The Joseph F. Rosenfield Reproductive Health Clinic in Des Moines looks like one of those dominoes these days that stays upright for an unknown amount of time.
Abortion is still legal in Iowa for 20 weeks after fertilization, but its governor, Republican Kim Reynolds, announced Tuesday that she will do everything possible to change that as soon as possible.
She is in a hurry to align herself with the recent Supreme Court ruling that overturned the
Roe v. Wade
ruling , which in 1973 gave constitutional status to that right.
With her decision, which does not coincide with the majority feeling of society reflected in the polls, the high court returned to the States the power to regulate abortion.
It is estimated that 26 of the 50 are willing to kill him.
The Supreme Court strikes down the right to abortion in the United States
So while Washington still has a political-judicial hangover, the war over women's reproductive health is now being waged state by state.
In this last week, the organizations that defend the right to decide have challenged regulations in 11 of them, and have managed to stop them in four.
And in the midst of that confusing and shifting landscape stands the vast and predominantly conservative Midwest region, where some of the bloodiest battles between the two sides are being fought.
In Iowa there is a law, stopped by the judges, that would lower the limit to six weeks, which in practice looks a lot like a ban.
At the moment, Reynolds, who is playing for his position in the November elections, has managed to carry out a rule that requires, both for surgical abortions and for the administration of pills, to hold two visits and for at least 24 hours to pass. between them.
In the first, the patient must sign a consent form, receive information about alternatives to termination of pregnancy, undergo an ultrasound scan, and be given the option of looking at it.
In the second, they operate on her or give her pills.
That provision is intended to give pregnant women pause, but Elizabeth Nash of the Guttmacher Institute
Pro-abortion protests in St. Louis on June 24. ANGELA WEISS (AFP)
Megan Amato, one of the registered nurses at the Des Moines center, which, like most of the sexual and reproductive health clinics that are spread across the United States, belongs to the Planned Parenthood network, explained this Wednesday at the place where who has been working “for 15 years” that the regulatory change forced them to a logistical puzzle to relocate those who already had an appointment.
"It's just another way to stop us from doing our job," she said.
The director, Jordawn Williams, added that this is suffered above all by those who are forced to travel to receive the attention they are denied at home;
Iowa borders three of the seven states (Wisconsin, South Dakota and Missouri) that have already totally banned abortion in the last week, so the Rosenfield clinic (one of the seven centers that Planned Parenthood has in Iowa;
But not only here.
A doctor from the center, who agreed to speak with EL PAÍS protected by anonymity, later said that she had just treated someone who had come from New Orleans, 1,600 kilometers away.
Since the woman in question could afford it, she looked at clinics State by State up North, until she got the first available appointment in Iowa.
Since in recent months, in places like Texas or Oklahoma, restrictive laws began to be enacted, the Des Moines center has received, like others throughout the country, women who have come from far beyond the usual.
Its director calculates that last week there was a day when they treated “42 patients”, “the closest thing to a record”.
“Those who lack resources can't afford a hotel, and they drive for hours,” she added.
And she gave an ordinary example in a country where everything is too far away: a woman traveled for the first consultation three hours one way (and three hours back) from Dubuque (Iowa).
Two days later, she had to do another six hours for the second one.
Anti-abortion activists protest June 25 outside the Hope Clinic For Women in Granite City, Illinois. ANGELA WEISS (AFP)
If the Des Moines domino falls, the pressure that the center is now under will shift to places where abortion remains legal.
Neighboring to the east, post-Roe America
an island of permissiveness surrounded by states where it is banned or threatens to ban or restrict it soon.
A five-hour drive along a straight-line highway — along which 32-wheelers whiz through endless cornfields — separates Des Moines from Flossmoor, south of Chicago, where one of 29 abortion clinics is located. from Illinois.
There they are also working more than ever, as explained last Tuesday in one of the offices of the Mary Jane Maharry health center, of the Planned Parenthood affiliate in the State.
It is located in an ordinary suburb, whose tranquility is disturbed every morning by anti-abortion activists who protest "in groups of at least five people," according to assistant Beatriz González, before posing pregnant for a portrait in the "recovery room, where the patients rest 45 minutes” after the quick intervention.
Beatriz Domínguez, assistant at the Planned Parenthood branch, in Flossmoor (Illinois).Iker Seisdedos García
Planned Parenthood has 17 centers in Illinois, where abortion has been covered by social security (Medicaid) since 2017. They serve some 60,000 patients annually.
They have been preparing, according to Maharry, “since 2016, when Donald Trump came to power”, for what they saw coming: that the most conservative Supreme Court in eight decades, that the former president left tied and well tied with the patient collaboration of Mitch McConnell, leader Republican in the Senate, will break a precedent that women in the United States have had for half a century.
