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<p>It’s quiet over the lunch hour on a recent Friday at the Planned Parenthood clinic in Mankato, Minn.</p><p>Brooke Zahnle, the health center manager, steps into the southern Minnesota clinic’s small hallway to point out the clinic’s lab and five exam rooms, including an ultrasound room. The clinic is tucked away in a strip mall close to Minnesota State University, Mankato. It’s about an hour from the Iowa border.</p><p>“We're set up to see 14 patients a day here in Mankato, and we're looking to increase that to up to 22,” Zahnle said.</p><p>As Iowa’s so-called "heartbeat law" worked its way through the courts, she said the clinic has been getting ready for more Iowa patients. It moved into a new location last November, which added an exam room, and it recently started offering abortion services, she said.</p><p>“We started providing medication abortion services in January,” she said. “And we're actually looking at cross training staff right now to increase access on Wednesdays when we do provide that service.”</p><p>The Iowa law bans abortion when cardiac activity is detected, which can be as early as six weeks of pregnancy – or before some people know they’re pregnant.</p><p>The law is set to go into effect July 29. Planned Parenthood estimates <a href="https://www.plannedparenthood.org/about-us/newsroom/press-releases/iowans-will-soon-lose-access-to-most-abortions-as-iowa-supreme-court-announces-that-abortion-ban-can-take-effect" class="Link" target="_blank">it will block nearly all abortions</a> in the state.</p><p>The ban will likely affect abortion access not only in Iowa, but in the entire Midwest region.</p><p><b>‘They feel crushed’</b></p><p>Shira Klane, a nurse practitioner who works at Planned Parenthood clinics across Minnesota, is already seeing Iowa patients traveling as far as three or four hours to get to the nearest Minnesota clinic.</p><p>“They feel crushed,” she said. “It feels like such a heaviness that they're forced to carry, and then extreme gratitude that they're able to find care through us.”</p><p>Last year, an estimated <a href="https://www.guttmacher.org/monthly-abortion-provision-study" class="Link" target="_blank">940 Iowans sought abortions</a> in Nebraska, Minnesota and Illinois, according to data from the Guttmacher Institute, which supports abortion rights.</p><p>A similar law from 2018 was blocked by the state Supreme Court. The justices remained deadlocked, preventing the law from taking effect. Then during a special session in July 2023, a nearly identical bill <a href="https://www.iowapublicradio.org/state-government-news/2023-07-11/iowa-legislature-special-session-fetal-heartbeat-six-week-abortion-ban" class="Link" target="_blank">was passed by the legislature</a>. The new version was also put on hold until June 28 when the justices ruled the injunction should be lifted.</p><p>Even without the so-called “heartbeat law” in effect, Iowa still <a href="https://states.guttmacher.org/policies/" class="Link" target="_blank">has many more abortion restrictions</a> compared to neighboring Minnesota and Illinois, said Candace Gibson, the director of state policy at the Guttmacher Institute.</p><p>“You have a forced 24-hour waiting period after the [required in-person] counseling, forced ultrasound, there's parental notice requirements in Iowa. And so, all of those restrictions add up in terms of obstacles for a person to get care,” she said.</p><p>Gibson said with Iowa’s new law, the number of Iowans seeking abortion care in another state will likely increase significantly.</p><p><b>A surge in out-of-state patients</b></p><p>Since the U.S. Supreme Court’s Dobbs decision more than two years ago, which ended the constitutional right to abortion, Planned Parenthood has expanded abortion services in states like Minnesota, <a href="https://nebraskapublicmedia.org/en/news/news-articles/nebraska-is-down-to-two-clinics-providing-abortion-appointments-in-the-state/" class="Link" target="_blank">Nebraska</a>, <a href="https://www.kmuw.org/news/2024-05-14/planned-parenthood-southeast-kansas-expanding-new-clinic-pittsburg" class="Link" target="_blank">Kansas</a> and <a href="https://ipmnewsroom.org/planned-parenthood-is-expanding-abortion-services-in-champaign-statewide-to-meet-a-surge-of-out-of-state-patients/ " class="Link" target="_blank">Illinois</a>. That’s to accommodate the increase in people coming from states like South Dakota, North Dakota, Missouri, Indiana, Kentucky – and now Iowa – that have <a href="https://states.guttmacher.org/policies/" class="Link" target="_blank">severely restricted or nearly eliminated</a> the procedure.</p><p>This influx of abortion seekers can put a strain on clinics and providers, Gibson said.</p><p>“As states think through policies to protect and meet the need that's coming from other states, they also have to make sure that residents within their respective state can continue to get that care,” she said.