New data shows 76% of clinician-provided Iowa abortions were by medication in 2023, the last full year before the state's so-called 'heartbeat' law went into effect.
The data from the Guttmacher Institute, which supports abortion rights, is a new state-level breakdown of medication abortion rates that year. It includes 39 states and Washington, D.C., that do not have a total abortion ban. It doesn't include information on self-managed abortion.
The data also shows 29% of abortions in Iowa were provided through online-only clinics in 2023.
Iowa's numbers are higher than the U.S. average. The Guttmacher Institute found nationally 63% of abortions were provided through medication, while just 10% were through online-only clinics.
Isabel DoCampo, a senior research associate at the Guttmacher Institute, said medication abortion proportions greatly varied between states, ranging from 44% in Washington DC and 46% in Ohio to 95% in Wyoming.
"We're seeing quite diverse environments with similar medication abortion proportions," she said. "You have Iowa, where the proportion is 76%. The proportion is 77% in a state like Delaware, which is quite different from Iowa, in terms of the level of population density, abortion policies, what the region looks like."
Guttmacher Institute researchers failed to find a single driving factor for medication abortion rates, instead concluding that a combination of factors likely influence each state.
"This might look like clinic counts in a given state, as well as population density, abortion policies like insurance reimbursement rates for medication abortion versus procedural abortion [and] method availability at clinics," DoCampo said.
Last summer, the Iowa Supreme Court issued a ruling that allowed an Iowa law banning abortion when cardiac activity is detected, which can be as early as six weeks of pregnancy, to go into effect. The law allows exceptions for rape, incest, life of the pregnant person and fetal abnormalities. Previously, abortion was legal up to 20 weeks of pregnancy.
Iowa only has two brick-and-mortar clinics that provide abortions in the state — a Planned Parenthood clinic in Ames and the Emma Goldman Clinic in Iowa City.
DoCampo said the loss of brick-and-mortal abortion clinics in the state, as well its new abortion restrictions, could drive up the number of Iowans seeking medication abortions from online-only clinics.
"It could be that we see further changes in clinic counts in Iowa, which could place greater importance on telemedicine provision throughout the state as a result of this ban," she said.
The Food and Drug Administration approved the use of mifepristone and misoprostol for the termination of pregnancy up to 10 weeks of gestation. The agency removed its requirement to dispense the medication in person in 2021, paving the way for it to be dispersed though telehealth appointments. The medication is also commonly used for miscarriage management.
In the wake of the U.S. Supreme Court's Dobbs V. Jackson Women's Health Organization decision in 2022, which ended the constitutional right to abortion, anti-abortion supporters have sought to restrict access and add additional requirements to the medications used in abortions.
Last June, the U.S. Supreme Court dismissed a case filed by a group of doctors who were challenging the FDA's approval of mifepristone.
This week, Iowa House lawmakers advanced a bill in a subcommittee that would require abortion clinics and providers to provide patients with information on the risk associated with medication abortion and 'abortion reversal' options.
House lawmakers also introduced a bill that would make dispersing or manufacturing medication used for abortion a Class C felony, but it has failed so far to make any movement in the Statehouse.
