Letter to the Editor from Iowa medical providers regarding abortion as health care
July 19, 2022
To The Editor:
(Note: Read the published letter here.)
As physicians and advanced practice providers from across the State of Iowa who care for women, we are compelled to outline our concerns for their healthcare after the recent SCOTUS decision Dobbs v. Jackson Women’s Health which overturned prior precedent of autonomy and privacy for women. While abortion and contraception remain legal and available in Iowa for now, we are concerned about future legislation that has the potential to negatively impact the health and autonomy of our patients.
We have conversations daily with women about medical conditions that may adversely affect a pregnancy or vice versa. Complications that can arise in pregnancy are complex, different for every person, and often unpredictable. We are highly trained medical professionals, yet we cannot foresee every pregnancy complication; therefore, policymakers cannot be expected to do so. We are concerned that maternal outcomes will be adversely affected in Iowa if more restrictive abortion legislation is enacted. Maternal outcomes have already suffered in Texas after legislation that significantly limited abortion was signed into law in September 2021. 1 Furthermore, legislation restricting abortion may worsen inequities in maternal health outcomes for people of color and those with limited economic resources. The pregnancy-related maternal mortality rate in Iowa for non-Hispanic Black women is currently six times higher than
the rate for non-Hispanic White women. 2
Some states have passed legislation that defines life as beginning at conception and these laws threaten medical advances such as in vitro fertilization (IVF) and medicated intrauterine devices (IUDs). IVF accounts for 2% of all births in the United States. Defining life as beginning with fertilization, even outside a woman's body and restricting a patient’s autonomy over their own embryos will result in reductions of pregnancy rates. Medicated IUDs are used for medical conditions such as endometriosis, irregular menstrual bleeding or to prevent cancer of the uterus. Some states have targeted IUDs under restrictive legislation despite little evidence that their mechanism of action is to prevent implantation of an embryo. We hope our legislators can appreciate that farreaching legislation can have inadvertent consequences that place lives at risk. These reproductive health decisions, including abortion, should be made after an informed individual in consultation with a trusted healthcare provider.
And finally, physician staffing in Iowa may worsen if additional legislation is passed to restrict abortion and healthcare for women. Recruitment and retention will be more difficult and physician training programs could lose accreditation, resulting in closure. Highly restrictive laws will make this state much less attractive to outstanding physicians who desire to practice evidence-based medicine utilizing the best treatments for helping patients in need. The State of Iowa is understaffed for Family Medicine and OBGYN physicians and this deficit is projected to worsen by 2030. 3 - 4 Since 2000, 40 rural Iowa hospitals have closed their maternity units. 5 This has resulted in maternity care deserts in 29 Iowa counties. 6 Women often drive 2 hours or more, one way, for prenatal care. These hardships will worsen with legislation that impairs reproductive and medical autonomy for patients and their physicians. 7
We implore the policymakers for Iowa at the State and Federal level to collaborate with us, the physicians and advanced practice providers who provide healthcare to the women of Iowa. We advocate for public policy that maintains bodily autonomy and privacy for women, does not restrict medical practices designed to improve the health and fertility of women and sometimes saves their lives. Give us a seat at the table, so that we can learn from one another and find the common ground we all desire: Improved health and well-being for women and infants in our state.
Andrea Greiner, MD and numerous others
1 Nambiar A, Patel S, Santiago-Munoz P, Spong CY, Nelson DB, Maternal morbidity and fetal outcomes among pregnant women at 22 weeks’ gestation or less with complications in two Texas hospitals after legislation onabortion, American Journal of Obstetrics and Gynecology (2022), doi: https://doi.org/10.1016/j.ajog.2022.06.060.
2 https://s3.amazonaws.com/cdn.smfm.org/mortality_records/134-:state_slug.pdf, accessed 7/5/2022
3 https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/projections-supply-demand-2018-2030.pdf. Accessed 7/5/2022
4 https://www.ama-assn.org/about/masterfile/ama-physician-masterfile. Accessed 7/5/2022.
5 Access to Obstetrical Care in Iowa: A report to the Iowa State Legislature – Calendar year 2019. Division of Health Promotion & Chronic Disease Prevention – Bureau of Family Health, January 2021.
6 https://www.marchofdimes.org/peristats/datareg=99&top=23&stop=641&lev=1&slev=4&obj=9&sreg=19. Accessed 7/5/2022
20-2018.pdf. Accessed 7/5/2022