S.F. 42 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 1155XS (2) 84 pf/nh 1/ 11

S.F. 42 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. “Human pregnancy” means an individual organism of the 23 species homo sapiens from fertilization until live birth. 24 6. “Medical emergency” means a condition which, in 25 reasonable medical judgment, so complicates the medical 26 condition of a pregnant woman as to necessitate the immediate 27 abortion of the human pregnancy to avert the woman’s death or 28 for which a delay will create a serious risk of substantial and 29 irreversible physical impairment of a major bodily function. 30 “Medical emergency” does not include a condition which is based 31 on a claim or diagnosis that the pregnant woman will engage in 32 conduct which would result in the pregnant woman’s death or in 33 substantial and irreversible physical impairment of a major 34 bodily function. 35 -2- LSB 1155XS (2) 84 pf/nh 2/ 11

S.F. 42 7. “Medical facility” means any public or private hospital, 1 clinic, center, medical school, medical training institution, 2 health care facility, physician’s office, infirmary, 3 dispensary, ambulatory surgical center, or other institution or 4 location where medical care is provided to any person. 5 8. “Physician” means a person licensed under chapter 148. 6 9. “Postfertilization age” means the age of the human 7 pregnancy as calculated from the fertilization of the human 8 ovum. 9 10. “Probable postfertilization age” means what, in 10 reasonable medical judgment, will with reasonable probability 11 be the postfertilization age of the human pregnancy at the time 12 the abortion is to be performed. 13 11. “Reasonable medical judgment” means a medical judgment 14 made by a reasonably prudent physician who is knowledgeable 15 about the case and the treatment possibilities with respect to 16 the medical conditions involved. 17 12. “Unborn child” means a human pregnancy in the 18 postembryonic stage. 19 Sec. 3. NEW SECTION . 146A.2 Determination of 20 postfertilization age prior to abortion —— abortion prohibited 21 at twenty or more weeks postfertilization age —— exceptions —— 22 reporting requirements —— penalties. 23 1. Except in the case of a medical emergency, an abortion 24 shall not be performed or induced or be attempted to be 25 performed or induced unless the physician performing or 26 inducing the abortion has first made a determination of the 27 probable postfertilization age of the human pregnancy or relied 28 upon such a determination made by another physician. In making 29 such a determination, a physician shall make such inquiries 30 of the pregnant woman and perform or cause to be performed 31 such medical examinations and tests the physician considers 32 necessary in making a reasonable medical judgment to accurately 33 determine the postfertilization age of the human pregnancy. 34 2. a. A physician shall not perform or induce or attempt 35 -3- LSB 1155XS (2) 84 pf/nh 3/ 11

S.F. 42 to perform or induce an abortion upon a pregnant woman when it 1 has been determined, by the physician performing or inducing 2 the abortion or by another physician upon whose determination 3 that physician relies, that the probable postfertilization age 4 of the human pregnancy is twenty or more weeks unless, in the 5 physician’s reasonable medical judgment, any of the following 6 applies: 7 (1) The pregnant woman has a condition which the physician 8 deems a medical emergency. 9 (2) It is necessary to preserve the life of the unborn 10 child. 11 b. If an abortion is performed or induced under this 12 subsection, the physician shall terminate the human pregnancy 13 in the manner which, in the physician’s reasonable medical 14 judgment, provides the best opportunity for the unborn child 15 to survive, unless, in the physician’s reasonable medical 16 judgment, termination of the human pregnancy in that manner 17 would pose a greater risk than any other available method of 18 the death of the pregnant woman or of the substantial and 19 irreversible physical impairment of a major bodily function. 20 A greater risk shall not be deemed to exist if it is based on 21 a claim or diagnosis that the pregnant woman will engage in 22 conduct which would result in the pregnant woman’s death or in 23 substantial and irreversible physical impairment of a major 24 bodily function. 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 human pregnancy was made, the probable postfertilization 31 age determined and the method and basis of the determination. 32 b. If a determination of probable postfertilization 33 age of the human pregnancy was not made, the basis of the 34 determination that a medical emergency existed. 35 -4- LSB 1155XS (2) 84 pf/nh 4/ 11

S.F. 42 c. If the probable postfertilization age of the human 1 pregnancy was determined to be twenty or more weeks, the basis 2 of the determination of a medical emergency. 3 d. The method used for the abortion and, in the case of 4 an abortion performed when the probable postfertilization age 5 was determined to be twenty or more weeks, whether the method 6 of abortion used was one that, in the physician’s reasonable 7 medical judgment, provided the best opportunity for the unborn 8 child to survive or, if such a method was not used, the basis 9 of the determination that termination of the human pregnancy 10 in that manner would pose a greater risk than would any other 11 available method of the death of the pregnant woman or of the 12 substantial and irreversible physical impairment of a major 13 bodily function. 14 4. a. By June 30, annually, the department shall issue a 15 public report providing statistics for the previous calendar 16 year, compiled from the reports for that year submitted in 17 accordance with subsection 3. Each report shall also provide 18 the statistics for all previous calendar years, adjusted to 19 reflect any additional information from late or corrected 20 reports. The department shall ensure that none of the 21 information included in the public reports could reasonably 22 lead to the identification of any woman upon whom an abortion 23 was performed. 24 b. (1) A physician who fails to submit a report by the end 25 of thirty days following the due date shall be subject to a 26 late fee of five hundred dollars for each additional thirty-day 27 period or portion of a thirty-day period the report is overdue. 28 (2) A physician required to report in accordance with 29 subsection 3 who has not submitted a report or who has 30 submitted only an incomplete report more than one year 31 following the due date, may, in an action brought in the 32 manner in which actions are brought to enforce chapter 148, 33 be directed by a court of competent jurisdiction to submit a 34 complete report within a time period stated by court order or 35 -5- LSB 1155XS (2) 84 pf/nh 5/ 11

