What women can do when most abortions are banned in Iowa

With an interest in reproductive rights, I did some research to find out how a young woman (or girl) not intending to have a child might navigate this new legal landscape.

• Dr. Timothy Olson is a psychiatrist practicing in Des Moines and a lifelong Iowa resident.

The Iowa Supreme Court ruled June 28 that the state can hijack a woman’s body if it has a reason (“rational basis”). This means that the “fetal heartbeat” law, passed last year by the Republican-controlled Legislature and signed by the governor, can soon take effect.

The law is intended to force a woman (or girl) to bear a child. Pregnancy and childbirth threaten the health of the woman. Among other things, in about 30% of cases, she must have a cesarean section. The law caters to religious groups that consider intrauterine life the spiritual equal of a woman.

The “fetal heartbeat” can be detected by Doppler ultrasound at 6 weeks, before many women know they are pregnant. At this stage, the embryo — not yet a fetus — is about the size and shape of a pea. It is life, but not what most people would call a child.

More: As Iowa’s ‘fetal heartbeat’ abortion ban looms, clinics prepare for an uncertain future

The law is backward and cruel, but it is the law. I am a medical doctor with a specialty of psychiatry, not obstetrics. But with an interest in reproductive rights, I did some research to find out how a young woman (or girl) not intending to have a child might navigate this new legal landscape.

Most obviously, try not to get pregnant. Intrauterine devices and long-term implants are nearly 100% effective, but they are not right for everyone. Other methods often fail due to imperfect use. With condoms, for example, the real-world pregnancy rate approaches 20% per year. Strive to be perfect.

Consider the morning-after pill for contraceptive lapses. Generic levonorgestrel, 1.5 mg, is widely available for about $6. It should be used as early as possible after sex, generally within 72 hours.

Diagnose pregnancy as early as possible. On the first day of your missed period, you are already four weeks pregnant (from the last menstrual period), leaving just two weeks to get an abortion from an Iowa provider. Monitor your periods and test frequently. Pregnancy test strips are available in bulk for about 30 cents apiece.

There are other good reasons for diagnosing pregnancy early:

• An early abortion is less traumatic, physically and emotionally.
• For the 15% of women who are Rh negative, incompatibility risks rise later in the pregnancy.
• An early medication abortion is more likely to be successful.
• If an early medication abortion fails, there is time to repeat it.

If you miss the six-week cutoff in Iowa, you can still get an abortion at a clinic in Illinois (24 weeks), Minnesota (24 weeks), Kansas (22 weeks), Wisconsin (22 weeks), or Nebraska (12 weeks). An abortion in a clinic can be expensive, but financial help is often available.

Desperate women might be drawn to online clinics or pharmacies for a medication abortion, from about 10 to 13 weeks. The clinics violate Iowa law and provide only limited medical support. The pharmacies sometimes provide pills that are counterfeit or expired. As an Iowa physician, I can’t recommend these options.

Although the fetal heartbeat law doesn’t impose penalties on women, there are still legal risks. But if you have an illegal abortion and have problems, don’t hesitate to see a medical provider. Simply say that you think you are having a miscarriage, and ask the provider to avoid sensitive topics unless medically necessary.

If, for whatever reason, you wish to keep your abortion private:

• Tell a minimum number of people about your pregnancy and plans.
• Avoid mentioning your situation in text, email, or social media. Promptly delete any revealing content from all folders, including trash.
• Keep your abortion research private. Put your browser in incognito mode and use the DuckDuckGo search engine.

So, Iowa women, you can still control your own body. You can still choose to have a baby or not. You can still live by your own religious beliefs. Just don’t expect help from your state government.

Dr. Timothy Olson is a psychiatrist practicing in Des Moines and a lifelong Iowa resident.