Most abortions will soon be illegal in Iowa after six weeks of pregnancy following the Iowa Supreme Court’s decision Friday to overturn a lower court’s block on the 2023 abortion law.

The 4-3 decision allows enforcement of the law that was previously blocked by a temporary injunction in a case challenging Iowa’s law restricting most abortions after six weeks of pregnancy.

Abortion remains legal in Iowa for now, until the case returns to the district court for further proceedings, according to American Civil Liberties Union of Iowa. That will take at least 21 days under Iowa court rules, according to ACLU of Iowa, and abortion will remain legal during that time.

The law bans abortions after cardiac activity can be detected in an embryo, with exceptions in cases of rape, incest, and when the medical procedure is necessary to save the life of the mother. To qualify for an exception to the law, people must report the rape resulting in pregnancy within 45 days to law enforcement or a public health agency or doctor, and within 140 for cases of incest.

Embryonic cardiac activity can typically be detected as early as six weeks of gestation. Reproductive health care advocates have argued that many women do not know they are pregnant at six weeks, and that the law would effectively make most abortions illegal in Iowa. Abortions were previously legal in Iowa up to 20 weeks of pregnancy.

The lawsuit was brought forward by Planned Parenthood of the Heartland, the Emma Goldman Clinic — both health care providers that perform abortions — as well as Dr. Sarah Traxler and ACLU of Iowa.

The ruling states that the Iowa law is serving a legitimate state interest, and thus can be upheld legally.

“Every ground the State identifies is a legitimate interest for the legislature to pursue, and the restrictions on abortion in the fetal heartbeat statute are rationally related to advancing them,” Justice Matthew McDermott wrote in the majority opinion. “As a result, Planned Parenthood’s substantive due process challenge fails. The district court thus erred in granting the temporary injunction.”

Governor praises decision

Gov. Kim Reynolds, a supporter of the measure, alongside Senate Majority Leader Jack Whitver and House Speaker Pat Grassley, praised the court decision in a news release Friday.

“There is no right more sacred than life, and nothing more worthy of our strongest defense than the innocent unborn,” Reynolds said in a statement. “Iowa voters have spoken clearly through their elected representatives, both in 2018 when the original heartbeat bill was passed and signed into law, and again in 2023 when it passed by an even larger margin. I’m glad that the Iowa Supreme Court has upheld the will of the people of Iowa.”

Iowa Democratic Party Chair Rita Hart wrote in a statement that the decision strips Iowa women of “reproductive rights that they have maintained for more than 50 years.”

“It’s obvious Kim Reynolds and Iowa Republicans do not trust women to make their own decisions regarding their own medical care or for doctors to use their best judgment while treating their patients,” Hart said in a statement. “Republicans went too far with this abortion ban, and Iowa voters will hold them accountable this November.”

Reynolds signed the six-week abortion ban into law after convening the Legislature for a special session in July 2023. That session followed a state Supreme Court decision in June of the same year to uphold the injunction on the 2018 so-called “fetal heartbeat” law, a similar measure.

Justices were split in a 3-3 decision on the case, upholding a lower court’s decision to enjoin the law. The 2018 abortion law was previously ruled unconstitutional, but Reynolds challenged the decision following major changes to abortion law at both the state and federal levels. In June 2022, the U.S. Supreme Court ruled in Dobbs v. Jackson Women’s Health Organization that there was no constitutional right to an abortion, overturning the 1973 Roe v. Wade precedent and allowing states to enact abortion restrictions.

Since the U.S. constitutional protections for abortion lifted, multiple states have enacted restrictions or total bans on abortion. Most states surrounding Iowa have enacted laws limiting the procedure since 2022, according to information compiled by the Guttmacher Institute. South Dakota and Missouri have near total abortion bans with limited exceptions. Nebraska has restricted abortion at 12 weeks of gestation, and in Kansas and Wisconsin, abortions are currently legal up to 22 weeks of pregnancy.

Minnesota and Illinois have the fewest restrictions, allowing abortions to be performed until “fetal viability” — when a fetus is able to survive outside the uterus, typically around 25 weeks of pregnancy. Exceptions are granted for this limit in cases where the procedure is necessary to save the life of the woman, or if their health is at risk.

Days prior to the U.S. Supreme Court’s Dobbs decision, the Iowa Supreme Court found there is no state constitutional right to an abortion. That decision came in a case on the state law requiring a 24-hour waiting period and ultrasound for patients seeking an abortion.

While the state Supreme Court overturned the strict scrutiny legal standard for abortion laws — a test requiring a law serves a “compelling state interest” and uses the least restrictive means possible — Iowa Supreme Court Justice Edward Mansfield wrote that “we do not at this time decide what constitutional standard should replace it.”

‘Strict scrutiny’ legal standards

The arguments made in court about the 2018 abortion ban largely centered around what legal standard should replace “strict scrutiny” for Iowa abortion laws. But in the decision upholding the injunction, the Iowa Supreme Court did not put forward a new standard.

