Hundreds of Iowans are traveling out of state to get an abortion. Advocates say the relative cost of the procedure, and the lack of available appointments and providers are pushing some to travel hundreds of miles to get care.

In Iowa, patients have until they’re 20 weeks along to get an abortion, with exceptions if the mother’s health is at risk. But hundreds of Iowans are opting to leave the state to get the procedure done elsewhere.

"The legality is always being threatened, but it really becomes a moot point when you're considering that...for some, it's never accessible because they can't afford it." - Jessica Smith, Iowa Abortion Access Fund

The cost of the procedure can be a major factor for patients, according to Jessica Smith. She works for the Iowa Abortion Access Fund, which helps Iowans pay for the procedure, including some who decide to travel to clinics in nearby states like Nebraska and Illinois.

"Price is a huge factor here," Smith said. “The legality is always being threatened, but it really becomes a moot point when you’re considering that…for some, it’s never accessible because they can’t afford it."

The procedure can range from an estimated $0 to $1000, but cost can vary depending on a particular clinic, a patient’s insurance coverage and the stage of the pregnancy.

Advocates say the availability of appointment slots and practitioners can also be a factor, especially in Iowa, which has a shortage of OBGYNs. According to the American Congress of Obstetricians and Gynecologists, Iowa is second only to Arkansas for the lowest rate of OBGYNs per 10,000 people.

State leaders have also cut funding for Planned Parenthood and other family planning services, leading to the closure of some clinics, and fewer Iowans getting care, at a time when researchers say greater access to contraception is helping drive down the nation's abortion rates to historic lows.

"Folks travel to other states because of the limited access where they are. It's not an optimal situation to be outside of your home during the process of an abortion." - Leah Greenblum, Midwest Access Coalition

Advocates say not being able to get an appointment, or one soon enough, can also push patients to look out of state. While stigma against the procedure or a desire for privacy may motivate some, Leah Greenblum says access is more of a factor. She heads the Midwest Access Coalition, which helps patients across the region with travel expenses, housing needs and emotional support.

“Folks travel to other states because of the limited access where they are," Greenblum said. "It’s not an optimal situation to be outside of your home during the process of an abortion.”

While most of the group’s clients are traveling within Illinois, or from nearby Wisconsin and Indiana, patients from Iowa depend on their support as well. In 2018, the Midwest Access Coalition supported Iowans getting an abortion in Illinois, Minnesota and Colorado, helping them travel from communities across the state, including Cedar Rapids, Council Bluffs, Dubuque, Anamosa and Onawa.

"We do see that the political climate is making it really scary for Iowans to think about their futures and their reproductive rights." - Becca Lee, Planned Parenthood of the Heartland

According to public health records, more than 200 Iowans left the state for an abortion in 2017, including 158 to Nebraska, 51 to Minnesota and 7 to Colorado. Practitioners in Illinois served some 5,500 out-of-state patients, but state officials there do not record their residency, so it’s not known how many of those patients are from Iowa.

Advocates argue the state’s changing legal landscape can affect patients' decisions as well. Earlier this year the state’s Supreme Court affirmed Iowans have a constitutional right to an abortion. But laws implementing a ban on abortions after approximately six weeks still faces a court challenge, with another hearing slated for Friday morning in Polk County Court.

"So what we've seen is an increase in the number of bills that have been introduced in the Iowa Legislature that are seeking to restrict access to safe, legal abotion in the state of Iowa," said Becca Lee with Planned Parenthood of the Heartland. "We do see that the political climate is making it really scary for Iowans to think about their futures and their reproductive rights."

Smith says when lack of access and higher costs put abortions out of reach, that means Iowans have unequal access to something that is a constitutional right.

"Funds like the Iowa Abotion Access Funds and so many others are trying to bridge that gap and make it an equal right, and equally accessible to everyone," Smith said. "But it may as well be illegal to those of us who don't have enough money to afford it."