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 health care after the recent Supreme Court decision Dobbs v. Jackson Women’s Health, which overturned precedents that protected 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. 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.
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 patients' 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 far-reaching 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 health care provider.
And finally, physician staffing in Iowa may worsen if additional legislation is passed to restrict abortion and health care 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. Since 2000, 40 rural Iowa hospitals have closed their maternity units. This has resulted in maternity care deserts in 29 Iowa counties. Women often drive two hours or more, one way, for prenatal care.
These hardships would worsen with legislation that impairs reproductive and medical autonomy for patients and their physicians.
We implore the policymakers for Iowa at the state and federal levels to collaborate with us, the physicians and advanced practice providers who provide health care to the women of Iowa. We advocate for public policy that maintains bodily autonomy and privacy for women and 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.
This essay was signed by 92 Iowa medical providers. They are: Andrea Greiner, MD; Stephanie Radke, MD; Jennifer Schuchmann, MD; Diana Kaufman, MD; Prapti Singh, MD; Karla Yancy, MD; Brad Van Voorhis, MD; Bennett Stephens, MD; Francesca Turner, MD; Allie Wampler, MSN, ARNP, WHNP; Rei Christian Calma, MD; Alice May CNM, ARNP; Emily Welder, MD; Jeff Quinlan, MD; Rebecca Winnike, MSN, ARNP, CNM; Sarina Martini, MD; Kate Thoma, MD; Kelsey Lee Wagner, MD; Meghan Connett, MD; Jill Endres, MD; Emily Boevers, MD; Shelby Green, MD; Emily Hill, MD; Whitney Cowman, MD; Abigail Mancuso, MD; Karl Meierding, MD; Elizabeth Boggs, MD; Jessica Baer Karnell, MSN, WHNP-BC; Hakan Duran, MD; Abbey Hardy-Fairbanks, MD; Laura Dellos, ARNP, CNM; Alex Dickenson, MD; Kelly Ferroni, MD; Kim Kenne, MD; Amber Goodrich, CNM, ARNP, MSN, FACNM; Colin Johnson, MD; Michael Haugsdal, MD; Miriam Murray, MD; Marika Raff, MD; Erika Testani, DO; Holly Bolger, DO; Marygrace Elson, MD; Brandy Mitchell, DNP, ARNP; Erin Haeger, MD; Abbey Merryman, MD; Maren Bettermann, MD; Allison Allen, MD; Sarah Rabice, MD; Silvia Villagomez, ARNP; Stephen Pedron, MD; Maureen Boyle, MD; Elizabeth Graf, PA; David Bedell, MD; Yulia Matveeva, MD; Alexandra Hubbell, DO; Stacey K Neu, MD; Michele Martins, MD; Cynthia Williams Hoque, DO; Sarah Ledger, DO; Megan Sloat, CNM; Brooke Knope, CNM; Tana Perry, MD; Kristin Orr, MD; Avery Whitis, MD; Lindsey Jenkins, MD; Dana Aybout El Sayed, ARNP; Francesca Turner, MD; Heather Marthers, MD; Lindsey Northness, ARNP; Shannon Leveridge, MD; Jessica Kresowik, MD; Cindy Haugsdal, ARNP; Alysha Reese, ARNP; Niral Tilala, MD; Carolyn Martin, MD; Alison Seline, MD; Amy Bingaman, MD; Clare Harney, MD; Abbi Madden, DO; Emily Lange, MD; Ann Forcey, CNM; Autumn Schmoker, CNM, ARNP; Brooke Knop, CNM; Khara Keegan, CNM; Bonnie Beer MD; Cameron Hinrichsen, DO; Crystal Iddings APRN-CNM; Rachel Hayward MSN, CNM; Aubree Remsburg, CNM, ARNP; Mattea Otten CNM, ARNP; Dawn Rohrer, CNM; Cynthia Wong, MD.
This article originally appeared on Des Moines Register: 92 Iowa medical providers: Please protect women's health