H.F. 657 Section 1. FINDINGS. The general assembly finds all of the 1 following: 2 1. Abortion can cause serious short-term and long-term 3 physical and psychological complications for women including 4 but not limited to uterine perforation, uterine scarring, 5 cervical perforation or other injury, infection, bleeding, 6 hemorrhage, blood clots, failure to actually terminate the 7 pregnancy, incomplete abortion or retained tissue, pelvic 8 inflammatory disease, endometritis, missed ectopic pregnancy, 9 cardiac arrest, respiratory arrest, renal failure, metabolic 10 disorder, shock, embolism, coma, placenta previa in subsequent 11 pregnancies, preterm delivery in subsequent pregnancies, 12 free fluid in the abdomen, organ damage, adverse reactions 13 to anesthesia and other drugs, psychological or emotional 14 complications such as depression, anxiety, sleeping disorders, 15 and death. 16 2. Abortion has a higher medical risk when the procedure is 17 performed later in the pregnancy. Compared to an abortion at 18 eight weeks’ gestation or earlier, the relative risk increases 19 exponentially at higher gestations. The incidence of major 20 complications is highest after twenty weeks of gestation. 21 3. The state has a legitimate concern for the public’s 22 health and safety. 23 4. The state has a legitimate interest from the outset 24 of pregnancy in protecting the health of the woman. More 25 specifically, the state has a legitimate concern with the 26 health of women who undergo abortions. 27 5. There is substantial evidence that by at least twenty 28 weeks after fertilization, an unborn child has the physical 29 structures necessary to experience pain. 30 6. There is substantial evidence that by twenty weeks 31 after fertilization, an unborn child seeks to evade certain 32 stimuli in a manner which, in an infant or an adult, would be 33 interpreted as a response to pain. 34 7. Anesthesia is routinely administered to an unborn child 35 -1- LSB 1155HV (3) 84 pf/nh 1/ 10

H.F. 657 twenty weeks or more after fertilization when the unborn child 1 undergoes prenatal surgery. 2 8. Even before twenty weeks after fertilization, the unborn 3 child has been observed to exhibit hormonal stress responses to 4 painful stimuli, and a reduction in such response results when 5 pain medication is administered directly to the unborn child. 6 9. It is the purpose of the state of Iowa to assert a 7 compelling state interest in protecting the unborn child from 8 the stage at which substantial medical evidence indicates the 9 unborn child is capable of feeling pain. 10 Sec. 2. NEW SECTION . 146A.1 Definitions. 11 As used in this chapter unless the context otherwise 12 requires: 13 1. “Abortion” means abortion as defined in section 146.1. 14 2. “Attempt to perform or induce an abortion” means an act, 15 or an omission of a statutorily required act, that, under the 16 circumstances as the actor believes them to be, constitutes a 17 substantial step in a course of conduct planned to culminate in 18 the performance or inducing of an abortion. 19 3. “Department” means the department of public health. 20 4. “Fertilization” means the fusion of a human spermatozoon 21 with a human ovum. 22 5. “Medical emergency” means a condition which, in 23 reasonable medical judgment, so complicates the medical 24 condition of a pregnant woman as to necessitate the immediate 25 abortion of the human pregnancy to avert the woman’s death or 26 for which a delay will create a serious risk of substantial and 27 irreversible physical impairment of a major bodily function. 28 “Medical emergency” does not include a condition which is based 29 on a claim or diagnosis that the pregnant woman will engage in 30 conduct which would result in the pregnant woman’s death or in 31 substantial and irreversible physical impairment of a major 32 bodily function. 33 6. “Medical facility” means any public or private hospital, 34 clinic, center, medical school, medical training institution, 35 -2- LSB 1155HV (3) 84 pf/nh 2/ 10

