Will restrictions on medication abortion in Iowa emerge during the 2026 legislative session?

DES MOINES — After altering Iowa’s reproductive health care landscape in recent years through enacting a law restricting abortion access, state lawmakers will now see a new push to focus on the next target of anti-abortion advocates: the abortion pill.

Unlike other issues that are expected to receive substantial focus this session, including property tax relief, eminent domain and the state budget, abortion-related legislation that once took center stage in past years now looms in the background.

But anti-abortion advocacy groups in the state are urging lawmakers to place restrictions on the abortion pill following an uptick in its use in Iowa after Roe v. Wade was overturned in 2022, and the enactment in 2024 of an law that restricts most abortions in Iowa.

The bill, signed by Gov. Kim Reynolds in 2023, defined a fetal heartbeat as any cardiac activity, which typically can be detected around the sixth week of pregnancy, often before a person is aware they are pregnant.

The law contains limited exceptions that allow for an abortion in some cases of rape or incest, if the life or health of the mother is threatened, or there is a fetal abnormality judged by a doctor to be incompatible with life.

Maggie DeWitte, executive director of anti-abortion advocacy group Pulse Life Advocates, announced in July during the Iowa March for Life that the organization is teeing up a bill that she says would put guardrails on the abortion pill in the state.

  Buy Photo

“The pro-life movement in Iowa has really been looking at how we can put some common sense safeguards around these dangerous abortion drugs,” DeWitte told the Gazette-Lee Des Moines Bureau.

But Republican legislative leaders in both chambers have not confirmed whether their caucuses are planning on taking up the legislation.

  Buy Photo

Iowa Senate Majority Leader Mike Klimesh, R-Spillville, said while he anticipates potentially seeing the bill, he is not aware of any members interested in taking it up, adding that there would need to be consensus among members for it to move forward.

“We've done the things we've done regarding life now, simply because we've been able to arrive at a consensus within the Senate, caucus, the House, and then the governor signs that, right?” Klimesh said. “We've had conversations on that last year. This is not a new topic for our caucus, and the end of the day, you know, if we see a bill, conversations will take place internally, and if there's a consensus arrived at amongst my caucus members, then we'll make a decision.”

House Speaker Pat Grassley of New Hartford said while House Republicans have a track record of being clear where they stand on “issues of life,” he has not engaged in conversations about abortion pill-related legislation with other lawmakers.

“This caucus has displayed, you know, long before I was speaker, that we're going to be pro-life. At the same time, I think, we’ve been pretty practical in our approaches to taking a look at pieces of legislation,” Grassley said.

Gov. Kim Reynolds declined to be interviewed for the Gazette-Lee Des Moines Bureau’s legislative preview series.

The push to restrict the abortion pill

Since the 2023 law went into effect, the number of Iowans accessing medication pills by mail has increased. This includes Mifepristone, a medication used within the first 10 weeks of pregnancy that blocks a hormone called progesterone needed for a pregnancy to continue.

  Buy Photo

This mirrors the national uptick in medication abortions following the Supreme Court's Dobbs decision in 2022, overturning Roe v Wade. The rate of medication abortions made up 63 percent of all abortions in the country in 2023, compared to 53 percent in 2020, according to the Guttmacher Institute, a nonprofit that supports abortion rights.

DeWitte, along with other anti-abortion advocates, says restrictions are needed on the abortion pill because the federal government has yet to do so, arguing that those who take them experience “adverse effects.”

“We want to really wrap our arms around this dangerous abortion pill, and put some common sense safeguards back in place so that women are informed of this before they take these dangerous pills, of all of the complications, both physically and emotionally, that can happen to them,” DeWitte said.

Citing a recently published study from the right-leaning think tank, the Ethics and Public Policy Center, DeWitte said one in 10 women experience adverse effects after taking the abortion pill. The study, a key source of anti-abortion advocates' argument against abortion pills released in 2025, has not been peer-reviewed or published in a medical journal, and reproductive rights advocates have criticized it, arguing it's not supported by science.

