Closely divided Iowa Supreme Court finds challenges to abortion restrictions under Iowa constitution subject to rational-basis review, reverses injunction against “fetal heartbeat” law

by Chloe Dinardo | July 3, 2024

In a 4-3 decision, the Iowa Supreme Court held that rational basis review is the applicable standard in addressing challenges to abortion restrictions under the Iowa constitution. The Court then applied rational basis review to the 2023 “fetal heartbeat law” and concluded that the statute is rationally related to the state’s legitimate interest in protecting unborn lives. As a result, the temporary injunction enjoining enforcement of the law will be dissolved.

This opinion, authored by Justice Matthew McDermott and joined by Justices McDonald, Oxley, and May, may represent the culmination of a sequence of near-annual opinions from the Iowa Supreme Court regarding the standard of review for challenges to abortion restrictions. Justice McDermott began the opinion of the Court by explaining the background of legislation and litigation which led to this appeal. More recently, in 2022, the Court overturned its 2018 decision in Planned Parenthood v. Reynolds and ruled instead that there is no fundamental right to abortion under the Iowa Constitution. (See our coverage of that opinion here). Since then, there has been a question regarding whether the Court would adjust the level of scrutiny to be applied to challenges to abortion regulations. Faced with an opportunity to clarify the appropriate standard last term, the Court split evenly on the issue; thus, nothing was resolved.

The majority reaffirmed PPH 2022’s holding that “neither text nor history establishes abortion as a fundamental right.” According to the Court, there is no legal basis to subject rights without constitutional grounding to heightened scrutiny. Instead, reaching a conclusion similar to the United States Supreme Court in Dobbs v. Jackson Women’s Health Org., the Court held that rational-basis review applies to challenges to abortion regulations under the Iowa Constitution. Rational-basis review is the most deferential standard of review, under which a law is constitutional as long as it is rationally related to a legitimate state interest.

In this case, the Court found that the State identified six legitimate interests advanced by the fetal heartbeat law: respect for and preservation of prenatal life at all stages of development, protection of maternal health and safety, elimination of particularly gruesome or barbaric medical procedures, preservation of the integrity of the medical profession, mitigation of fetal pain, and prevention of discrimination of the basis of race, sex, or disability. Despite Planned Parenthood’s arguments to the contrary, a fully developed record was not necessary for the Court to decide that the law was rationally related to these interests. Because the fetal heartbeat law passed the rational-basis test, Planned Parenthood’s substantive due process challenge failed. On remand, the temporary injunction blocking enforcement of the law will be dissolved.

Next, the Court considered the State’s challenges to standing and ripeness. These issues were important for the Court to address because a ruling in favor of the State on these points would change the nature of relief available on the merits. When a party has an interest in the litigation and is injured by it, the party has standing to bring a lawsuit. Applying that principle to the case at hand, the Court held that Planned Parenthood suffers an injury-in-fact when forbidden by statute from performing abortions, especially considering the potential fines and threats to licensure at stake should abortion providers fail to comply with the fetal heartbeat law. Under Iowa precedents, Planned Parenthood was also properly positioned to bring suit as a third-party on behalf of the pregnant women it serves. The Court also found the case ripe for review.

Chief Justice Christensen, joined by Justices Waterman and Mansfield, would have found the fetal heartbeat law unconstitutional and affirmed the injunction. Chief Justice Christensen began by criticizing the majority for “strip[ping] Iowa women of their bodily autonomy.” She disagreed with the majority’s narration of the history of women, detailing instead the history of oppression women have faced in society. Additionally, in her view, the fundamental right at stake goes beyond that to obtain an abortion. Rather, the fetal heartbeat law implicates individuals’ ability to “make medical decisions affecting their health and bodily integrity in partnership with their healthcare provider free from government interference.” Chief Justice Christensen compared this right to a person’s right to make decisions about organ transplants and blood transfusions.

Next, Chief Justice Christensen took issue with the exceptions listed in the fetal heartbeat law. Her overarching argument was that the exceptions contradict the State’s position that one of its interests is protecting the health of the mother. In her view, the exceptions elevate the health of the unborn above that of the mother. She also argued that the law will deter medical professionals, as well as jobseekers, generally, from moving to the state.

Justice Christensen argued that rape and incest exceptions are practically “unattainable” because they require physicians to navigate through legal definitions before performing an abortion under one of the exceptions. The “even bigger problem” with the exceptions, she argued, is that many victims of rape or incest don’t report it. Justice Christensen observed how the “medical emergency” exception has garnered confusion in other states because it “pits the life of the mother against the life of the fetus.” Additionally, the “fetal abnormalities incompatible with life” exception is subject to time constraints that make it “unusable” for parents who learn of the abnormality after twenty weeks. In light of these issues, Chief Justice Christensen would have affirmed the injunction enjoining enforcement of the fetal heartbeat law.

Justice Mansfield authored a separate dissent, joined by Chief Justice Christensen and Justice Waterman, in which he disagreed with the majority about the effect of PPH 2022. He argued that the Court’s 2022 decision rejected the application of strict scrutiny to abortion laws, but did not go further to hold that there was no fundamental right to abortion at all. Justice Mansfield argued that the Iowa Constitution protects a person’s right to make decisions about procreation and parenting, which in his view, extends to making personal choices about one’s own body—including the decision not to procreate. Justice Mansfield compared the right to abortion to other rights regarding the “zone of personal autonomy.” Yet, he argued, rational-basis review is not applied to laws relating to contraception, sodomy, and same-sex marriage. He criticized the majority’s interpretation of history, tradition, and the democratic process, and, like Chief Justice Christensen, highlighted a historical perspective where women were not seen as equals to men.

Finally, Justice Mansfield argued that a right can be fundamental without being subject to strict scrutiny. Because he “believe[s] the right of autonomy over one’s body includes a limited but realistic opportunity to end a pregnancy,” he would apply the intermediate undue burden standard as first articulated in the United States Supreme Court’s Casey decision to abortion restrictions before the sixteenth week of pregnancy. According to Justice Mansfield, although an undue burden analysis may be more difficult to administer than the rational basis test, it is not as unworkable as the majority represents. Because the fetal heartbeat law largely bans abortion after the sixth week, Justice Mansfield would have found it unconstitutional and would have affirmed the injunction.




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The Iowa Supreme Court entered opinions in nine cases during April 2024.  Opinions from April not covered elsewhere on the blog are summarized below.



On Brief: Iowa’s Appellate Blog is devoted to appellate litigation with a focus on the Iowa Supreme Court, the Iowa Court of Appeals, and the U.S. Court of Appeals for the Eighth Circuit.


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