Abortion in Iowa: Medical Concerns and Religious Taboos 

Abortion-rights advocates cite issues with wording regarding medical exceptions in a law promoted by religious anti-abortion groups

IOWA CITY, Iowa— Aubrey Stark remembers coming home from elementary school to see her usually lively pregnant mother, Mandy Stark, ill and bedridden. “She was in so much pain,” Stark said. “[Her condition] was not safe for her at all.” Mandy Stark was suffering from a molar pregnancy, defined by the National Cancer Institute as a slow-growing tumor developing from cells that help an embryo attach to the uterus after an egg's fertilization. These tumors can potentially spread to nearby tissue and become malignant. She had to receive two shots of chemotherapy because of the complication. Mandy Stark endured five molar pregnancies between 2008 and 2010. Each required her to undergo a type of abortion called a dilation and curettage procedure (D&C) to remove. That procedure may be extremely difficult to procure now under the same circumstances. Two years after the U.S. Supreme Court overturned Roe v. Wade in the 2022 Dobbs decision, Iowa Governor Kim Reynolds signed a law prohibiting most abortions after the detection of fetal heartbeat activity. This so-called ‘fetal heartbeat law’ makes getting an abortion in Iowa illegal after six weeks without a special exception. But the permissibility of such exceptions may not always be clear. Medical community voices concern Annie Galloway, a medical student at the University of Iowa’s Carver College of Medicine, is the co-president of Carver’s chapter of the national student-led organization Medical Students for Choice. The group’s mission is “to support future abortion care providers and advocate for reproductive justice globally.” “It's each person's right to make [abortion] choices for themselves,” Galloway said. “And I think that as a future health care provider, I feel obligated to advocate for people's health and safety in that way.” On the University of Iowa campus, she said the organization of about 150 students leads efforts to support reproductive rights such as hosting lectures about legislation updates and workshops demonstrating abortion procedures. The group also fundraises for the local Emma Goldman clinic, an independent nonprofit that provides abortion services. Galloway said growing up in liberal Seattle caused her to take abortion protections for granted. But that feeling changed when she moved to more conservative Iowa. “I've just felt called to work to provide this human right that I think everyone deserves, whether legislators in Iowa think so or not,” she said. Galloway said a serious issue for medical practitioners is unclear wording in Iowa laws that fail to clarify when abortions are permitted past six weeks out of medical necessity. “A lot of these laws that are bans say things like, no abortions unless the health of the mother is at risk,” Galloway said. “And the problem is that's a very gray line.” To fit the definition of medical emergency defined by Chapter 146B of the Iowa Legal Code, an abortion must be performed to preserve the life of the mother against physical illness or injury caused by the pregnancy, or to prevent serious risk of substantial and irreversible impairment of a major bodily function caused by the pregnancy. “There's no definitive, ‘once their vitals are this, you can do an intervention,’” Galloway said. “You're just sort of waiting for them to get sick enough so that their life is at risk. Like, that's the language. It's not like, ‘when their blood pressure drops to this, then you can intervene.’ You're just sort of watching them tank and you have to, in this gray zone, decide.” And getting the call wrong can have extreme repercussions on practicing physicians. CNN reported that if doctors break laws relating to the Iowa abortion ban, they risk losing their medical license and facing fines up to $10,000. Galloway said this poses an unreasonable risk for medical providers. “To have your license put on the line when you're trying to decide, ‘is this person sick enough that I could do an abortion because it would save their life?’ It’s putting doctors in high risk situations and it's unfair,” she said. An analysis by the American Association of Medical Colleges suggested this as a reason why MD senior residency programs in states with abortion bans have seen a disproportionate decrease in recent numbers of applications compared to those in states where abortion is protected. Galloway herself says she does not plan to stay in Iowa to practice. “[The ban] creates a horrible cognitive dissonance of, like, you know what you can do to save someone in the moment and they're right there and you could do it, but the legislation is saying you can't. And instead, then you're being put in this position where you have to wait until they get even sicker,” she said. “But I guess at least you kept your medical license.” Pro-life organizations promote their perspective