S.F. 12 Section 1. NEW SECTION . 146A.1 Definitions. 1 As used in this chapter unless the context otherwise 2 requires: 3 1. “Abortion” means abortion as defined in section 146.1. 4 2. “Department” means the department of public health. 5 3. “Medical emergency” means a condition which, on the basis 6 of a physician’s good-faith clinical judgment, so complicates 7 the medical condition of a pregnant woman as to necessitate 8 the immediate abortion of the woman’s pregnancy to avert the 9 woman’s death or for which a delay will create a serious risk 10 of substantial and irreversible impairment of a major bodily 11 function of the pregnant woman. 12 4. “Qualified professional” means a physician licensed 13 pursuant to chapter 148, a physician assistant licensed 14 pursuant to chapter 148C, a registered nurse or licensed 15 practical nurse licensed pursuant to chapter 152, a 16 psychologist licensed pursuant to chapter 154B, a social 17 worker licensed pursuant to chapter 154C, or a mental health 18 counselor licensed pursuant to chapter 154D, acting under 19 the supervision of the physician performing or inducing 20 the abortion, and acting within the course and scope of the 21 qualified professional’s authority as provided by law. 22 Sec. 2. NEW SECTION . 146A.2 Abortion —— voluntary and 23 informed consent —— waiting period. 24 1. Except in the case of a medical emergency, an abortion 25 shall not be performed or induced on a woman without the 26 woman’s voluntary and informed consent, given freely and 27 without coercion. Consent to an abortion is voluntary and 28 informed and given freely and without coercion if, at least 29 seventy-two hours prior to the abortion, all of the following 30 conditions are met: 31 a. The physician who is to perform or induce the abortion 32 or a qualified professional has informed the woman orally, 33 in person, which shall be reduced to writing, of all of the 34 following: 35 -1- LSB 1055XS (4) 86 pf/nh 1/ 13

S.F. 12 (1) The name of the physician who will perform or induce 1 the abortion. 2 (2) Medically accurate information that a reasonable 3 patient would consider material to the decision of whether or 4 not to undergo the abortion, including all of the following: 5 (a) A description of the proposed abortion method. 6 (b) The immediate and long-term medical risks to the woman 7 associated with the proposed abortion method including but not 8 limited to infection, hemorrhage, cervical tear or uterine 9 perforation, harm to subsequent pregnancies or the ability 10 to carry a subsequent child to term, and possible adverse 11 psychological effects associated with the abortion. 12 (c) The immediate and long-term medical risks to the 13 woman, in light of the anesthesia and medication that is to be 14 administered, the gestational age of the fetus, and the woman’s 15 medical history and medical condition. 16 (3) Alternatives to the abortion including making the woman 17 aware that information and materials shall be provided to the 18 woman detailing such alternatives to the abortion. 19 (4) A statement that the physician performing or inducing 20 the abortion is available for any questions concerning the 21 abortion and the telephone number at which the physician may be 22 later reached to answer any questions that the woman may have. 23 (5) The location of the hospital that offers obstetrical or 24 gynecological care located within thirty miles of the location 25 where the abortion is performed or induced and at which the 26 physician performing or inducing the abortion has clinical 27 privileges and where the woman may receive follow-up care by 28 the physician if complications arise. 29 (6) The gestational age of the fetus at the time the 30 abortion is to be performed or induced. 31 (7) The anatomical and physiological characteristics of the 32 fetus at the time the abortion is to be performed or induced. 33 b. The physician who is to perform or induce the abortion 34 or a qualified professional has provided the woman, in 35 -2- LSB 1055XS (4) 86 pf/nh 2/ 13