They used to see about 1,000 patients from out of state, according to Maharry;
now they expect “between 20,000 and 30,000 a year”.
“We started seeing a dramatic increase from the Texas law [passed in September],” she explains.
“Our dating search engine went crazy between Friday and Saturday.
And on the day of the sentence [June 24] we received twice as many calls as usual.”
The Flossmoor center opened in 2018. In 2020, they opened one in Waukegan, to the north, to serve the needs of neighboring, prohibitionist Wisconsin.
Although the one that receives the most pressure in the State of Illinois actually belongs to the Planned Parenthood affiliate for the Southwest Region of Missouri.
Located in Fairview Heights, it is 20 kilometers from St. Louis, on the other side of the natural border of the Mississippi River.
Kendal Underwood (left) and Brittany Nickens protest in favor of women's ability to decide, at the Planned Parenthood clinic in San Luis, on the same day, June 24, that the Supreme Court ruling came out, and in the State of Missouri banned abortion.
Jeff Robertson (AP)
Yamelsie Rodríguez, the president of the branch, explained last Tuesday that, before the Missouri attorney general rushed to ban abortion after the sentence was known (it took more or less 20 minutes), the San Luis clinic served 1 .3 million women of reproductive age.
Now they will be treated on the other side of the border, in facilities that "opened in 2019 strategically and quietly."
In the legislative period that is now ending, Rodríguez recalls, Missouri tried to pass a law that would prohibit patients from traveling to another state to interrupt a pregnancy.
"They did not succeed, but they have warned that they will try again in the next course," she adds.
They are not the only ones: stopping this exodus is among the following objectives of the anti-abortion movement in the United States.
As reported this week by
The Washington Post,
there is a conservative Chicago firm called the Thomas More Society that is preparing model legislation to make available to states that need it.
It is inspired by Texas law, and invites citizens to sue anyone who helps a woman make the journey.
The Department of Justice has already said that it will combat these regulations, and the issue was even addressed in the Supreme Court ruling that repealed abortion.
The controversy was buried in the concurring opinion of conservative Justice Brett Kavanaugh.
He wondered if these prohibitions are legitimate.
“In my opinion”, he answered himself, “the answer is
, based on the constitutional right to interstate travel.”
Of the 52,780 abortions that, according to the Guttmacher Institute, were performed in 2020 in Illinois, about one in five was to a patient who came from outside.
Rodríguez does not intend, however, to sit and wait for more restrictions to be imposed, given that the Republicans no longer hide their aspiration to pass a law that prohibits abortion at the federal level.
The clinic he runs expects 14,000 more patients this year (in addition to the 8,000 they see on average).
“Now we are open six days a week, but in order to absorb the demand we will expand to seven days;
we also plan to increase the number of service providers and are working with the Governor of Illinois [Democrat JB Pritzker] to pass a law allowing qualified nurses to prescribe abortion medications,” he warns.
Around the pills – which in 2020 were used in half of the abortions in the United States (again, according to the Guttmacher Institute) – there is also a war going on.
Compared to places like Illinois, where a remote consultation is enough (although to receive medications by return mail you have to order them from a telephone or a computer whose IP is recorded within the State), in Iowa it is mandatory that the entire process be face-to-face.
The pills are banned in places like Missouri and South Dakota, where a law went into effect Friday that threatens serious penalties for those who prescribe abortion drugs without a license from local authorities, a rule designed to prevent doctors from other states from can treat South Dakota patients.
In response to that move, Planned Parenthood Montana clinics,
Pro-abortion protest in Indianapolis, Indiana, on June 25.
AJ Mast (AP)
The anonymous doctor from Des Moines explained in her interview with EL PAÍS that they are also under enormous pressure.
To what they already endured (many, like herself, do not live in the same place where they work to avoid problems), the threat of committing a crime and the dilemma of having to choose have now been added in the most restrictive States. between obeying the law or the Hippocratic Oath.
“There are already stories of women coming in with ectopic pregnancies, and in order to intervene, doctors have to prove that they are unstable and that their blood pressure drops decidedly before they can treat them.
Otherwise, they risk jail,” she clarifies.
Also problematic are the exceptions, which admit only certain laws, such as rape or incest.
From left: Danielle Yonemoura, nursing assistant at the Rosenfield clinic in Des Moines, Jordawn Williams, director of one of Planned Parenthood's centers in the Iowa capital, and Sheenah Dooley, communications director for Planned Parenthood North Central States .
Despite everything, the doctor affirms that this is the "most rewarding" job she has ever done.
“When they come to me, patients are faced with a vital dilemma.
I help them take control over their future.
And that happens multiple times a day,” she says.
"The idea of a future where he can't do it anymore, where his hands are tied, it's really heartbreaking."
She defines herself as "optimistic".
So she can only hope that the Iowa domino stands tall and doesn't end up falling.
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