeal (many, like her, do not live in the same city where they work to avoid problems), the threat of committing a crime and the dilemma of having to choose between obeying the law or the Hippocratic Oath is already an reality in the most restrictive states. “There are already stories of women going into ectopic pregnancies, and in order to intervene, doctors must prove that they are unstable and that their blood pressure has dropped dramatically before they can be treated. Otherwise, they risk imprisonment,” she explained. Exceptions, governed by specific laws, such as rape or incest, are also problematic. Women must first file a police report in order to have access to a safe, legal abortion. Many of the victims of these new laws are undocumented immigrants who fear deportation if they go to the authorities.
All in all, the doctor says this is the most rewarding job she’s ever had. “When they come to me, patients are faced with a vital dilemma. I help them take control over their future. And that happens many times a day,” she says. “The idea of a future where you can’t do that anymore, where your hands are tied, is really heartbreaking.” She says she’s optimistic and can only hope that the Iowa domino tile stays strong and doesn’t fall.
Edited by Xanthe Holloway.