S.F. 12 person, with printed materials provided by the department 1 which describe the probable anatomical and physiological 2 characteristics of the fetus at two-week gestational increments 3 from conception to full term, including color photographs 4 or images of the developing fetus at two-week gestational 5 increments. Such descriptions shall include information about 6 brain and heart functions, the presence of external members and 7 internal organs during the applicable stages of development and 8 information on when the fetus is viable. The printed materials 9 shall prominently display the following statement: “The life 10 of each human being begins at conception. Abortion will 11 terminate the life of a separate, unique, living human being.” 12 c. The physician who is to perform or induce the abortion 13 or a qualified professional has provided the woman, in person, 14 with printed materials provided by the department which 15 describe the various surgical and drug-induced methods of 16 abortion relevant to the stage of pregnancy, as well as the 17 immediate and long-term medical risks commonly associated with 18 each abortion method including but not limited to infection, 19 hemorrhage, cervical tear or uterine perforation, harm to 20 subsequent pregnancies or the ability to carry a subsequent 21 child to term, and the possible adverse psychological effects 22 associated with an abortion. 23 d. The physician who is to perform or induce the abortion 24 or a qualified professional has provided the woman with the 25 opportunity to view an active ultrasound of the fetus and 26 hear the heartbeat of the fetus if the heartbeat is audible. 27 The woman shall be provided with a geographically indexed 28 list maintained by the department of health care providers, 29 facilities, and clinics that perform ultrasounds, including 30 those that offer ultrasound services free of charge. Such 31 materials shall provide contact information for each provider, 32 facility, or clinic including telephone numbers and, if 33 available, internet site addresses. If the woman decides to 34 obtain an ultrasound from a provider, facility, or clinic other 35 -3- LSB 1055XS (4) 86 pf/nh 3/ 13

S.F. 12 than the facility at which the abortion will be performed or 1 induced, the woman shall be offered a reasonable time to obtain 2 the ultrasound examination before the date and time set for 3 performing or inducing an abortion. The person conducting the 4 ultrasound shall ensure that the active ultrasound image is 5 of a quality consistent with standard medical practice in the 6 community, contains the dimensions of the fetus, and accurately 7 portrays the presence of external members and internal organs, 8 if present or viewable, of the fetus. The auscultation of 9 fetal heart tone must also be of a quality consistent with 10 standard medical practice in the community. If the woman 11 chooses to view the ultrasound or hear the heartbeat or both 12 at the facility at which the abortion will be performed or 13 induced, such services shall be provided to the woman at the 14 facility at which the abortion is to be performed or induced at 15 least seventy-two hours prior to the abortion being performed 16 or induced. 17 e. Prior to an abortion being performed or induced on 18 a fetus of twenty-two weeks gestational age or older, the 19 physician who is to perform or induce the abortion or a 20 qualified professional has provided the woman, in person, 21 with printed materials provided by the department that offer 22 information on the possibility of the abortion causing pain to 23 the fetus. This information shall include but is not limited 24 to all of the following: 25 (1) That at least by twenty-two weeks of gestational age, 26 the fetus possesses all the anatomical structures, including 27 pain receptors, spinal cord, nerve tracts, thalamus, and 28 cortex, that are necessary in order to feel pain. 29 (2) A description of the actual steps in the abortion 30 procedure to be performed or induced, and at which steps the 31 abortion procedure could be painful to the fetus. 32 (3) That there is evidence that by twenty-two weeks of 33 gestational age, a fetus seeks to evade certain stimuli in a 34 manner that in an infant or an adult would be interpreted as a 35 -4- LSB 1055XS (4) 86 pf/nh 4/ 13

S.F. 12 response to pain. 1 (4) Anesthesia is given to a fetus that is twenty-two weeks 2 or more gestational age who undergoes prenatal surgery. 3 (5) Anesthesia is given to premature children who are 4 twenty-two weeks or more gestational age who undergo surgery. 5 (6) Anesthesia or an analgesic is available in order to 6 minimize or alleviate the pain to the fetus. 7 f. The physician who is to perform or induce the abortion 8 or a qualified professional has provided the woman, in person, 9 with printed materials provided by the department explaining 10 to the woman alternatives to abortion the woman may wish to 11 consider. The materials shall provide all of the following: 12 (1) Identification on a geographical basis of public 13 and private agencies available to assist a woman in carrying 14 a fetus to term, and to assist the woman in caring for 15 her dependent child or placing her child for adoption, 16 including agencies commonly known and generally referred to 17 as pregnancy resource centers, crisis pregnancy centers, 18 maternity homes, and adoption agencies. Such materials 19 shall provide a comprehensive list by geographical area of 20 the agencies, a description of the services they offer, and 21 the telephone numbers and addresses of the agencies provided 22 that such materials shall not include any programs, services, 23 organizations, or affiliates of organizations that perform or 24 induce, or assist in the performing or inducing of, abortions, 25 or that refer for abortions. 26 (2) An explanation of any programs and services available 27 to pregnant women and mothers of newborn children offered by 28 public or private agencies which assist a woman in carrying 29 a fetus to term and to assist the woman in caring for her 30 dependent child or placing her child for adoption, including 31 but not limited to prenatal care; maternal health care; newborn 32 or infant care; mental health services; professional counseling 33 services; housing programs; utility assistance; transportation 34 services; food, clothing, and supplies related to pregnancy; 35 -5- LSB 1055XS (4) 86 pf/nh 5/ 13