H.F. 657 health care facility, physician’s office, infirmary, 1 dispensary, ambulatory surgical center, or other institution or 2 location where medical care is provided to any person. 3 7. “Physician” means a person licensed under chapter 148. 4 8. “Postfertilization age” means the age of the unborn child 5 as calculated from the fertilization of the human ovum. 6 9. “Probable postfertilization age” means what, in 7 reasonable medical judgment, will with reasonable probability 8 be the postfertilization age of the unborn child at the time 9 the abortion is to be performed. 10 10. “Reasonable medical judgment” means a medical judgment 11 made by a reasonably prudent physician who is knowledgeable 12 about the case and the treatment possibilities with respect to 13 the medical conditions involved. 14 11. “Unborn child” means an individual organism of the 15 species homo sapiens from fertilization until live birth. 16 Sec. 3. NEW SECTION . 146A.2 Determination of 17 postfertilization age prior to abortion —— abortion prohibited 18 at twenty or more weeks postfertilization age —— exceptions —— 19 reporting requirements —— penalties. 20 1. Except in the case of a medical emergency, an abortion 21 shall not be performed or induced or be attempted to be 22 performed or induced unless the physician performing or 23 inducing the abortion has first made a determination of the 24 probable postfertilization age of the unborn child or relied 25 upon such a determination made by another physician. In making 26 such a determination, a physician shall make such inquiries 27 of the pregnant woman and perform or cause to be performed 28 such medical examinations and tests the physician considers 29 necessary in making a reasonable medical judgment to accurately 30 determine the postfertilization age of the unborn child. 31 2. a. A physician shall not perform or induce or attempt 32 to perform or induce an abortion upon a pregnant woman when it 33 has been determined, by the physician performing or inducing 34 the abortion or by another physician upon whose determination 35 -3- LSB 1155HV (3) 84 pf/nh 3/ 10

H.F. 657 that physician relies, that the probable postfertilization age 1 of the unborn child is twenty or more weeks unless, in the 2 physician’s reasonable medical judgment, any of the following 3 applies: 4 (1) The pregnant woman has a condition which the physician 5 deems a medical emergency. 6 (2) It is necessary to preserve the life of an unborn child. 7 b. If an abortion is performed or induced under this 8 subsection, the physician shall terminate the human pregnancy 9 in the manner which, in the physician’s reasonable medical 10 judgment, provides the best opportunity for the unborn child 11 to survive, unless, in the physician’s reasonable medical 12 judgment, termination of the human pregnancy in that manner 13 would pose a greater risk than any other available method of 14 the death of the pregnant woman or of the substantial and 15 irreversible physical impairment of a major bodily function. 16 A greater risk shall not be deemed to exist if it is based on 17 a claim or diagnosis that the pregnant woman will engage in 18 conduct which would result in the pregnant woman’s death or in 19 substantial and irreversible physical impairment of a major 20 bodily function. 21 c. An abortion performed or induced under this subsection 22 shall be performed or induced in a medical facility that 23 provides the appropriate level of perinatal care as specified 24 in 641 IAC 150. 25 3. A physician who performs or induces or attempts to 26 perform or induce an abortion shall report to the department, 27 on a schedule and in accordance with forms and rules adopted by 28 the department, all of the following: 29 a. If a determination of probable postfertilization age of 30 the unborn child was made, the probable postfertilization age 31 determined and the method and basis of the determination. 32 b. If a determination of probable postfertilization age of 33 the unborn child was not made, the basis of the determination 34 that a medical emergency existed. 35 -4- LSB 1155HV (3) 84 pf/nh 4/ 10

H.F. 657 c. If the probable postfertilization age of the unborn 1 child was determined to be twenty or more weeks, the basis of 2 the determination of a medical emergency, or the basis of the 3 determination that the abortion was necessary to preserve the 4 life of an unborn child. 5 d. The method used for the abortion and, in the case of 6 an abortion performed when the probable postfertilization age 7 was determined to be twenty or more weeks, whether the method 8 of abortion used was one that, in the physician’s reasonable 9 medical judgment, provided the best opportunity for the unborn 10 child to survive or, if such a method was not used, the basis 11 of the determination that termination of the human pregnancy 12 in that manner would pose a greater risk than would any other 13 available method of the death of the pregnant woman or of the 14 substantial and irreversible physical impairment of a major 15 bodily function. 16 4. a. By June 30, annually, the department shall issue a 17 public report providing statistics for the previous calendar 18 year, compiled from the reports for that year submitted in 19 accordance with subsection 3. The department shall ensure that 20 none of the information included in the public reports could 21 reasonably lead to the identification of any woman upon whom an 22 abortion was performed. 23 b. (1) A physician who fails to submit a report by the end 24 of thirty days following the due date shall be subject to a 25 late fee of five hundred dollars for each additional thirty-day 26 period or portion of a thirty-day period the report is overdue. 27 (2) A physician required to report in accordance with 28 subsection 3 who has not submitted a report or who has 29 submitted only an incomplete report more than one year 30 following the due date, may, in an action brought in the 31 manner in which actions are brought to enforce chapter 148, 32 be directed by a court of competent jurisdiction to submit a 33 complete report within a time period stated by court order or 34 be subject to contempt of court. 35 -5- LSB 1155HV (3) 84 pf/nh 5/ 10