S.F. 42 be subject to contempt of court. 1 (3) A physician who intentionally or recklessly falsifies 2 a report required under this section is subject to a civil 3 penalty of one hundred dollars. 4 5. The department shall adopt rules to implement this 5 section. 6 Sec. 4. NEW SECTION . 146A.3 Civil and criminal actions 7 —— penalties. 8 1. Failure of a physician to comply with any provision of 9 section 146A.2, with the exception of the late filing of a 10 report or failure to submit a complete report in compliance 11 with a court order, is grounds for license discipline under 12 chapter 148. 13 2. A physician who intentionally or recklessly performs or 14 attempts to perform an abortion in violation of this chapter is 15 guilty of a class “C” felony. 16 3. A medical facility licensed in this state in which 17 abortions are performed or induced in violation of this chapter 18 is subject to immediate revocation of licensure. 19 4. A medical facility licensed in this state in which 20 abortions are performed or induced in violation of this chapter 21 is ineligible to receive state funding and is subject to 22 repayment of any state funds received from the state during the 23 time after which an abortion in violation of this chapter was 24 performed or induced. 25 5. A woman upon whom an abortion has been performed in 26 violation of this chapter or the biological father may maintain 27 an action against the physician who performed the abortion in 28 intentional or reckless violation of this chapter for actual 29 damages. 30 6. A woman upon whom an abortion has been attempted in 31 violation of this chapter may maintain an action against the 32 physician who attempted to perform the abortion in intentional 33 or reckless violation of this chapter for actual damages. 34 7. A cause of action for injunctive relief to prevent a 35 -6- LSB 1155XS (2) 84 pf/nh 6/ 11

S.F. 42 physician from performing abortions may be maintained against a 1 physician who has intentionally violated this chapter by the 2 woman upon whom the abortion was performed or attempted to be 3 performed, by the spouse of the woman, by a parent or guardian 4 of the woman if the woman is less than eighteen years of age or 5 unmarried at the time the abortion was performed or attempted 6 to be performed, by a current or former licensed health care 7 provider of the woman, by a county attorney with appropriate 8 jurisdiction, or by the attorney general. 9 8. A woman upon whom an abortion was performed or was 10 attempted to be performed shall not be subject to prosecution 11 for a violation of this chapter. 12 9. If the plaintiff prevails in an action brought under 13 this section, the plaintiff shall be entitled to an award for 14 reasonable attorney fees. 15 10. If the defendant prevails in an action brought under 16 this section and the court finds that the plaintiff’s suit was 17 frivolous and brought in bad faith, the defendant shall be 18 entitled to an award for reasonable attorney fees. 19 11. Damages and attorney fees shall not be assessed against 20 the woman upon whom an abortion was performed or attempted to 21 be performed except as provided in subsection 10. 22 12. In a civil or criminal proceeding or action brought 23 under this chapter, the court shall rule whether the anonymity 24 of any woman upon whom an abortion has been performed or 25 attempted shall be preserved from public disclosure if the 26 woman does not provide consent to such disclosure. The court, 27 upon motion or on its own motion, shall make such a ruling 28 and, upon determining that the woman’s anonymity should be 29 preserved, shall issue orders to the parties, witnesses, 30 and counsel and shall direct the sealing of the record and 31 exclusion of individuals from courtrooms or hearing rooms to 32 the extent necessary to safeguard the woman’s identity from 33 public disclosure. Each such order shall be accompanied by 34 specific written findings explaining why the anonymity of the 35 -7- LSB 1155XS (2) 84 pf/nh 7/ 11