While Galloway and her fellow Medical Students for Choice members voice discontent with Iowa’s strict abortion laws, anti-abortion advocates view them as a step in the right direction. Pulse Life Advocates, a Christian-based non-profit based in West Des Moines and originally known as Iowans for Life, is the longest-standing pro-life organization in the state. Pulse’s executive director, Maggie DeWitte, is also the spokesperson for the Iowa Coalition of Pro-life Leaders, a collective of organizations that have banded together to lobby for Republican-supported anti-abortion legislation in Iowa. “The Republican Party is a party of life,” DeWitte said. “And so as such, they have a priority of life legislation.” The implementation of the fetal heartbeat law was backed solely by Republican lawmakers following a marathon one-day special session at the Iowa Capitol. DeWitte said the Coalition of Pro-life Leaders was instrumental in pushing for that law. “We've been able to implement some really good, powerful pro-life legislation to safeguard Iowa citizens. So it's been a good thing for us and a good thing for Iowa,” she said. She believes the abortion laws as written are clear in terms of when medical exceptions should be allowed. “Our law does have an exception for life of the mother and so I would trust that in the years and years of medical training that a doctor should certainly know when a life is in danger and they would take appropriate action to do so,” she said. In Johnson County, Sheryl Schwager is the executive director of Johnson County Right to Life. The organization is a 501(c)(3) charity describing itself as dedicated to ensuring the legal protection of all human life. Though its downtown Iowa City office is filled with images of Jesus and other Christian figures, Schwager said the organization is not religiously based. But she said many involved with the organization are religious, herself included. Schwager works with and supports DeWitte and her organization. She agrees that the laws are written clearly. “They're seeing gray areas where there are not gray areas,” Schwager said. “It clearly, as far as I understand, states that if an abortion is medically necessary to save the life of the mother, then that can be done. And it's up to the doctor to determine if that's the case.” Schwager said abortion-rights advocates have made the medical exception issue seem more serious than it actually is. “Sometimes I think that propaganda can sort of creep in there and they can use that as an excuse to say, see, you know, you've made it so vague that we, our hands are tied and so women are dying,” she said. “But that's not the case.” DeWitte said a genuine medical concern is posed by medication abortions, calling the pills taken to end pregnancies “very dangerous.” Schwager shares a similar belief. “[Women are] dying,” Schwager said. “They're hemorrhaging. They're suffering all sorts of terrible side effects and not the least to say witnessing the death of their little eight, nine, ten week [old] baby.” According to Yale Medicine, medication abortions, which account for over half of all abortions, require first taking a mifepristone pill which blocks activity of the pregnancy-supporting hormone progesterone. Within 48 hours, a second pill containing misoprostol is taken, which causes the uterus to contract and expel its contents. Side effects of the second pill often cause discomfort with symptoms similar to a heavy period, including cramps, heavy bleeding and the potential for nausea and fever. But a 2013 study by the international reproductive health journal Contraception reported less than a 0.4% risk of serious complications. In an article published by the National Library of Medicine, Frontiers in Public Health called abortion “one of the safest medical procedures.” Yet, it reported in 2023 that maternal death rates were 62% higher in states with abortion restrictions compared to those with greater abortion access. Such discrepancies could not exist before the Dobbs decision. But since the choice to maintain abortion rights has become something state legislatures can opt in or out of, 20 states have instated a full or partial abortion ban, according to the New York Times. Former President Donald Trump said returning abortion back to the states would put the issue “where everyone wanted it from a legal standpoint.” But CNN reported many scholars and politicians argue this was not the will of the American people. On that point, Schwager agrees. “I compare it to slavery and a lot of people don't like it when I do this,” Schwager said. “But if slavery is wrong, we're not going to send it back to the state to let each state decide.” Schwager would prefer a federal mandate banning all abortion procedures. “There are things that can be overturned just like slavery was overturned,” Schwager said. “The right to abortion can be overturned too.” Democratic dissent DeWitte attributes much of Pulse Life Advocates lobbying success