H.F. 657 (3) A physician who intentionally or recklessly falsifies 1 a report required under this section is subject to a civil 2 penalty of one hundred dollars. 3 5. Any medical facility in which a physician is authorized 4 to perform an abortion shall implement written medical 5 policies and procedures consistent with the requirements and 6 prohibitions of this chapter. 7 6. The department shall adopt rules to implement this 8 section. 9 Sec. 4. NEW SECTION . 146A.3 Civil and criminal actions 10 —— penalties. 11 1. Failure of a physician to comply with any provision of 12 section 146A.2, with the exception of the late filing of a 13 report or failure to submit a complete report in compliance 14 with a court order, is grounds for license discipline under 15 chapter 148. 16 2. A physician who intentionally or recklessly performs or 17 attempts to perform an abortion in violation of this chapter is 18 guilty of a class “C” felony. 19 3. A woman upon whom an abortion has been performed in 20 violation of this chapter or the biological father may maintain 21 an action against the physician who performed the abortion in 22 intentional or reckless violation of this chapter for actual 23 damages. This subsection shall not be interpreted to apply to 24 a biological father when the pregnancy is the result of rape 25 or incest. 26 4. A woman upon whom an abortion has been attempted in 27 violation of this chapter may maintain an action against the 28 physician who attempted to perform the abortion in intentional 29 or reckless violation of this chapter for actual damages. 30 5. A cause of action for injunctive relief to prevent a 31 physician from performing abortions may be maintained against a 32 physician who has intentionally violated this chapter by the 33 woman upon whom the abortion was performed or attempted to be 34 performed, by the spouse of the woman, by a parent or guardian 35 -6- LSB 1155HV (3) 84 pf/nh 6/ 10

H.F. 657 of the woman if the woman is less than eighteen years of age or 1 unmarried at the time the abortion was performed or attempted 2 to be performed, by a current or former licensed health care 3 provider of the woman, by a county attorney with appropriate 4 jurisdiction, or by the attorney general. 5 6. A woman upon whom an abortion was performed or was 6 attempted to be performed shall not be subject to prosecution 7 for a violation of this chapter. 8 7. If the plaintiff prevails in an action brought under 9 this section, the plaintiff shall be entitled to an award for 10 reasonable attorney fees. 11 8. If the defendant prevails in an action brought under 12 this section and the court finds that the plaintiff’s suit was 13 frivolous and brought in bad faith, the defendant shall be 14 entitled to an award for reasonable attorney fees. 15 9. Damages and attorney fees shall not be assessed against 16 the woman upon whom an abortion was performed or attempted to 17 be performed except as provided in subsection 8. 18 10. In a civil or criminal proceeding or action brought 19 under this chapter, the court shall rule whether the anonymity 20 of any woman upon whom an abortion has been performed or 21 attempted shall be preserved from public disclosure if the 22 woman does not provide consent to such disclosure. The court, 23 upon motion or on its own motion, shall make such a ruling 24 and, upon determining that the woman’s anonymity should be 25 preserved, shall issue orders to the parties, witnesses, 26 and counsel and shall direct the sealing of the record and 27 exclusion of individuals from courtrooms or hearing rooms to 28 the extent necessary to safeguard the woman’s identity from 29 public disclosure. Each such order shall be accompanied by 30 specific written findings explaining why the anonymity of the 31 woman should be preserved from public disclosure, why the 32 order is essential to that end, how the order is narrowly 33 tailored to serve that interest, and why no reasonable less 34 restrictive alternative exists. In the absence of written 35 -7- LSB 1155HV (3) 84 pf/nh 7/ 10