Pulse Life Advocates’ “Black Market Abortion Prevention Act” would require an in-person exam and prescription for abortion drugs, as well as a follow-up visit. It also would classify abortion drugs as Schedule IV controlled substances.

The draft legislation would require informed consent, which means medical providers would have to notify patients of risks associated with the drug and provide information about how to reverse the medication abortion.

This issue came up during the 2025 legislative session when the Republicans introduced House Study Bill 186, which would’ve required health care providers in Iowa to tell patients that it may be possible to reverse the effects of a medication abortion. Reproductive rights advocates said the bill would mislead people into thinking medication abortions are unsafe and reversible. The bill made it out of committee but failed to make it to the House floor.

The FDA has found that performing abortions using Mifepristone followed by misoprostol is safe and effective.

Last year, Susan B. Anthony Pro Life America and other anti-abortion groups vocally denounced the U.S. Food and Drug Administration’s approval of a generic abortion pill ahead of the government shutdown in October. Now, they are calling on the Trump administration to establish “reasonable rules” around the distribution of the abortion pill, similar to its actions during President Donald Trump’s first term in office.

In the meantime, attorneys general in six Republican-led states are attempting to curb the flow of Mifepristone into their states by bringing lawsuits against doctors in other states prescribing the drug, according to Reuters.

Texas Attorney General Ken Paxton sued a doctor in New York for prescribing abortion pills to a woman in the Dallas area via telehealth. The case was dismissed last year by a New York judge.

While Republican legislative leaders don’t have a solidified goal to advance the legislation in 2026, Republican state Sen. Sandy Salmon, of Janesville, confirmed with the Gazette-Lee Des Moines bureau that she plans to introduce Pulse Life Advocates’ bill in her chamber, arguing the “Pro-Life-Chemical abortion drug trafficking into Iowa has become rampant as the abortion industry seeks to do an end run around our heartbeat law.”

  Buy Photo

Reproductive rights advocates, Democrats worry about access to health care

Since the new state law went into effect more than a year ago, the rate of abortions in Iowa has declined by more than half, while the number of Iowa women traveling to neighboring states to seek abortions has in some cases, doubled.

In 2025, Planned Parenthood announced plans to close four centers in Iowa — Cedar Rapids, Ames, Sioux City and Urbandale — leaving only clinics in Des Moines and Iowa City.

  Buy Photo

Kyrstin Delagardelle, the Iowa director of public affairs for Planned Parenthood Advocates of Iowa, said potential restrictions on the abortion pill, coupled with the closure of brick-and-mortar clinics in the state, would further exacerbate Iowa’s physician shortage and limited access to all forms of reproductive health care.

“Iowa is already facing growing maternal mortality rates and infant mortality rates," Delagardelle said. "We have an OBGYN shortage, and we know that states that have abortion bans and continue to chip away at the ability for patients to receive abortions, it really causes there to be struggles for health care systems to recruit OBGYN to their state."

About 82 percent of abortions performed in Iowa are medication abortions and it remains the most used form of abortion care at Planned Parenthood in Iowa, according to Delagardelle.

  Buy Photo

She added that restricting the abortion pill, which has been around for more than 25 years, is about “control,” not safety or health.

House Minority Leader Brian Meyer, D-Des Moines, said any more restrictions on abortion in the state would negatively impact Iowa’s ability to recruit physicians and health care providers to the state, while hospitals are already grappling to do so.

“What I'm hearing from out in rural Iowa and some of the doctors that practice OBGYN stuff is that, yeah, people don't want to be here because of that,” Meyer said. “They don't want to have that extra pressure of having to deal with the government sticking their nose where they don't belong.”

Senate Minority Leader Janice Weiner, D-Iowa City, said Democrats would challenge efforts by Republicans to bring up legislation restricting abortion access, but they primarily plan to focus on affordability and access to health care, especially in rural areas — issues she says she hears about from Iowans the most.

“This is another extreme attempt at a culture war bill and a policy that would further harm Iowans,” Weiner said. “That's not what we should be focusing on. We should be working on helping all Iowans dealing with the issues that we have heard time and again.”

  Buy Photo