to the Republican majority held in the Iowa legislature. Republicans make up about twice the number of Democrats in both chambers. But Iowa Representative Elinor Levin said despite their fewer numbers, Iowa Democrats are still pushing for reproductive protections. Levin is a Democrat representing Iowa House District 89, which encompasses Iowa City and University Heights. She openly supports abortion rights. “Bodily autonomy, the right to determine what we do with our bodies is one of the most fundamental rights I think we have and making abortion illegal strips away that autonomy,” Levin said. “And in my mind that is wrong.” But Levin says it’s not just her opinion that she considers in her push for greater abortion access in Iowa. She said 63% of Iowans believe access to safe and legal abortions should be protected by state law. This statistic is similar to results of a poll from the Des Moines Register, which found 59% of Iowans disagree with the state’s abortion restrictions. Considering only female responses, the number increases to 69%. “Most Iowans agree that this is a matter to be decided between a pregnant person and their physician,” Levin said. Levin said the rules dictating doctors’ permissions to perform a medically necessary abortion are not directly drafted in the legislature, but created by medical boards in response to abortion restrictions passed in Iowa law. She said legislators are working to open conversation with providers about issues arising from ambiguity in rules born out of legislation. “We have physicians who are very concerned because they have to make a lot of judgment calls that will determine whether or not they get to keep their jobs,” Levin said. “If somebody disagrees with their judgment on whether something is a medical emergency… that physician could lose their job.” She acknowledged that many groups behind lobbying efforts for abortion restriction, such as Pulse Life Advocates, have a religious foundation. She said the creation of laws largely promoted by such groups may pose an even more significant Constitutional risk. “When we make laws based on our own morals that govern other people who might have different religions and therefore different morals, that's where I think we get into trouble,” she said. “And where we have contention, and where we have a potential First Amendment violation.” The First Amendment of the U.S. Constitution contains two provisions regarding religion. The first prohibits Congress from establishing religion, while the second protects citizens’ freedom to exercise religion. These protections are also guaranteed in state law through the incorporation doctrine. Levin, who describes herself as one of the few openly non-religious legislators in Iowa, said the religious lobbying for restrictions is “frustrating” to see. “[The restriction is] an issue that is unpopular with Iowans. Regardless of their faith, regardless of their party,” Levin said. “Unpopular with Iowans, pushed forward by folks who do share a religious agenda.” Looking ahead in the legislature Student Aubrey Stark, now 19-years-old, remembered seeing her mother in pain as she cast her first-ever ballot in November’s presidential election between Democratic Vice President Harris and Republican former President Donald Trump. Abortion protections were at the top of her priority list as she voted for Harris. “It's just surreal it ever happened to [my mother], and it’s scary that it could ever happen to someone else, and they just could not get the help that my mom got,” Stark said. Harris was outspoken during her campaign about her support for Roe v. Wade, and her desire to reinstate the discarded Supreme Court decision. But the election did not turn out in Harris nor Stark’s favor. With 312 electoral votes, former President Donald Trump became President-elect once again. Medical Students for Choice Co-President Annie Galloway was disappointed in the results. “There's definitely shame, I think, especially for people who are from Iowa and, you know, really support reproductive justice. There's a certain shame to the way that Iowa voted,” Galloway said. “I think in that way, I'm lucky to feel a little detached because I'm not from here.” With a Republican majority secured in all branches of government following the election, anti-abortion advocates could rest assured that states’ would keep power to maintain abortion restrictions. According to a CNN chart, 13 states have stricter abortion laws than Iowa— Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, South Dakota, Tennessee, Texas and West Virginia— which all ban abortion outright. Maggie DeWitte said the Pro-Life Coalition plans to continue to lobby for a similar total ban in Iowa. “It would entail that life begins at the moment of fertilization and as such would be guaranteed full protection under our law,” DeWitte said. Johnson County Right to Life Director Schwager supports these efforts. She said she is thankful for the potential the Dobbs