</p><p><img src="https://npr.brightspotcdn.com/70/10/b4ecb99a4533a404d691db74148f/dsc-7030.jpg" width="3024" height="2016" alt="An employee of Planned Parenthood in Mankato, Minnesota sits at the front desk during lunch hour. The clinic recently moved into a new, larger location closer to a large state university."></p><p>Illinois, in particular, has seen a sharp increase in those coming from out-of-state seeking abortions since the Dobbs decision two years ago.</p><p>Around patients at 25% of Planned Parenthood of Illinois now come from out-of-state compared to 3% to 5% before Dobbs, said Julie Uhal, the abortion expansion program manager at Planned Parenthood of Illinois.</p><p>“It was really limited [before Dobbs] to folks that were in Milwaukee, for example, like close by coming down [to the Chicago area],” she said. “But now we've seen patients from 41 states around the country.”</p><p>Since Dobbs, Planned Parenthood of Illinois has opened new clinics near state borders, including a clinic in Carbondale at the end of last year, where more than 90% of patients are <a href="https://news.wttw.com/2024/06/10/vast-majority-patients-planned-parenthood-illinois-newest-clinic-carbondale-come-out" class="Link" target="_blank">coming from outside Illinois</a>, Uhal said.</p><p>The organization is monitoring how Iowa’s new law will change where people travel for abortion care regionally, she said.</p><p>“It'll also impact people from the northern part of Missouri, for example, [who] may have been going into Iowa for care, or even further in the west like Nebraska, South Dakota,” she said. ”It's hard to tell, and there are a lot of factors that go into why someone might travel to Illinois versus travel to Minnesota versus fly to California.”</p><p>Planned Parenthood of Illinois doesn’t have plans to open a clinic closer to the Iowa border, but it’s “definitely in the realm of future possibility,” Uhal said.</p><p><b>‘Where’s that line?’</b></p><p>Meanwhile in Iowa, health care providers are still trying to figure out what they can and can’t do under the new law.</p><p>Francesca Turner, an OB-GYN in Des Moines and co-founder of <a href="https://iowans4healthliberty.com/" class="Link" target="_blank">Iowans for Health Liberty</a>, which supports abortion rights, said, for example, the <a href="https://www.legis.iowa.gov/docs/aco/arc/7720C.pdf" class="Link" target="_blank">rules approved by the Iowa Board of Medicine</a> say you can provide an abortion for someone having miscarriage who has not expelled all the tissue from their uterus.</p><p>“But it doesn't explicitly say if that embryo has a heartbeat or fetus has a heartbeat, would you still be able to provide them with emergency medical care? Where's that line?” she said.</p><p>Even though the law has exceptions for rape, incest and life-threatening conditions, Turner said properly documenting them can be complicated, requiring doctors to collect information they normally wouldn’t, such as the date the “sex act” occurred and whether it “constituted a rape” or happened with a “closely related person.”</p><p>Doctors worry a misstep could affect their medical licenses, she said.</p><p>“If I see something that I can't take care of, I can call my high risk OB colleagues and specialists and get their opinion from their experiences and make those decisions in real time,” Turner said. “I don't want to stop after we make some decisions and say, ‘Well, maybe I should call my hospital attorney and get some more information if I can act now or not.’”</p><p>She said this means many of those Iowa patients will still end up crossing borders for abortion care –– or won’t get it at all.</p><p><i>This story comes from a collaboration between </i><a href="https://www.sideeffectspublicmedia.org/" class="Link" target="_blank">Side Effects Public Media</a><i> and the </i><a href="https://www.kcur.org/midwest-newsroom" class="Link" target="_blank">Midwest Newsroom</a><i> — an investigative journalism collaboration including </i><a href="https://www.iowapublicradio.org/" class="Link" target="_blank">IPR</a><i>, </i><a href="https://www.kcur.org/" class="Link" target="_blank">KCUR 89.3</a><i>, </i><a href="https://nebraskapublicmedia.org/" class="Link" target="_blank">Nebraska Public Media News</a><i>, </i><a href="https://news.stlpublicradio.org/" class="Link" target="_blank">St. Louis Public Radio</a><i>and </i><a href="https://www.npr.org/" class="Link" target="_blank">NPR</a><i>.</i></p><p><i>Side Effects Public Media is a health reporting collaboration based at WFYI in Indianapolis. We partner with NPR stations across the Midwest and surrounding areas — including KBIA and KCUR in Missouri, Iowa Public Radio, Ideastream in Ohio and WFPL in Kentucky.</i> <div class="fullattribution">Copyright 2024 Side Effects Public Media</div></p>

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