Nearly three years after Iowa lawmakers passed the state’s fetal heartbeat law, questions remain about how its exceptions work in practice — and whether women can actually access care allowed under the law.Jessica Djukanovic, a wife and mother of three from Des Moines, learned she was pregnant last summer. Because of her age, the woman’s doctor recommended genetic testing. Her screening came back at high risk for Trisomy 18, a severe fetal condition that is often fatal.Djukanovic said she immediately asked about her options. “I was told I could miscarry at home,” she said. “That I could wait it out and miscarry at home or go out of state.”She later sought confirmation and advice from two more doctors at two different central Iowa hospitals. She says none would provide an abortion.”My OB office told me there was gray area in the law, and that’s why a lot of OBS are hesitant to treat,” she said. Djukanovic believes providers hesitated because of Iowa’s fetal heartbeat law, which bans most abortions once cardiac activity is detected, usually around six weeks of pregnancy. The law includes exceptions in cases of rape, incest, medical emergency and fetal abnormality, including conditions such as Trisomy 18.An Iowa OB-GYN who spoke on condition of anonymity for fear of backlash said Djukanovic legally qualified for an abortion in Iowa under those exceptions.Still, Djukanovic said she spent a week searching for answers and care.“It is the most lonely and helpless feeling that you could ever imagine,” she said.Earlier in February 2025, the Iowa Department of Inspections and Appeals published guidance for physicians meant to clarify the law. The department acknowledged misleading information surrounding the statute was causing confusion among some health care providers and warned that misinformation could harm patients’ health and well-being.The department told KCCI that no doctors have faced disciplinary action for violating the law, though it said complaints and investigations are confidential. The Iowa Board of Medicine did not respond to a request for comment.The OB-GYN who spoke anonymously called the guidance a “political move,” arguing the law was intentionally vague and created confusion rather than safety. The doctor also said that even before the abortion ban, few Iowa hospitals would provide abortion care in cases involving fatal fetal conditions because of institutional restrictions or lack of institutional will.Now, abortion rights advocates and critics of Iowa’s restrictions say access could become even tighter.House File 571, awaiting Gov. Kim Reynolds’ signature, would allow medical professionals, hospitals and clinics to refuse services that conflict with their conscience, moral or religious beliefs. Supporters say the bill would help address Iowa’s health care workforce shortage.”Nine out of 10 doctors, nurses, and other medical professionals who identify as religious or faith — based say they would rather stop practicing medicine than to violate their ethical, moral or religious beliefs,” said Republican Rep. Bill Gustoff. Opponents say the bill could leave patients with even fewer options. Democratic Rep. Austin Baeth, a physician, called the measure discriminatory.”There is nothing in this law that requires disclosure to a patient that they aren’t receiving standard of care. There is nothing in this law that requires that doctor or that hospital to refer that patient elsewhere,” Baeth said. After days of uncertainty, Djukanovic ultimately received abortion care at the University of Iowa Hospitals and Clinics. She is out speaking to raise awareness that hospital policy should not override what the law allows, in hopes that other women will not face the same struggles. “They are worried more about legal recourse than they are about saving a woman’s life,” she said. “That’s disgusting. That’s not medical care. That’s business.” Nationally, abortion access funds, which provide financial assistance and support to families seeking abortions who can’t afford them, saw an increase in their 2024 budgets. Iowa’s Abortion Access Fund is already spending $40,000 a month to help Iowans travel out of state for care.”Ultimately, the cost is women who want their pregnancies and are not able to carry them to term,” said executive director Beaufield Berry. “The cost is losing us.”She said that many patients have begun internalizing the law’s messaging and feel they should not seek care.

DES MOINES, Iowa —

Nearly three years after Iowa lawmakers passed the state’s fetal heartbeat law, questions remain about how its exceptions work in practice — and whether women can actually access care allowed under the law.

Jessica Djukanovic, a wife and mother of three from Des Moines, learned she was pregnant last summer. Because of her age, the woman’s doctor recommended genetic testing. Her screening came back at high risk for Trisomy 18, a severe fetal condition that is often fatal.

Djukanovic said she immediately asked about her options.

“I was told I could miscarry at home,” she said. “That I could wait it out and miscarry at home or go out of state.”

She later sought confirmation and advice from two more doctors at two different central Iowa hospitals. She says none would provide an abortion.

“My OB office told me there was gray area in the law, and that’s why a lot of OBS are hesitant to treat,” she said.

Djukanovic believes providers hesitated because of Iowa’s fetal heartbeat law, which bans most abortions once cardiac activity is detected, usually around six weeks of pregnancy. The law includes exceptions in cases of rape, incest, medical emergency and fetal abnormality, including conditions such as Trisomy 18.

An Iowa OB-GYN who spoke on condition of anonymity for fear of backlash said Djukanovic legally qualified for an abortion in Iowa under those exceptions.

Still, Djukanovic said she spent a week searching for answers and care.

“It is the most lonely and helpless feeling that you could ever imagine,” she said.

Earlier in February 2025, the Iowa Department of Inspections and Appeals published guidance for physicians meant to clarify the law. The department acknowledged misleading information surrounding the statute was causing confusion among some health care providers and warned that misinformation could harm patients’ health and well-being.

The department told KCCI that no doctors have faced disciplinary action for violating the law, though it said complaints and investigations are confidential. The Iowa Board of Medicine did not respond to a request for comment.

The OB-GYN who spoke anonymously called the guidance a “political move,” arguing the law was intentionally vague and created confusion rather than safety. The doctor also said that even before the abortion ban, few Iowa hospitals would provide abortion care in cases involving fatal fetal conditions because of institutional restrictions or lack of institutional will.

Now, abortion rights advocates and critics of Iowa’s restrictions say access could become even tighter.

House File 571, awaiting Gov. Kim Reynolds’ signature, would allow medical professionals, hospitals and clinics to refuse services that conflict with their conscience, moral or religious beliefs. Supporters say the bill would help address Iowa’s health care workforce shortage.

“Nine out of 10 doctors, nurses, and other medical professionals who identify as religious or faith — based say they would rather stop practicing medicine than to violate their ethical, moral or religious beliefs,” said Republican Rep. Bill Gustoff.

Opponents say the bill could leave patients with even fewer options. Democratic Rep. Austin Baeth, a physician, called the measure discriminatory.

“There is nothing in this law that requires disclosure to a patient that they aren’t receiving standard of care. There is nothing in this law that requires that doctor or that hospital to refer that patient elsewhere,” Baeth said.

After days of uncertainty, Djukanovic ultimately received abortion care at the University of Iowa Hospitals and Clinics. She is out speaking to raise awareness that hospital policy should not override what the law allows, in hopes that other women will not face the same struggles.

“They are worried more about legal recourse than they are about saving a woman’s life,” she said. “That’s disgusting. That’s not medical care. That’s business.”

Nationally, abortion access funds, which provide financial assistance and support to families seeking abortions who can’t afford them, saw an increase in their 2024 budgets. Iowa’s Abortion Access Fund is already spending $40,000 a month to help Iowans travel out of state for care.

“Ultimately, the cost is women who want their pregnancies and are not able to carry them to term,” said executive director Beaufield Berry. “The cost is losing us.”

She said that many patients have begun internalizing the law’s messaging and feel they should not seek care.