decision allows for creating further abortion restrictions in Iowa. She hopes to one day see abortion outlawed in the U.S. entirely. “That [national ban] would be the goal,” Schwager said. “But right now, we’ll work with what we have.” Representative Levin anticipates these efforts, but said their outcome is far from decided. “I am a hundred percent sure there will be a bill,” Levin said. “I will be interested to see how many co-sponsors that bill has and to see where it starts. I am not at the moment feeling concerned that it will become law this year.” Levin said the recent retirement of outspoken anti-abortion Republican Representatives Luana Stoltenberg and Brad Sherman may dampen the fervor for anti-abortion legislation in the Iowa government. She also said Iowa Democrats will be presenting their own bills directly opposing those pushed by anti-abortion lobbyists. “You will definitely see us putting forward legislation that would reverse the six-week ban,” she said. “And make it very clear that it has never been our intent to make abortion illegal in Iowa, and that we want to see it completely reversed.” Meanwhile, Annie Galloway said she has seen an influx of fellow medical students interested in joining Medical Students for Choice in light of the election. “I think there's shame and then there's also a lot of motivation to help,” Galloway said. And Representative Levin reminds her fellow abortion-rights advocates that they have power in their voice. “When they're losing hope, I remind them that Iowans at large believe in the right to healthcare access, including abortion access,” Levin said. I remind them that not too long ago, less than 12 years ago, this was a state that was caucusing for Obama and then voting for Barack Obama and strongly supporting individual freedoms in healthcare.” Works Cited 2024 House Results: Republicans keep control. (2024, December 17). NBC News. https://www.nbcnews.com/politics/2024-elections/house-results ABORTION — POSTFERTILIZATION AGE. (2024, November 19). In Iowa Code (pp. 20–22). https://www.legis.iowa.gov/docs/code/146b.pdf Amdt1.2.1 Overview of the Religion Clauses (Establishment and Free Exercise Clauses). (n.d.). Constitution Annotated. https://constitution.congress.gov/browse/essay/amdt1-2-1/ALDE_00013267/ Choi, A., & Cole, D. (2024, November 8). See where abortions are banned and legal — and where it’s still in limbo. CNN. https://www.cnn.com/us/abortion-access-restrictions-bans-us-dg/index.html Coalition of Pro-Life Leaders (n.d.). Coalition of Pro-Life Leaders. https://iowaprolifeleaders.com/ Dilation and Curettage (D and C). (n.d.). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/dilation-and-curett age-d-and-c Dobbs v. Jackson Women’s Health Organization | Constitution Center. (n.d.). National Constitution Center – constitutioncenter.org. https://constitutioncenter.org/the-constitution/supreme-court-case-library/dobbs-v-jackso n-womens-health-organization#:~:text=In%20Dobbs%2C%20the%20Supreme%20Court, law%20and%20overturned%20Roe%20v. Election 2024: Presidential results. (n.d.). CNN. https://www.cnn.com/election/2024/results/president?election-data-id=2024-PG&election -painting-mode=projection-with-lead&filter-key-races=false&filter-flipped=false&filter-r emaining=false Emma Goldman Clinic. (n.d.). Emma Goldman Clinic. https://emmagoldman.com/index.html Gruber-Miller, S., Akin, K., & Bacharier, G. (2024, September 24). What you should know about Iowa’s 6-week abortion ban that is now in effect. Des Moines Register. https://www.desmoinesregister.com/story/news/politics/2024/07/23/iowa-abortion-law-ta kes-effect-july-29-fetal-heartbeat-law-planned-parenthood/74512355007/ Iowa Legislature - Representatives. (n.d.). Iowa Legislative Services Agency. https://www.legis.iowa.gov/legislators/house incorporation doctrine. (n.d.). LII Legal Information Institute. https://www.law.cornell.edu/wex/incorporation_doctrine Johnson County Right to life. (n.d.). Johnson County Right to Life. https://www.jcrtl.org/ Kheyfets, A., Dhaurali, S., Feyock, P., Khan, F., Lockley, A., Miller, B., Cohen, L., Anwar, E., & Amutah-Onukagha, N. (2023). The impact of hostile abortion legislation on the United States maternal mortality crisis: a call for increased abortion education. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1291668 Mascarenhas, L. (2024, August 5). As Iowa’s maternity care deserts continue to grow, doctors say the state’s new abortion ban will only make matters worse. CNN. https://www.cnn.com/2024/08/05/us/iowa-abortion-ban-maternity-care/index.html McCann, A., & Walker, A. S. (2024, December 3). Abortion bans across the country: Tracking restrictions by state. The New York Times. https://www.nytimes.com/interactive/2024/us/abortion-laws-roe-v-wade.html Medical Students for Choice. (n.d.) Medical Students for Choice. https://msfc.org/ Medication abortion: Your questions answered. (2023, September 11). Yale Medicine. https://www.yalemedicine.org/news/medication-abortion-your-questions-answered Morgan, D. (2024, November 21). Kamala Harris says her first priority as president is to “stop this pain” resulting from abortion bans. CBS News. https://www.cbsnews.com/news/kamala-harris-on-abortion-first-priority-as-president-rest oring-roe-v-wade/ NCI Dictionary of Cancer Terms. (n.d.). Cancer.gov. