S.F. 2215 Section 1. Section 146A.1, Code 2020, is amended to read as 1 follows: 2 146A.1 Prerequisites for abortion —— licensee discipline. 3 1. a. A physician performing an abortion or a qualified 4 technician to whom the physician has delegated the 5 responsibility, shall comply with all of the following prior 6 to a woman providing informed consent to any part of the 7 performance of an abortion: 8 (1) Perform an obstetric ultrasound on the pregnant woman. 9 (2) Provide a simultaneous explanation of what the 10 ultrasound is depicting, including the presence and location 11 of the unborn child within the uterus and the number of unborn 12 children depicted, and, if the ultrasound image indicates fetal 13 demise has occurred, inform the woman of the fetal demise. 14 (3) Display the ultrasound images so that the pregnant woman 15 may view the images. 16 (4) Auscultate the fetal heartbeat of the unborn child so 17 that the pregnant woman may hear the heartbeat if the heartbeat 18 is audible. 19 (5) Provide a medical description of the ultrasound images 20 including the dimensions of the unborn child and the presence 21 of external members and internal organs of the unborn child, 22 if present and viewable. 23 (6) Obtain and retain in the pregnant woman’s medical 24 file written certification from the pregnant woman that an 25 ultrasound was performed on the pregnant woman and the pregnant 26 woman has viewed the ultrasound images, listened to the 27 fetal heartbeat of the unborn child if the fetal heartbeat is 28 audible, or declined to do so. 29 b. When the ultrasound images and fetal heartbeat sounds are 30 provided to and reviewed with the pregnant woman, nothing in 31 this section shall be construed to prevent the pregnant woman 32 from averting the pregnant woman’s eyes from the ultrasound 33 images or requesting the volume of the fetal heartbeat of the 34 unborn child be reduced or turned off if the fetal heartbeat 35 -1- LSB 5685XS (6) 88 pf/rh 1/ 6

S.F. 2215 is audible. The physician and the pregnant woman shall not 1 be subject to any penalty if the pregnant woman refuses to 2 view the displayed ultrasound images or to listen to the fetal 3 heartbeat if the fetal heartbeat is audible. 4 2. a. A physician performing an abortion shall obtain 5 written certification from the pregnant woman of all of the 6 following at least seventy-two hours prior to performing an 7 abortion : 8 a. That the woman has undergone an ultrasound imaging of the 9 unborn child that displays the approximate age of the unborn 10 child. 11 b. That the woman was given the opportunity to see the 12 unborn child by viewing the ultrasound image of the unborn 13 child. 14 c. That the woman was given the option of hearing a 15 description of the unborn child based on the ultrasound image 16 and hearing the heartbeat of the unborn child. 17 d. (1) That that the woman has been provided information 18 regarding all of the following, based upon the materials 19 developed by the department of public health pursuant to 20 subparagraph (2) paragraph “b” : 21 (a) (1) The options relative to a pregnancy, including 22 continuing the pregnancy to term and retaining parental rights 23 following the child’s birth, continuing the pregnancy to 24 term and placing the child for adoption, and terminating the 25 pregnancy. 26 (b) (2) The indicators, contra-indicators, and risk 27 factors including any physical, psychological, or situational 28 factors related to the abortion in light of the woman’s medical 29 history and medical condition. 30 (2) b. The department of public health shall make available 31 to physicians, upon request, all of the following information: 32 (a) (1) Geographically indexed materials designed to inform 33 the woman about public and private agencies and services 34 available to assist a woman through pregnancy, at the time of 35 -2- LSB 5685XS (6) 88 pf/rh 2/ 6

S.F. 2215 childbirth, and while the child is dependent. The materials 1 shall include a comprehensive list of the agencies available, 2 categorized by the type of services offered, and a description 3 of the manner by which the agency may be contacted. 4 (b) (2) Materials that encourage consideration of 5 placement for adoption. The materials shall inform the woman 6 of the benefits of adoption, including the requirements of 7 confidentiality in the adoption process, the importance of 8 adoption to individuals and society, and the state’s interest 9 in promoting adoption by preferring adoption over abortion. 10 (c) (3) Materials that contain objective information 11 describing the methods of abortion procedures commonly used, 12 the medical risks commonly associated with each such procedure, 13 and the possible detrimental physical and psychological effects 14 of abortion. 15 2. 3. Compliance with the prerequisites of this section 16 shall not apply to an abortion performed in a medical 17 emergency. 18 3. 4. A physician who violates this section is subject to 19 licensee discipline pursuant to section 148.6 . A qualified 20 technician who violates this section is subject to licensee 21 discipline by the applicable licensing or accrediting 22 authority. 23 4. 5. This section shall not be construed to impose 24 civil or criminal liability on a woman upon whom an abortion 25 is performed, or to prohibit the sale, use, prescription, or 26 administration of a measure, drug, or chemical designed for the 27 purposes of contraception. 28 5. 6. The board of medicine shall adopt rules pursuant to 29 chapter 17A to administer this section . 30 6. 7. As used in this section : 31 a. “Auscultate” means to examine by listening for sounds 32 made by internal organs of the unborn child, specifically for a 33 fetal heartbeat utilizing an ultrasound transducer or a fetal 34 heart rate monitor. 35 -3- LSB 5685XS (6) 88 pf/rh 3/ 6