S.F. 12 parenting skills; educational programs; job training and 1 placement services; drug and alcohol testing and treatment; and 2 adoption assistance. 3 (3) The prominently displayed statement: “There are 4 public and private agencies willing and able to help you carry 5 your fetus to term, and to assist you and your child after 6 your child is born, whether you choose to keep your child or 7 place your child for adoption. The state of Iowa encourages 8 you to contact those agencies before making a final decision 9 about abortion. State law requires that your physician or a 10 qualified professional give you the opportunity to contact 11 agencies like these before you undergo an abortion.” 12 g. The physician who is to perform or induce the abortion 13 or a qualified professional has provided the woman, in person, 14 with printed materials provided by the department explaining 15 that the father of the unborn child is liable to assist in the 16 support of the child, even in instances where the father has 17 offered to pay for the abortion. Such materials shall include 18 information on the legal duties and support obligations of the 19 father of a child, including but not limited to child support 20 payments, and the fact that paternity may be established by the 21 father’s name on a birth certificate or statement of paternity, 22 or by court action. Such printed materials shall also state 23 that more information concerning paternity establishment and 24 child support services and enforcement may be obtained by 25 contacting the department of human services. 26 h. The physician who is to perform or induce the abortion or 27 a qualified professional has informed the woman that the woman 28 is free to withhold or withdraw the woman’s consent to the 29 abortion at any time without affecting her right to future care 30 or treatment and without the loss of any state or federally 31 funded benefits to which the woman might otherwise be entitled. 32 2. All information required to be provided to a woman 33 considering abortion pursuant to subsection 1 shall be 34 presented to the woman individually, in the physical presence 35 -6- LSB 1055XS (4) 86 pf/nh 6/ 13

S.F. 12 of the woman and in a private room, to protect the woman’s 1 privacy, to maintain the confidentiality of her decision, to 2 ensure that the information focuses on the woman’s individual 3 circumstances, to ensure she has an adequate opportunity to 4 ask questions, and to ensure that she is not a victim of 5 coerced abortion. If a woman is unable to read the materials 6 provided to her, they shall be read to her. If a woman needs 7 an interpreter to understand the information presented in 8 the written materials, an interpreter shall be provided to 9 the woman. If a woman asks questions concerning any of the 10 information or materials, answers shall be provided in a 11 language the woman is able to understand. 12 3. An abortion shall not be performed or induced unless and 13 until the woman upon whom the abortion is to be performed or 14 induced certifies in writing on a checklist form provided by 15 the department that she has been presented all the information 16 required in subsection 1, that she has been provided the 17 opportunity to view an active ultrasound image of the fetus 18 and hear the heartbeat of the fetus if it is audible, and 19 that she further certifies that she gives her voluntary and 20 informed consent, freely and without coercion, to the abortion 21 procedure. 22 4. An abortion shall not be performed or induced on a 23 fetus of twenty-two weeks gestational age or older unless and 24 until the woman upon whom the abortion is to be performed or 25 induced has been provided the opportunity to choose to have an 26 anesthetic or analgesic administered to eliminate or alleviate 27 pain to the fetus caused by the particular method of abortion 28 to be performed or induced. The administration of anesthesia 29 or analgesics shall be performed in a manner consistent with 30 standard medical practice in the community. 31 5. A physician shall not perform or induce an abortion 32 unless and until the physician has obtained from the woman 33 her voluntary and informed consent given freely and without 34 coercion as provided in this section. If the physician has 35 -7- LSB 1055XS (4) 86 pf/nh 7/ 13