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/molar-pregnancy Opsahl, R. (2024, July 29). Iowa’s six-week abortion ban is now in effect. Iowa Capital Dispatch. https://iowacapitaldispatch.com/2024/07/29/iowas-six-week-abortion-ban-takes-effect-m onday/ Orgera, K., & Grover, A. (2024). States with abortion bans see continued decrease in U.S. MD senior residency applicants. https://doi.org/10.15766/rai_dnhob2ma Pulse for Life | Iowa’s pro-life leaders since 1972. (2024). Pulse Life Advocates. https://pulseforlife.org/ Ramm, M. (2024, September 24). Iowa Poll: Most Iowans oppose state’s 6-week abortion ban law now in effect. Des Moines Register. https://www.desmoinesregister.com/story/news/politics/iowa-poll/2024/09/22/most-iowa ns-support-legal-abortion-oppose-iowas-six-week-ban-new-iowa-poll-shows-fetal-heartb eat-law/75180451007/ Raymond, E., Shannon, C., Weaver, M., & Winikoff, B. (2013). First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review. Contraception, 87(1). https://www.contraceptionjournal.org/article/S0010-7824(12)00643-9/fulltext Representative Elinor A. Levin - Iowa House District 89. (n.d.). Representative Elinor a. Levin - Iowa House District 89. https://www.levinforiowa.com/ Sullivan, K., Holmes, K., Contorno, S., & Dale, D. (2024, April 8). Trump says abortion legislation should be left to states. CNN. https://www.cnn.com/2024/04/08/politics/donald-trump-abortion-2024/index.html

From Southeast Asian remedy to smoke shop controversy: charting kratoms controversial history in Iowa City 

A once-traditional remedy found itself at the center of a heated debate regarding local regulation, business survival, and public health in Iowa City. 

IOWA CITY, Iowa—During the Sept. 17, 2024, Iowa City City Council meeting, vape shop employee and Johnson County community member Fenck spoke during the community comment to share their thoughts on the proposed ban on the sale of kratom. “My coworkers, myself, and more importantly, my customers, are very worried about what happens if kratom is banned,” Fenck said. Since May 2024, the Iowa City Council has been working to ban the sale of kratom, a substance with opioid-like effects, within the city limits. Kratom, scientifically known as Mitragyna speciosa, is a short, unassuming evergreen tree native to Southeast Asia. It thrives in tropical countries like Malaysia, Thailand, and Indonesia, where the flower has been used as medicine for centuries. Traditionally, Thai and Malaysian laborers chewed, brewed, or consumed kratom to relieve aches and pains, allowing them to continue working throughout the day. As the internet grew in the early 2000s, online chat forums began discussing ancient medicine and its potential application in the U.S. market. Webpages like the Kratom Connoisseurs Forum allowed for open discussion and exposure. Operating from 2008 to 2013, these forums hosted initial conversations about sourcing, preparation, and personal experiences with kratom. This forum, along with hundreds of others, played a crucial role in integrating kratom into Western markets. Conversations that began in digital spaces soon entered physical ones, and kratom began to be seen in stores. Gas stations, head shops, and herbal supplement stores began stocking kratom on shelves, making it more accessible to everyday consumers. This shift from niche online wellness communities to mainstream retail was a turning point in kratom's journey. Around the same time, vape culture was growing in America. Marketed as a healthier, smokeless alternative to cigarettes, vaping quickly became a cultural phenomenon. The introduction of ergonomic, sleek, and user-friendly devices like Juul in 2015 propelled the movement even further. Juul’s minimalist design and innovative nicotine delivery system captured consumers' interest and helped the brand achieve a $38 billion valuation by 2018. By 2018, the number of vape shops in the United States had significantly increased, with more than 10,000 stores in operation. The rise of vape culture forced a change in the business model of smoke shops and convenience stores. Establishments that focused on selling tobacco and nicotine products began expanding their offerings to include CBD, herbal supplements,s and kratom. This shift allowed store owners to capitalize on the growing consumer interest in “natural” and “alternative” remedies. Joe Barboza is a third-year marketing student at the University of Iowa. He remembers driving around and seeing the signs around his hometown. As a marketer, he recognizes the effect the marking of kratom had on him. Barboza said, “The colorful signs are what mostly get you.” Barboza has never