S.F. 2215 b. “Fetal heartbeat” means cardiac activity, the steady and 1 repetitive rhythmic contraction of the fetal heart within the 2 gestational sac. 3 a. c. “Medical emergency” means a situation in which an 4 abortion is performed to preserve the life of the pregnant 5 woman whose life is endangered by a physical disorder, physical 6 illness, or physical injury, including a life-endangering 7 physical condition caused by or arising from the pregnancy, but 8 not including psychological conditions, emotional conditions, 9 familial conditions, or the woman’s age; or when continuation 10 of the pregnancy will create a serious risk of substantial 11 and irreversible impairment of a major bodily function of the 12 pregnant woman. 13 d. “Obstetric ultrasound” or “ultrasound” means the use 14 of ultrasonic waves for diagnostic or therapeutic purposes, 15 specifically to monitor a developing unborn child. 16 e. “Qualified technician” means a diagnostic medical 17 sonographer who is certified in obstetric and gynecological 18 sonography by the American registry of diagnostic medical 19 sonography; or a nurse midwife or an advanced registered nurse 20 practitioner licensed under chapter 152 or an advanced practice 21 registered nurse licensed under chapter 152E in obstetrics, 22 with a certification in obstetrical sonography. 23 b. f. “Unborn child” means an individual organism of the 24 species homo sapiens from fertilization to live birth. 25 EXPLANATION 26 The inclusion of this explanation does not constitute agreement with 27 the explanation’s substance by the members of the general assembly. 28 This bill relates to ultrasound prerequisites for abortion. 29 Current law requires as one of the prerequisites to an 30 abortion that a physician performing an abortion shall 31 obtain written certification from the pregnant woman of the 32 following, relating to an ultrasound, at least 72 hours prior 33 to performing an abortion: that the woman has undergone 34 an ultrasound imaging of the unborn child that displays 35 -4- LSB 5685XS (6) 88 pf/rh 4/ 6

S.F. 2215 the approximate age of the unborn child; that the woman was 1 given the opportunity to see the unborn child by viewing the 2 ultrasound image of the unborn child; and that the woman was 3 given the option of hearing a description of the unborn child 4 based on the ultrasound image and hearing the heartbeat of the 5 unborn child. 6 The bill replaces these prerequisites relating to an 7 ultrasound and instead requires that a physician, or a 8 qualified technician to whom the physician has delegated the 9 responsibility, shall comply with certain requirements prior 10 to a woman providing informed consent to any part of the 11 performance of an abortion. The requirements include that 12 the physician or qualified technician perform an obstetric 13 ultrasound on the pregnant woman; provide a simultaneous 14 explanation of what the ultrasound is depicting, including the 15 presence and location of the unborn child within the uterus and 16 the number of unborn children depicted, and if the ultrasound 17 image indicates fetal demise has occurred, inform the woman 18 of the fetal demise; display the ultrasound images so that 19 the pregnant woman may view the images; auscultate the fetal 20 heartbeat of the unborn child so that the pregnant woman may 21 hear the heartbeat if the heartbeat is audible; provide a 22 medical description of the ultrasound images including the 23 dimensions of the unborn child and the presence of external 24 members and internal organs of the unborn child, if present and 25 viewable; and obtain and retain in the pregnant woman’s medical 26 file written certification from the pregnant woman that an 27 ultrasound was performed on the pregnant woman and the pregnant 28 woman has viewed the ultrasound images, listened to the fetal 29 heartbeat if the heartbeat is audible, or declined to do so. 30 The bill provides that when the ultrasound images and fetal 31 heartbeat sounds are provided to and reviewed with the pregnant 32 woman, nothing in the bill shall be construed to prevent the 33 pregnant woman from averting the pregnant woman’s eyes from 34 the ultrasound images or requesting the volume of the fetal 35 -5- LSB 5685XS (6) 88 pf/rh 5/ 6

S.F. 2215 heartbeat be reduced or turned off if the fetal heartbeat is 1 audible. The physician and the pregnant woman shall not be 2 subject to any penalty if the pregnant woman refuses to view 3 the displayed ultrasound images or to listen to the fetal 4 heartbeat if the fetal heartbeat is audible. 5 The bill revises the remaining prerequisite provisions 6 relating to the provision of certain information to the 7 pregnant woman to retain the requirement that the prerequisites 8 be completed at least 72 hours prior to the performing of an 9 abortion. 10 The bill provides definitions for “auscultate”, “fetal 11 heartbeat”, “qualified technician”, and “ultrasound”. 12 Under current law, a physician who violates the bill is 13 subject to licensee discipline. The bill provides that in 14 addition, a qualified technician who violates the bill is 15 subject to licensee discipline by the applicable licensing or 16 accrediting authority. 17 -6- LSB 5685XS (6) 88 pf/rh 6/ 6