S.F. 12 reason to believe that the woman is being coerced into having 1 an abortion, the physician or qualified professional shall 2 inform the woman that services are available to her and shall 3 provide her with private access to a telephone and information 4 about such services, including domestic abuse or sexual assault 5 centers and orders of protection. 6 6. A physician shall not perform or induce an abortion 7 unless and until the physician has received and signed a copy 8 of the form prescribed in subsection 3. The physician shall 9 retain a copy of the form in the woman’s medical record. 10 7. If a medical emergency exists, the physician who 11 performed or induced the abortion shall clearly certify in 12 writing the nature and circumstances of the medical emergency. 13 This certification shall be signed by the physician who 14 performed or induced the abortion, and shall be maintained in 15 the woman’s medical record. 16 8. A person shall not require, obtain, or accept payment 17 for an abortion from or on behalf of a patient until at least 18 seventy-two hours have passed since the time the information 19 required by subsection 1 has been provided to the patient. 20 Nothing in this subsection shall prohibit a person or entity 21 from notifying the patient that payment for the abortion will 22 be required after the seventy-two-hour period has expired if 23 the patient voluntarily chooses to have the abortion. 24 9. By November 1, 2015, the department shall produce the 25 written materials and forms described in this section. Any 26 written materials produced shall be printed in a typeface 27 large enough to be clearly legible. All information shall 28 be presented in an objective, unbiased manner designed to 29 convey only accurate scientific and medical information. The 30 department shall furnish the written materials and forms at 31 no cost and in sufficient quantity to any person who performs 32 or induces abortions, or to any hospital or facility that 33 provides abortions. The department shall make all information 34 required by subsection 1 available to the public through its 35 -8- LSB 1055XS (4) 86 pf/nh 8/ 13

S.F. 12 department internet site. The department shall maintain a 1 toll-free, twenty-four-hour hotline telephone number thorough 2 which a caller may obtain information on a regional basis 3 concerning the agencies and services described in subsection 1. 4 Identifying information regarding persons who use the internet 5 site shall not be collected or maintained. The department 6 shall monitor the internet site on a regular basis to prevent 7 tampering and correct any operational deficiencies. 8 Sec. 3. EFFECTIVE DATES. 9 1. The provisions of this Act requiring the department of 10 public health to produce certain written materials and forms as 11 described in section 146A.2, subsection 9, as enacted in this 12 Act, by November 1, 2015, being deemed of immediate importance, 13 take effect upon enactment. 14 2. The remainder of this Act takes effect November 1, 2015. 15 EXPLANATION 16 The inclusion of this explanation does not constitute agreement with 17 the explanation’s substance by the members of the general assembly. 18 This bill establishes new Code chapter 146A, requiring 19 voluntary and informed consent to an abortion. 20 The bill specifies the conditions of voluntary and informed 21 consent that must be completed at least 72 hours prior to an 22 abortion including: 23 1. The physician who is to perform or induce the abortion 24 or a qualified professional shall inform the woman orally, in 25 person, which shall be reduced to writing, of the name of the 26 physician who will perform or induce the abortion, medically 27 accurate information relating to the decision of whether or 28 not to undergo the abortion, the medical risks to the woman 29 associated with the abortion, alternatives to the abortion, how 30 the physician may be reached, the location of the hospital, the 31 gestational age of the fetus at the time the abortion is to 32 be performed or induced, and the anatomical and physiological 33 characteristics of the fetus at the time of the abortion. 34 2. The physician who is to perform or induce the abortion 35 -9- LSB 1055XS (4) 86 pf/nh 9/ 13

S.F. 12 or a qualified professional shall provide the woman, in 1 person, with printed materials provided by the department of 2 public health (DPH) which describe the probable anatomical 3 and physiological characteristics of the fetus at two-week 4 gestational increments and includes the prominently displayed 5 statement: “The life of each human being begins at conception. 6 Abortion will terminate the life of a separate, unique, living 7 human being.” 8 3. The physician who is to perform or induce the abortion or 9 a qualified professional shall provide the woman, in person, 10 with printed materials provided by DPH which describe the 11 various methods of abortion relevant to the stage of pregnancy, 12 as well as the medical risks commonly associated with each 13 abortion method. 14 4. The physician who is to perform or induce the abortion 15 or a qualified professional shall provide the woman with the 16 opportunity to view an active ultrasound of the fetus and hear 17 the heartbeat of the fetus if the heartbeat is audible. 18 5. Prior to an abortion being performed or induced on a 19 fetus of at least 22 weeks gestational age, the physician 20 who is to perform or induce the abortion or a qualified 21 professional shall provide the woman, in person, with printed 22 materials provided by DPH that offer information on the 23 possibility of the abortion causing pain to the fetus. 24 6. The physician who is to perform or induce the abortion or 25 a qualified professional shall provide the woman, in person, 26 with printed materials provided by DPH explaining to the woman 27 alternatives to abortion she may wish to consider, including 28 the agencies, programs, and services available to assist her. 29 7. The physician who is to perform or induce the abortion or 30 a qualified professional shall provide the woman, in person, 31 with printed materials provided by DPH explaining that the 32 father of the unborn child is liable to assist in the support 33 of the child, even in instances where the father has offered 34 to pay for the abortion. 35 -10- LSB 1055XS (4) 86 pf/nh 10/ 13

