Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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Women living in the three of Minnesota's neighboring states shouldn't have to travel here to receive the medical care they need and deserve. But that's now a reality, with Iowa joining North and South Dakota in enacting some of the nation's most restrictive abortion bans.

As of Monday morning, Iowa's new prohibition on abortions after six weeks of pregnancy — a controversial measure passed by its legislature in 2023 — is finally in place after a court battle delayed its debut. The Hawkeye State joins South Carolina, Georgia and Florida in outlawing abortion after this point, a time when women may not even realize they're pregnant.

Restrictions are even more severe in South Dakota and North Dakota, which are listed as having a "total abortion ban" by the nonprofit Guttmacher Institute.

That draconian abortion restrictions nearly encircle Minnesota is another reminder of what's at stake in this presidential election. The likely Democratic nominee, current Vice President Kamala Harris, is a staunch advocate of abortion rights. Former President Donald Trump has boasted of killing off Roe v. Wade, the 1973 U.S. Supreme Court ruling that protected abortion access until the high court overturned it in 2022.

Iowa's new ban also underscores the importance of quick action taken by Minnesota's DFL leadership in January 2023. After Roe fell, DFL legislative leaders passed the Protect Reproductive Options (PRO) Act as one of their first orders of business during that session.

This landmark legislation puts protections into law guaranteeing the right to this medical procedure. That prescient action has commendably benefited women beyond our borders by making the state a reproductive health refuge in the Upper Midwest.

There are now 14 states the Guttmacher Institute considers to have a "total abortion ban." Iowa's might as well be on the list because of its narrow window to obtain a legal abortion. Many women may not have taken a pregnancy test at six weeks because they may think they've merely skipped a period. Or, they might not be tracking their menstrual cycle. By the time they've confirmed they're pregnant, there's a good chance they're past six weeks and abortion is no longer a legal option.

The exceptions in Iowa's ban also provide little reassurance that sensible exceptions will be made for women who have been sexually assaulted or are facing a medical emergency.

Rape or incest survivors can get an abortion beyond six weeks, but only if they meet the law's tight deadlines for reporting the assault. "After they are sexually abused, survivors have exactly 45 days to tell police or a doctor. Survivors of incest have 140 days. To perform an abortion without risking professional discipline, doctors must document the attack in detail and judge the girl's or woman's credibility," the Des Moines Register reported this week.

In other states with exceptions like this, determining whether a woman meets the legal threshold has led to potentially dangerous delays. Hospitals are fearful of second-guessing by prosecutors. Instead of doctors determining what care a woman needs, hospital lawyers are now involved. Decisions made are what's in the best interest of the medical institution, not the patient.

A shocking case in Oklahoma, one reported by the Washington Post, is a real-world example. Jaci Statton developed a life-threatening pregnancy complication but was told by physicians to wait in the hospital parking lot until her condition became an emergency, at which point the hospital felt comfortable proceeding with an abortion. It's not hard to see how delays could happen for Iowa women as both doctors and hospital lawyers weigh a patient's credibility and jump through other bureaucratic hoops.

Minnesota's U.S. Sen. Tina Smith appropriately is sounding the alarm about Iowa's new ban. "This is a tragedy for women in Iowa, who have now for all practical purposes lost their rights to control their own bodies," she said in a statement. "People want the freedom to make their own decisions about health care, including abortion, without government interference, and without politicians mucking around in their personal business. There is a direct through-line between Donald Trump's appointment of the far-right Supreme Court justices who overturned Roe v. Wade, and the Trump abortion bans happening across the country and causing this chaos and cruelty to women."

Iowa's new ban will likely strain Minnesota health care providers' capacity. A spokeswoman for Planned Parenthood's regional office said that this health care organization is seeing more patients at its Minnesota locations since Roe was overturned. The organization is laudably strengthening its capacity here to serve out-of-state women. A key reason that Planned Parenthood is confident in making the investment: the deep commitment to reproductive health care choice demonstrated by lawmakers here who passed the PRO Act.

The Minnesota legislation's prescient protections are commendable and clearly necessary. But women shouldn't have to cross state lines to get the medical care they need. That this is now reality for women in this region is chilling.