thought about trying kratom. “My first time running into kratom was at this gas station over by Kirkwood Avenue,” said John Carter-Martinez, an employee at Almost Paradise, a local vape and smoke shop. “They always have a big sign outside that says, ‘We sell kratom here.’” That first encounter came before Almost Paradise. Carter-Martinez's interest was piqued by YouTube videos like “First Time Doing Kratom” by Goblin in 2018. These long-format videos, filled with personal experiential testimonies, were popular then but appear to have removed curiosity from the target demographic, college-aged viewers. Liam Ashton, a fifth-year pharmacy student, had known about kratom before his first direct encounter with it. “I was trying to, like, go get, like, some beers, and then the dude behind the counter was, like, trying to sell me on it,” Ashton said. “I had seen it, but that was the first time I'd realized, like, kind of the purpose of it,” Ashton continued. “The dude was just kind of saying, like, helps relax you or whatnot.” Ashton ultimately decided not to purchase the kratom. While students like Ashton are still hesitant, kratom’s accessibility has only grown. What was once only available behind the counter of a gas station on the outskirts of town has now entered most gas stations, liquor stores, and vape shops. In downtown Iowa City alone, at least five vape shops are grouped within a few blocks of East Bloomington, South Clinton, East Burlington, and South Gilbert streets. These shops, which once focused on selling tobacco products, have since evolved into multi-purpose retailers, offering items like CBD, nitrous oxide, and kratom. While kratom accessibility was growing in retail spaces, city officials began to notice the rise in requests for permits to open vape stores. What started as a push to tighten tobacco regulations gradually expanded to include other substances like nitrous oxide. The process, spearheaded by Councilor Andrew Dunn, unfolded in a series of pivotal moments that would create the council's stance on kratom. On April 2, 2024, according to an email from Councilman Josh Moe, Councilor Andrew Dunn took the first steps in the ban, issuing tobacco permits from the council's consent calendar and requesting tobacco permits not be renewed. This action created further deliberation about what substances beyond tobacco might warrant stricter regulation. By April 24, 2024, most councilors, including Josh Moe, had written to the city attorney to formally express support for restricting tobacco sales. A few weeks later, the conversation shifted again on May 7, 2024. During this meeting, Councilor Dunn suggested adding kratom, nitrous oxide, and other substances known to cause harm to the list of products under review. "This was the first time I’d seriously considered kratom,” Moe said. “I’d seen the signs around town but did not know much about it.” What followed for Moe was a months-long process of research, education, and public discussion. Moe describes his initial research as beginning with a simple Google search. However, it soon expanded to include input from healthcare professionals, city attorneys, and public health officials. One key contributor to council education was Becky Connolly, an addiction and community health expert who presented a webinar for the council on Sept. 4, 2024. This session focused on the potential public health risks associated with kratom, particularly the dangers of an unregulated market. Moe recalled that public health experts, including addiction specialists, highlighted a significant flaw in how kratom was being sold. “If it were provided to people in the way some of the promotional literature describes it… it seems like it might be okay,” Moe said. “But in a completely unregulated environment, we learned that it can come adulterated… with other substances. It can come in very high concentrations. It can be sold to kids.” Moe emphasized that it was not kratom's presence that concerned council members — it was the fact that the substance being sold in Iowa City’s gas stations and vape shops might not be what they claim. Unlike tobacco or alcohol, kratom operates in a legal gray area. It is not classified as a controlled substance or regulated as a supplement or medication by the Food and Drug Administration. This lack of oversight means kratom is sold without consistent testing. In 2016, the Drug Enforcement Administration attempted to list kratom as a Schedule I drug. This would put the substance in the same category as heroin and LSD, citing its potential abuse. But, after receiving 23,000 public comments, mostly in opposition, the DEA withdrew its decision and allowed kratom to remain legal at a federal level. The reversal left regulation in the hands of states and cities. With no federal guidelines, states have taken inconsistent approaches. Some, like Wisconsin, Alabama, and Vermont, have chosen to ban kratom entirely. Others, like Georgia and Arizona, have passed the Kratom