During oral arguments in April, attorneys representing Iowa and reproductive health care providers and advocates argued for what legal standard should replace “strict scrutiny” for Iowa abortion laws.

Eric Wessen, representing the state, called for the “rational basis” test to be used  — a lower standard that means a law is constitutional if the state has a legitimate reason to enact it. Attorney Peter Im, representing Planned Parenthood and the ACLU of Iowa, argued for the “undue burden” test, a standard higher than “rational basis” that requires laws not be too burdensome or restrictive of an individual’s fundamental rights.

The court sided with the state in the case, with McDermott writing that the Supreme Court holds “that abortion restrictions alleged to violate the due process clause are subject to the rational basis test.”

“Employing that test here, we conclude that the fetal heartbeat statute is rationally related to the state’s legitimate interest in protecting unborn life,” McDermott wrote.

The case was returned to the district court to “dissolve the temporary injunction and continue with further proceedings,” he wrote.

Chief justice dissents

In a dissenting opinion, Chief Justice Susan Christensen wrote that she “cannot stand by this decision,” holding there is no fundamental right to terminate a pregnancy under the state constitution.

“The majority’s rigid approach relies heavily on the male-dominated history and traditions of the 1800s, all the while ignoring how far women’s rights have come since the Civil War era,” Christensen wrote. “It is a bold assumption to think that the drafters of our state constitution intended for their interpretation to stand still while we move forward as a society. Instead, we should interpret our constitution through a modern lens that recognizes how our lives have changed with the passage of time.”

Christiansen wrote in the opinion that the majority opinion was too reliant on the state constitutional text adopted in 1857, during a time when women were not granted the same rights as men in the state. In the decision concluding abortion is not a fundamental right under the state constitution, Christiansen wrote “the majority perpetuates the gendered hierarchies of old when women were second-class citizens.”

Mansfield: Rule ‘gives no weight to a woman’s autonomy over her body’

Justice Edward Mansfield also wrote a dissenting opinion, reflecting on his dissent in 2018 to a ruling on the state’s 72-hour abortion waiting period that found abortion was protected by the state constitution and subject regulations to “strict scrutiny” review.

In that decision, Mansfield wrote that both sides are seeking to address important issues – “a woman’s autonomy over her body” as well as preserving “human life.”

“I remain of that view,” Mansfield wrote in the dissent published Friday. “But the court around me has shifted. So, instead of a constitutional rule that gives no weight to the State’s interest in human life, we now have in Iowa a constitutional rule that gives no weight to a woman’s autonomy over her body.”

He wrote that the “rational basis” test is not an appropriate measure for determining the constitutionality of abortion laws.

“I believe that subjecting a near-total ban on abortion to a rational basis test — the same test we apply to traffic cameras, and a more forgiving test than the one we apply to a law not allowing county auditors to correct defective absentee ballot applications — disserves the people of Iowa and their constitution,” Mansfield wrote.

Potential effects beyond abortion

State regulations on abortion following the 2022 Dobbs decision have caused challenges for people seeking to access other reproductive health care, like in vitro fertilization (IVF), in some states. The Alabama Supreme Court’s February ruling that found frozen embryos outside the womb are “children” caused multiple providers to cease IVF services until the governor signed a law providing certain protections to clinics and manufacturers of products used in IVF treatments.

The Alabama decision cited a 2018 state constitutional amendment stating “it is the public policy of this state to recognize and support the sanctity of unborn life and the rights of unborn children, including the right to life.” Reproductive health care advocates rallied against states enacting so-called “unborn personhood” language, often supported by anti-abortion proponents, in the wake of the decision because of concerns over the language’s impact on IVF access.

In March, Iowa House lawmakers passed a bill to raise penalties for the nonconsensual ending of a pregnancy that would have changed the language on these crimes from referring to the termination of a “human pregnancy” to the “death of an unborn person.” The legislation was tabled by Senate Republicans over concerns about the bill’s “unintended consequences” related to IVF access, Sen. Brad Zaun, R-Urbandale told reporters.

Reynolds said in a Friday statement that as the six week abortion law takes effect, she and GOP leaders will “continue to develop policies that encourage strong families, which includes promoting adoption and protecting in vitro fertilization (IVF).”

“As the heartbeat bill finally becomes law, we are deeply committed to supporting women in planning for motherhood, and promoting fatherhood and its importance in parenting,” Reynolds said in a statement Friday. “… Families are the cornerstone of society, and it’s what will keep the foundation of our state and country strong for generations to come.”

Access to abortion medication has also been questioned following the 2022 Dobbs ruling. However, the U.S. Supreme Court ruled earlier in June that mifepristone, a pharmaceutical that can be used to terminate pregnancies, can remain available under the U.S. Food and Drug Administration’s prescribing guidelines.

This article first appeared in the Iowa Capital Dispatch, a sister site of the Nebraska Examiner in the States Newsroom network.