H.F. 657 consent of the woman upon whom an abortion has been performed 1 or attempted, anyone, other than a public official, who brings 2 an action under this section shall do so under a pseudonym. 3 This subsection shall not be construed to conceal the identity 4 of the plaintiff or of witnesses from the defendant or from 5 attorneys for the defendant. 6 Sec. 5. NEW SECTION . 146A.4 Construction. 7 1. Nothing in this chapter shall be construed as creating or 8 recognizing a right to an abortion. 9 2. Nothing in this chapter shall be construed as determining 10 life to begin at twenty weeks’ gestation. Instead, it is 11 recognized that life begins at fertilization. 12 Sec. 6. NEW SECTION . 146A.5 Severability clause. 13 If any provision of this chapter or its application to any 14 person or circumstance is held invalid, the invalidity does 15 not affect other provisions or application of this chapter 16 which can be given effect without the invalid provision or 17 application, and to this end the provisions of this chapter are 18 severable. 19 Sec. 7. EFFECTIVE UPON ENACTMENT. This Act, being deemed of 20 immediate importance, takes effect upon enactment. 21 EXPLANATION 22 This bill relates to abortions. The bill provides findings 23 of the general assembly and definitions. 24 The bill provides that, except in the case of a medical 25 emergency, an abortion shall not be performed or induced 26 or be attempted to be performed or induced unless the 27 physician performing or inducing the abortion has first made 28 a determination of the probable postfertilization age of the 29 unborn child. Additionally, the bill prohibits a physician 30 from performing or inducing or attempting to perform or induce 31 an abortion upon a pregnant woman when it has been determined, 32 that the probable postfertilization age is 20 or more weeks 33 unless, in the physician’s reasonable medical judgment, either 34 the pregnant woman has a condition which the physician deems a 35 -8- LSB 1155HV (3) 84 pf/nh 8/ 10

H.F. 657 medical emergency or it is necessary to preserve the life of 1 the unborn child. If an abortion is performed or induced when 2 the probable postfertilization age is 20 or more weeks, the 3 physician is required to terminate the pregnancy in a manner 4 which, in the physician’s reasonable medical judgment, provides 5 the best opportunity for the unborn child to survive unless 6 such termination would pose a greater risk either of the death 7 of the pregnant woman or of the substantial and irreversible 8 physical impairment of a major bodily function of the woman 9 than would another available method. 10 The bill also requires certain reports to be filed by a 11 physician who performs or induces or attempts to perform or 12 induce an abortion with the department of public health, on 13 a schedule and in accordance with forms and rules adopted by 14 the department. The department is required to compile the 15 information collected annually and issue a public report, 16 ensuring that none of the information included in the public 17 reports could reasonably lead to the identification of any 18 pregnant woman upon whom an abortion was performed. The bill 19 provides monetary penalties for a physician who fails to submit 20 a report in a timely manner, submits an incomplete report, or 21 intentionally or recklessly falsifies a required report. 22 The bill provides for civil and criminal actions and 23 penalties relating to violations of the bill. Failure of a 24 physician to comply with any provision, with the exception of 25 the late filing of a report or failure to submit a complete 26 report in compliance with a court order, is grounds for license 27 discipline. A physician who intentionally or recklessly 28 performs or attempts to perform an abortion in violation of 29 the bill is guilty of a class “C” felony, which is punishable 30 by confinement for no more than 10 years and a fine of at 31 least $1,000 but not more than $10,000. However, the woman 32 upon whom the abortion was performed or was attempted to be 33 performed is not subject to prosecution for a violation of 34 the bill. The bill provides for the maintaining of actions 35 -9- LSB 1155HV (3) 84 pf/nh 9/ 10

H.F. 657 by certain people based on alleged violations of the bill. A 1 woman upon whom an abortion has been performed in violation 2 of the bill or the biological father may maintain an action 3 against the physician who performed the abortion in intentional 4 or reckless violation of the bill for actual damages. However, 5 the bill is not to be interpreted to apply to a biological 6 father when the pregnancy is the result of rape or incest. A 7 woman upon whom an abortion has been attempted in violation 8 of the bill may maintain an action against the physician who 9 attempted to perform the abortion in intentional or reckless 10 violation of the bill for actual damages. Additionally, a 11 cause of action for injunctive relief to prevent a physician 12 from performing abortions may be maintained against a physician 13 who has intentionally violated the bill by the woman upon whom 14 the abortion was performed or attempted to be performed, by the 15 spouse of the woman, by a parent or guardian of the woman if 16 the woman is less than 18 years of age or unmarried at the time 17 the abortion was performed or attempted to be performed, by a 18 current or former licensed health care provider of the woman, 19 by a county attorney with appropriate jurisdiction, or by the 20 attorney general. 21 The bill provides a process for preserving the anonymity of 22 the woman upon whom an abortion has been performed or attempted 23 from public disclosure if the woman does not provide consent to 24 such disclosure during any proceeding or action under the bill. 25 The bill also provides that the bill is not to be construed 26 as creating or recognizing a right to an abortion, and the 27 bill is not to be construed as determining life to begin at 20 28 weeks’ gestation; instead, it is recognized that life begins 29 at fertilization. 30 The bill includes a severability clause as is applicable to 31 every Act or statute pursuant to Code section 4.12. 32 The bill takes effect upon enactment. 33 -10- LSB 1155HV (3) 84 pf/nh 10/ 10