Consumer Protection Acts, which require testing,labelingn,g, and quality checks for kratom products sold in their states. However, decisions fall to local governments in cities like Iowa City, where no statewide law exists. With no federal regulations in place, Iowa City councilors were left with two options: ban the sale of kratom or do nothing. Unlike tobacco and alcohol, which have state-funded compliance checks, kratom has no such support. Councilman Joshua Moe explained the challenges of attempting to regulate kratom at the city level. “We weren't banning having it or using it,” Moe said. “We were banning the sale. So, we have the capacity to ban the sale of products, like we do with cigarettes and alcohol.” However, unlike cigarettes or alcohol, which have support from the state for compliance checks, Iowa City would have no outside funding for inspections or enforcement. When Iowa City council members first proposed banning the sale of kratom, it took a little while for community members to organize and push back. Opposition grew louder as word moved through vape shops, local retailers and online forums. Business owners, in particular, saw the ban as a threat to their customers and livelihoods. One of the most vocal opponents was Kevin Munn, the owner of The Konnexion, a smoke shop established in Iowa City for more than 20 years. During the formal council meeting on Sept. 3, 2024, Munn stepped to the podium and made his case. He argued that banning kratom would affect customers and destroy his business. “I am here to share my deep concerns about the kratom ban,” Munn said. “It will have devastating consequences for my business, my family, my employees, and the community.” For Munn, the stakes were personal. Unlike large vape stores and gas station chains, which can absorb product loss, Konnexion depended on the to-be-banned products to stay in business. “I’ll have to close down immediately, file for bankruptcy, and people lose their jobs,” Munn said. Munn urged the council to understand the medical benefits of the substance rather than recreation. Munn said the ban “should be based on science, not political views of the state, other people, or even the FDA.” His remarks reflected a broader frustration shared by kratom users and advocates nationwide. For many users, kratom is a tool used to manage chronic pain, anxiety, or opioid withdrawal symptoms. Opponents of the ban argued that removing the ban would push users to seek black market alternatives. As momentum for the ban grew, so did the resistance. Konnexion owner Kevin Munn took to social media and the streets to rally support from kratom users, small businesse,s and community members like Fenck, a Konnexion employee. At the Sept. 17, 2024, meeting, Fenck spoke to the council. “I understand that there can be concerns about kratom or other products similar to it,” Fenck said, “especially when catchy names like ‘gas station heroin.’ “But the truth of the matter is, there is a number of people in our community who have found an improved quality of life because they have access to a reliable, self-manageable product that can help address their pain, that can help them fight addictions, and helps them be able to participate in the things they need to and want to,” Fenck told the council. Fenck also raised concerns about how banning kratom would affect those seeking recovery from opioids. “And there are several people here that are using kratom to help with addiction,” Fenck said. “Prescription painkillers and heroin are, of course, notable, not only are they dangerous on their own, but also the fact that fentanyl now can be on anything that you're getting.” Fenck warned that removing access to kratom from retail stores would push users to unregulated online markets where product quality cannot be guaranteed. “While there are plenty of websites that will have reliable brands, and we'll send you what you're expecting, there are just as many websites, if not more, where you click on a description and a picture, and you order a product, but you get sent whatever,” Fenck said outside of council chambers. “I can't trust anything that I get from Amazon or even some of the, you know, direct-from-brand sites.” The rising opposition from Munn, Fenck, and other community members showed a shift in the council's approach. Once a proponent of a complete ban, Councilor Andrew Dunn began to lean toward regulation instead. Small business owners, vape shop employees, and residents framed the issue as health equity and access. Just before the Oct. 1 council meeting, Iowa City Mayor Bruce Teague received an email from a supposed resident expressing opposition to the ban. The email was clear and direct, signed with a familiar name — a friend's name. “I forwarded her the email, and a text said, ‘Did you send this?’” Teague recalled. “She said, ‘Absolutely not.’” City officials soon discovered that this email was not a single incident. According to Teague, nearly 100 suspicious emails flooded