ARI SHAPIRO, HOST:
A warning that, for the next five minutes or so, we're going to be talking about sexual assault.
This summer, Iowa started enforcing a six-week abortion ban. Like bans in other states, the law makes an exception for certain things like rape, at least on paper. But many doctors and reproductive rights advocates say it's nearly impossible for patients across the country, especially in Iowa, to actually get an abortion if they've been assaulted. Katia Riddle reports.
KATIA RIDDLE, BYLINE: The town of Waverly in northeast Iowa has just about 10,000 people. Old, beautiful farmhouses sit along its streets and among its cornfields. Dr. Emily Boevers grew up close by to here, on a farm that's been in her family for seven generations.
EMILY BOEVERS: My grandpa would talk about how much he loved the seasons of farming, and that was something that was really - just shaped who I am, you know?
RIDDLE: After medical school, she returned home to serve the community where she grew up.
BOEVERS: It matters for me to raise my kids here, so that they can hopefully love Iowa and understand rural America the way that I feel like I do.
RIDDLE: Now she is one of the only obstetricians in a part of the state that is desperate for doctors like her. Many of her patients drive for at least an hour to see her. This work comes with a lot of difficulties - not enough staffing or specialists, elevated risks for patients. Lately, she's added to this list a new challenge, interpreting the state's abortion laws.
BOEVERS: (Reading) A physician who intends to perform or induce an abortion must use the date the sex act caused the pregnancy occurred.
RIDDLE: Boevers reads aloud from a document. It's the requirements for doctors, from the state's board of medicine, on how to comply with the law. She's sitting at her computer in her office.
BOEVERS: (Reading) Whether the sex act constituted a rape, which...
RIDDLE: If a patient comes to a doctor like Boevers and says she's been raped and wants an abortion, it's up to the doctor to determine if the claim is legitimate and qualifies for an abortion. Doctors who don't comply could face legal consequences. Eleven states have abortion restrictions with exemptions for rape. But Iowa's law requires doctors to collect and document an unusual level of the detail.
BOEVERS: Now I'm the investigator, trying to decide if the details of the incident constitute rape as per Iowa code. I'm supposed to maintain a therapeutic, caring relationship with this patient while I query all these details. And then I'm - finally, I'm at the point of deciding if she meets the criteria to get the medical care that I'm trained to provide.
RIDDLE: Alternatively, a rape victim can provide a police report to a doctor to evaluate. That could potentially serve as evidence in order to obtain an abortion. But people who work with rape victims say reporting a rape and collecting evidence is intimidating.
KATY RASMUSSEN: So oral swabs, vaginal swabs, anal swabs.
RIDDLE: Katy Rasmussen is a nurse with the Johnson County Sexual Assault Response Team in Iowa. Sitting behind her desk, she opens a small cardboard box - a rape kit. She works with assault victims who come to the emergency room. If they choose, they can make a police report using this kit. Rasmussen says many decline.
RASMUSSEN: It's just too much for them to manage at that point.
RIDDLE: Often, this is hours or days after an assault. Patients can be in shock. Thinking about a possible pregnancy, getting an abortion, needing a police report to qualify for a rape exception - it's overwhelming. Rasmussen tries to explain to patients that assault is not their fault.
RASMUSSEN: This has happened because someone chose to take advantage of you or to assault you or to - you know, to harm you in this way.
RIDDLE: Most rapes go unreported. Sometimes it can take months or even years for a person to identify what happened to them as assault. Kristi Judkins is the executive director of Iowa Right to Life.
KRISTI JUDKINS: My heart goes out to any woman who has had that happen to her.
RIDDLE: Judkins' group supports Iowa's abortion ban.
JUDKINS: It's awful, but, you know, again, where we stand is the life of both patients.
RIDDLE: Still, she admits there's many unanswered questions, like what standard doctors should use to determine if a rape is legitimate and what consequences they face for breaking the law. She says she looked to other states for useful precedent.
JUDKINS: I even did go out to look at other states who have had the laws enacted for longer than Iowa has, and I was not able to come up with anything.
RIDDLE: The lawmakers who sponsored this legislation didn't respond to interview requests. Republican Governor Kim Reynolds' office suggested any questions about the law could be answered by reading language put out by the board of medicine, the same language that has many Iowa doctors confused.
Back in Waverly, Dr. Emily Boevers sits at her desk and rubs her eyes. She describes what she's planning to do if she ever has to investigate a patient's claims of sexual assault. She's been rehearsing what she'll say.
BOEVERS: I will say, unfortunately, our government mandates that I must ask you some questions that don't impact your medical care but do impact my ability to provide care to you.
RIDDLE: If you are able to answer these questions, she plans to say, I might be able to help you.
For NPR News, I'm Katia Riddle in Iowa. Transcript provided by NPR, Copyright NPR.
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