S.F. 42 woman should be preserved from public disclosure, why the 1 order is essential to that end, how the order is narrowly 2 tailored to serve that interest, and why no reasonable less 3 restrictive alternative exists. In the absence of written 4 consent of the woman upon whom an abortion has been performed 5 or attempted, anyone, other than a public official, who brings 6 an action under this section shall do so under a pseudonym. 7 This subsection shall not be construed to conceal the identity 8 of the plaintiff or of witnesses from the defendant or from 9 attorneys for the defendant. 10 Sec. 5. NEW SECTION . 146A.4 Construction. 11 1. Nothing in this chapter shall be construed as creating or 12 recognizing a right to an abortion. 13 2. Nothing in this chapter shall be construed as determining 14 life to begin at twenty weeks’ gestation. Instead, it is 15 recognized that life begins at conception. 16 Sec. 6. NEW SECTION . 146A.5 Severability clause. 17 If any provision of this chapter or its application to any 18 person or circumstance is held invalid, the invalidity does 19 not affect other provisions or application of this chapter 20 which can be given effect without the invalid provision or 21 application, and to this end the provisions of this chapter are 22 severable. 23 Sec. 7. EFFECTIVE UPON ENACTMENT. This Act, being deemed of 24 immediate importance, takes effect upon enactment. 25 EXPLANATION 26 This bill relates to abortions. The bill provides findings 27 of the general assembly and definitions. 28 The bill provides that, except in the case of a medical 29 emergency, an abortion shall not be performed or induced 30 or be attempted to be performed or induced unless the 31 physician performing or inducing the abortion has first made 32 a determination of the probable postfertilization age of the 33 human pregnancy. Additionally, the bill prohibits a physician 34 from performing or inducing or attempting to perform or induce 35 -8- LSB 1155XS (2) 84 pf/nh 8/ 11

S.F. 42 an abortion upon a pregnant woman when it has been determined, 1 that the probable postfertilization age is 20 or more weeks 2 unless, in the physician’s reasonable medical judgment, either 3 the pregnant woman has a condition which the physician deems a 4 medical emergency or it is necessary to preserve the life of 5 the unborn child. If an abortion is performed or induced when 6 the probable postfertilization age is 20 or more weeks, the 7 physician is required to terminate the pregnancy in a manner 8 which, in the physician’s reasonable medical judgment, provides 9 the best opportunity for the unborn child to survive unless 10 such termination would pose a greater risk either of the death 11 of the pregnant woman or of the substantial and irreversible 12 physical impairment of a major bodily function of the woman 13 than would another available method. 14 The bill also requires certain reports to be filed by a 15 physician who performs or induces or attempts to perform or 16 induce an abortion with the department of public health, on 17 a schedule and in accordance with forms and rules adopted by 18 the department. The department is required to compile the 19 information collected annually and issue a public report, 20 ensuring that none of the information included in the public 21 reports could reasonably lead to the identification of any 22 pregnant woman upon whom an abortion was performed. The bill 23 provides monetary penalties for a physician who fails to submit 24 a report in a timely manner, submits an incomplete report, or 25 intentionally or recklessly falsifies a required report. 26 The bill provides for civil and criminal actions and 27 penalties relating to violations of the bill. Failure of a 28 physician to comply with any provision, with the exception of 29 the late filing of a report or failure to submit a complete 30 report in compliance with a court order, is grounds for license 31 discipline. A physician who intentionally or recklessly 32 performs or attempts to perform an abortion in violation of the 33 bill is guilty of a class “C” felony, which is punishable by 34 confinement for no more than 10 years and a fine of at least 35 -9- LSB 1155XS (2) 84 pf/nh 9/ 11

S.F. 42 $1,000 but not more than $10,000. The bill also provides that 1 a medical facility licensed in the state in which abortions 2 are performed or induced in violation of the bill is subject 3 to immediate revocation of licensure. Additionally, a 4 medical facility licensed in this state in which abortions are 5 performed or induced in violation of the bill is ineligible to 6 receive state funding and is subject to repayment of any state 7 funds received from the state during the time after which an 8 abortion in violation of the bill was performed or induced. 9 However, the woman upon whom the abortion was performed or was 10 attempted to be performed is not subject to prosecution for a 11 violation of the bill. The bill provides for the maintaining 12 of actions by certain people based on alleged violations of 13 the bill. A woman upon whom an abortion has been performed in 14 violation of the bill or the biological father may maintain 15 an action against the physician who performed the abortion 16 in intentional or reckless violation of the bill for actual 17 damages. A woman upon whom an abortion has been attempted 18 in violation of the bill may maintain an action against the 19 physician who attempted to perform the abortion in intentional 20 or reckless violation of the bill for actual damages. 21 Additionally, a cause of action for injunctive relief to 22 prevent a physician from performing abortions may be maintained 23 against a physician who has intentionally violated the bill by 24 the woman upon whom the abortion was performed or attempted 25 to be performed, by the spouse of the woman, by a parent or 26 guardian of the woman if the woman is less than 18 years of 27 age or unmarried at the time the abortion was performed or 28 attempted to be performed, by a current or former licensed 29 health care provider of the woman, by a county attorney with 30 appropriate jurisdiction, or by the attorney general. 31 The bill provides a process for preserving the anonymity of 32 the woman upon whom an abortion has been performed or attempted 33 from public disclosure if the woman does not provide consent to 34 such disclosure during any proceeding or action under the bill. 35 -10- LSB 1155XS (2) 84 pf/nh 10/ 11

S.F. 42 The bill also provides that the bill is not to be construed 1 as creating or recognizing a right to an abortion, and the 2 bill is not to be construed as determining life to begin at 20 3 weeks’ gestation; instead, it is recognized that life begins 4 at conception. 5 The bill includes a severability clause as is applicable to 6 every Act or statute pursuant to Code section 4.12. 7 The bill takes effect upon enactment. 8 -11- LSB 1155XS (2) 84 pf/nh 11/ 11