council inboxes, all written to appear to be sent by residents. Despite the influx of suspicious emails, the council voted to move forward with the sales ban. The first consideration passed 4-1. The Oct. 15, 2024, meeting marked a crucial moment in the push to ban kratom. During the meeting, the council voted 4-3 in favor of a second ban consideration, which advanced the proposal to a final vote. Councilor Andrew Dunn, initially a strong proponent of the ban, shifted his perspective, suggesting that regulation may be a better approach. Councilor Laura Bergus echoed this sentiment, citing harm reduction and the need for state-level guidance. However, Councilors Josh Moe and Mayor Teague supported the ban. This meeting also featured emotional public comment, including a virtual speaker from Michigan sharing personal stories of kratom use. The council's final vote was scheduled for Nov. 4, 2024. The Nov. 4, 2024, meeting marked a turning point in the Iowa City Council's handling of the kratom ban. After months of heated debate, the council voted 6-1 to defer the proposal indefinitely. Unlike in meetings where councilors favored an outright ban, the Nov. 4 session showed signs of a changing consensus. Dunn initially proposed the ban and emphasized a preference for regulation over prohibition. This decision was made after hearing the voices of the community, like Fenck and Munn. Mayor Teague, who had previously supported the ban, also changed course. The ban on the sale of kratom was dead. Rather than continue to pursue a local ban, councilors agreed to add kratom regulation to the city's list of state legislative priorities. The move acknowledged the limits of local action and recognized the need for broader state and federal oversight. “We weren't banning having it or using it,” Moe said. “We were banning the sale. So, we have the capacity to ban the sale of products, like we do with cigarettes and alcohol.” But unlike tobacco or alcohol, which have state support for compliance checks, kratom has no such support. “While its rightful place is the federal government, our federal government has been very slow to react,” Moe said. “I'd like our state government to do something, but... it's been many years since they first considered regulation or banning but didn't take it up at the state level, so I figured we should do something.” The ban on the sale of kratom was dead on a local level, but the story of its state and national regulation is far from over. Thank you Ty for this great class. Writing this was certainly a challenge. So many angles, so many anecdotes, so many perspectives. I would love to get your feedback as I find this story to be so interesting. How does one juggle everything? What a weight to bare for local officials to designate the choice of what people put in their bodies. What an embarsemnt to people who seek kratom to cure ailments due to the instibility of our medical system. What a disgust to see kratom manufacturers profit off shoestring laws and FDA regulations. It is all so strange. Thank you Ty, anxious for your feedback have a good break. Sources - Fenck wanted to keep their last name private at the time of recording and upon request. - Audio recordings of interviews can be found in the submission Name Date Time Location Contact Joe Barboza-Rodriguez 12/17/2024 7:35 pm Main Library joedwin-barboza-rodriguez@uiowa.ed John Carter-Martinez 12/17/2024 10:12 pm Almost Paradise (319) 359-1694 Liam Ashton 12/16/2024 8:30 Main Library liam-ashton@uiowa.edu Joshua Moe 12/17/2024 5:00 Phone 319.383.3099. Fenck 9/17/2024 6:00 City Hall 319-321-6401 Bibliography - I have hyperlinked any source that was not part of the public domain. - i.e. City Council meeting recordings Research (in order of appearance) - https://www.deadiversion.usdoj.gov/drug_chem_info/kratom.pdf - https://www.doublemherbals.com/viewtopic.php?f=7&t=5232 - https://www.bbc.com/news/business-46654063 https://www.youtube.com/watch?v=KXI3pgjfcoI - https://www.dea.gov/press-releases/2016/08/30/dea-announces-intent-schedu le-kratom - https://www.pbs.org/newshour/nation/kratom-dea-illegal - https://docs.legis.wisconsin.gov/2023/related/lcamendmemo/ab393 - https://choicekratom.com/blogs/news/is-kratom-legal-in-alabama#:~:text=T he%20legal%20status%20of%20Kratom%20in%20Alabama%20is%20clear %3A%20it,distribution%20illegal%20within%20the%20state. - https://kratomcountry.com/blog/is-kratom-legal-in-vermont List of Meetings Covered - May 7, 2024 - August 6, 2024 - August 20, 2024 - September 3, 2024 - September 17, 2024 - October 1, 2024 - October 15, 2024 - For these meetings, I used minutes, agendas, and the agenda packets - YouTube videos of meetings and work sessions are used as well.

‘We’re going to need a lot of luck’: Iowa City, University of Iowa students navigate divided thoughts, feelings on Israel-Hamas war

While Iowa City officials search for ways to balance differing viewpoints, Jewish and Palestinian students remain passionately divided.