If in-state abortion services stop, the University of Iowa may start an Illinois clinic

With the fetal heartbeat abortion ban signed into law, the University of Iowa will be faced with a decision: effectively kill the only obstetrics and gynecology residency program in the state or pay up to $900,000 to keep the program alive.

The "fetal heartbeat" abortion ban signed by Iowa Gov. Kim Reynolds on Friday afternoon restricts nearly all abortions after a fetal heartbeat is detected, which can happen six weeks into a pregnancy. If these abortion services are no longer provided in the state, UI's OB-GYN residency program will not be able to provide the full scope of family-planning training required to be accredited — at least not in Iowa.

More: Nearly all abortions banned in Iowa, as Gov. Kim Reynolds signs 'fetal heartbeat' law

Residents can opt out of training that involves abortions, but the UI program must provide the training to maintain its status with the Accreditation Council for Graduate Medical Education. What that would look like — or cost — if the ban becomes law isn't clear.

Dr. Marygrace Elson, director of the OB-GYN residency program, said the program might be able to form some sort of partnership with an out-of-state clinic. She's not sure if such an arrangement would be possible but says that if she had to put a figure to what that would cost, she'd say around $80,000 per year.

More likely, she thinks, the university would be able to establish its own clinic somewhere just across the border in Illinois, where students might be able to commute to their family-planning rotations. But this would likely cost somewhere around $800,000 to $900,000 per year, and Elson said the university hasn't yet scouted locations.

The outpatient clinic would provide abortions, and likely offer routine gynecological services.

'Funding doesn't grow on trees'

Finding money in the budget for such a project is becoming harder and harder. Faced with a mid-year budget cut, the University of Iowa recently temporarily froze most construction projects to make up a $5.49 million shortfall. Meanwhile, non-tenure track faculty at the university have begun protesting for higher salaries and more benefits after what they describe as decades of stagnant pay.

Whether its $80,000 or $900,000, the funding will have to cut into other programs at the University of Iowa, Elson said.

"It's going to be at the expense of something else, some other educational endeavors," she said. "It's hard to say what will be sacrificed, but funding doesn't grow on trees."

Part of the pipeline

Abortion training, which is included in the family-planning rotation, is just part of the OB-GYN residency training. Residents do two rotations on family planning during the course of four years, which amounts to about two months. UI has roughly one resident per month on this rotation.

If the training moves out of state, residents wouldn't have to spend the entire rotation in Illinois. Elson said the rotation can be restructured so students spend two weeks performing procedures.

Abortions are sometimes performed in other rotations, like the labor and delivery rotation, if there are certain instances of a serious fetal anomaly.

More: What are the exceptions to Iowa's anti-abortion legislation?

Currently, family-planning training is done at Iowa City Planned Parenthood. Without the training, the program will lose its accreditation, though not for a few years. The Accreditation Council for Graduate Medical Education, which reviews programs annually, gives programs that do not meet accreditation standards time to fix their noncompliance. After the first year without providing the training, the program would get a warning. After that, it would be put on probation before losing accreditation.

Assuming the program continued to exist after losing accreditation, graduates would struggle to find a job — most hospitals do not hire residents from unaccredited programs.

Though, Elson argues the bigger loss is for Iowa as a whole. Iowa faces an extreme shortage of gynecologists, and the biggest determinant of where a gynecologist will practice depends on the state they do perform their residency.

There are fewer than two OB-GYNs per 10,000 women in Iowa, and about four per 10,000 women between the ages of 15 and 45, according to 2014 data from the American College of Obstetricians and Gynecologists. Nationally there are fewer than three OB-GYNs per 10,000 women and about five per 10,000 women between the ages of 15 and 45.

More: Iowa has the 2nd fewest OBGYN doctors in the U.S. The fetal heartbeat bill could make it even worse.

Though the UI OB-GYN program only has 20 residents, about a third of these residents stay in the state.

Losing these gynecologists is a concern shared by clinics in the state, says Francine Thompson, Health Services director at the Emma Goldman Clinic in Iowa City. The University of Iowa’s OBGYN program, she says, is an important pipeline bringing physicians to clinics in the state.

Becca Lee, Communications Manager for Planned Parenthood of the Heartland, said losing the program would mean losing health care professionals that provide women with all kinds of care, including things like basic reproductive care or prenatal care.

“Iowans should be outraged and disgusted and should be calling on the governor to veto this legislation,” she said.

More: Iowa House hides lawmaker's Raygun 'vagina' T-shirt on video feed amid abortion debate

'It doesn’t stop abortion'

Both Thompson and Lee share concerns that in addition to losing a pool of qualified gynecologists, the ban could lead to unsafe abortions.

Fetal heartbeats typically show up six weeks into a pregnancy, often before women even know they’re pregnant. Thompson said women not expecting to get pregnant typically only get tested after they miss a period, and even then women might assume they’re late for some other reason. Plus, Thompson added, some women might not be able to get an abortion right after they find out they’re pregnant, so the new time frame is almost impossible to meet.

That leaves women past the six-week mark with only a couple options: leave the state, or take matters into their own hands.

“History shows us that when abortions are restricted, when there’s legislation that restricts access, it doesn’t stop abortion,” Thompson said.

More: Iowa could soon have the nation's strictest abortion laws. Here's how nearby states compare.

Elson said she clearly recalls the stories her residency instructors told her of OB-GYN care prior to the 1973 landmark case Roe v. Wade, which established that women have a constitutional right to an abortion — "wards full of women who had to have hysterectomies or died, because they got an abortion that wasn’t safe," she said in a prior interview with the Press-Citizen.

When the bill was introduced, Elson was surprised at first. She described lobbying efforts against the bill as "extensive" and was herself among those who offered testimony about the bill at the Capitol in Des Moines in March.

In Iowa City, Elson said she's now less surprised and more disillusioned with the prospect of the state spending money to defend the bill.

"I'm not quite as shocked now that I realize this was an agenda," she said. "It's disappointing. I think the bill, should it be signed into law is unconstitutional and will be challenged in court."

'We are taking a courageous step'

In the Capitol, proponents behind the ban hope it will be challenged, specifically in the U.S. Supreme Court.

Describing Iowa as "ground zero" for the pro-life movement, Sen. Bertrand, R-Woodbury said the goal of the legislation is to overturn Roe v. Wade.

"There's nothing hidden here about the agenda," he said. "Today with the pro-life movement won a battle, but the war rages on."

Like other republicans, Rep. Shannon Lundgren, R-Peosta, said the legislation was about taking a stand for the defenseless.

"We are taking a courageous step to tell the nation that Iowa will defend its most vulnerable, those without a voice, our unborn children," she said.

More: If it gets challenged, who will pay for Iowa to defend its 'fetal heartbeat' abortion ban?

Just before the Senate passed the legislation early Wednesday morning, Sen. Jim Carlin, R-Woodbury, said the bill was a matter affording unborn children the dignity people would want for themselves. He said that just as the congregation of lawmakers values people of different races and genders, lawmakers need to stand up for people of all ages — even if that age is just a few weeks.

"I think our path in this process is to seek to always elevate the dignity and value of human beings," he said.

Reading off list of the Supreme Court justices behind the 7-2 Roe v. Wade decision, Sen. Jake Chapman, R-Dallas, said their names will live in infamy. Iowan lawmakers, he said, had the opportunity to put their name down on the right side of history.

"While we cannot rewrite past history," he said, "we can certainly rewrite the course of history."

Reporter Aimee Breaux covers education for the Press-Citizen. Reach her at abreaux@press-citizen.com or 319-887-5414, and follow her on Twitter @aimee_breaux.