S.F. 12 8. The physician who is to perform or induce the abortion 1 or a qualified professional shall inform the woman that she is 2 free to withhold or withdraw her consent to the abortion at any 3 time without affecting her right to future care or treatment 4 and without the loss of any state or federally funded benefits 5 to which she might otherwise be entitled. 6 The bill requires that all information required to be 7 provided to a woman considering abortion be presented to the 8 woman individually, in the physical presence of the woman and 9 in a private room, to protect her privacy, to maintain the 10 confidentiality of her decision, to ensure that the information 11 focuses on her individual circumstances, to ensure she has an 12 adequate opportunity to ask questions, and to ensure that she 13 is not a victim of coerced abortion. 14 Under the bill, an abortion is prohibited from being 15 performed or induced unless and until the woman upon whom the 16 abortion is to be performed or induced certifies in writing on 17 a checklist form provided by DPH that she has been presented 18 all the information required, that she has been provided the 19 opportunity to view an active ultrasound image of the fetus 20 and hear the heartbeat of the fetus if it is audible, and 21 that she further certifies that she gives her voluntary and 22 informed consent, freely and without coercion, to the abortion 23 procedure. 24 Under the bill, an abortion shall not be performed or induced 25 on a fetus of 22 weeks gestational age or older unless and 26 until the woman upon whom the abortion is to be performed or 27 induced has been provided the opportunity to choose to have an 28 anesthetic or analgesic administered to eliminate or alleviate 29 pain to the fetus caused by the particular method of abortion 30 to be performed or induced. The administration of anesthesia 31 or analgesics shall be performed in a manner consistent with 32 standard medical practice in the community. 33 Under the bill, a physician is prohibited from performing 34 or inducing an abortion unless and until the physician has 35 -11- LSB 1055XS (4) 86 pf/nh 11/ 13

S.F. 12 obtained from the woman her voluntary and informed consent 1 given freely and without coercion. If the physician has 2 reason to believe that the woman is being coerced into having 3 an abortion, the physician or a qualified professional shall 4 inform the woman that services are available for her and shall 5 provide her with private access to a telephone and information 6 about such services, including domestic abuse or sexual assault 7 centers and orders of protection. Additionally, a physician is 8 prohibited from performing or inducing an abortion unless and 9 until the physician has received and signed a copy of the form 10 specified under the bill. The physician is required to retain 11 a copy of the form in the woman’s medical record. 12 If a medical emergency exists, the physician who performed 13 or induced the abortion is required to clearly certify in 14 writing the nature and circumstances of the medical emergency. 15 The certification must be signed by the physician who performed 16 or induced the abortion, and is required to be maintained in 17 the woman’s medical record. 18 The bill prohibits a person from requiring, obtaining, 19 or accepting payment for an abortion from or on behalf of 20 a patient until at least 72 hours have passed since the 21 time that the information required has been provided to the 22 patient. However, this does not prohibit a person or entity 23 from notifying the patient that payment for the abortion 24 will be required after the 72-hour period has expired if she 25 voluntarily chooses to have the abortion. 26 The bill requires that by November 1, 2015, DPH shall produce 27 the written materials and forms described in the bill, and 28 any written materials produced shall be printed in a typeface 29 large enough to be clearly legible. All information is to 30 be presented in an objective, unbiased manner designed to 31 convey only accurate scientific and medical information. DPH 32 is required to furnish the written materials and forms at no 33 cost and in sufficient quantity to any person who performs or 34 induces abortions, or to any hospital or facility that provides 35 -12- LSB 1055XS (4) 86 pf/nh 12/ 13

S.F. 12 abortions. DPH is required to make all information required 1 available to the public through its department internet site. 2 DPH is also required to maintain a toll-free, 24-hour hotline 3 telephone number through which a caller may obtain information 4 on a regional basis concerning the agencies and services 5 offering alternatives to abortion. 6 The provisions requiring DPH to produce certain written 7 materials and forms by November 1, 2015, take effect upon 8 enactment. The remainder of the bill takes effect November 1, 9 2015. 10 -13- LSB 1055XS (4) 86 pf/nh 13/ 13