With abortion ban near-certain by Indiana Legislature, health advocates turn to birth control as a counterbalance

As Indiana’s Republican-dominated legislature furthers its abortion-banning Senate Bill 1 during an ongoing special legislative session, attention is turning to birth control. Some lawmakers and health care providers are advocating for greater access to counterbalance the proposed ban, but it’s unclear how successful that push will be.  

“I’m really very optimistic because I think — particularly in the environment that we’re in now — a basic understanding is that if you’re not pregnant, you will not seek an abortion,” Rep. Rita Fleming, D-Jeffersonville, told the Capital Chronicle.

“That’s a pretty simple fact,” added Fleming, who is also an obstetrician and gynecologist.  

But there’s worry, too, that lawmakers will restrict access to birth control methods that use progestin, like the morning-after pill and a type of intrauterine device, or IUD.

“Although this bill doesn’t specifically contain it, I’m very concerned,” said Dr. Rhiannon Amodeo-Bankert, an Indianapolis-based OB-GYN. “… There’s a large group of people who spread untruths about progestin contraceptives … that they cause an abortion by preventing implantation. And the medical consensus on that idea is that they prevent pregnancy by either preventing ovulation or preventing entry of the sperm into the uterus.”

While Indiana’s Senate refines its abortion ban plan, lawmakers in both chambers are tackling bills meant to support the thousands of additional infants that could be born annually — and their families — should SB 1 become law. But some see room in the legislation to prevent unintended or undesired pregnancies from occurring in the first place.

“We want to make as many avenues available to help these people take those steps to ensure that they’re not having unwanted pregnancies if they’re not able or if they’re unwilling to carry a child to term,” said SB 1 author Sen. Sue Glick, R-LaGrange. “We would rather deal with it on the front end than … going to an abortion.”

Sen. President Pro Tempore Rodric Bray, R-Martinsville, has also indicated that some of the $50 million in Senate Bill 2, could go toward contraceptives.

But the bill doesn’t get into specifics, instead giving four state agencies the discretion to distribute the funds to programs that accomplish seven goals. Access to pregnancy planning is one.

Advocates ask for funds expansion

Advocates want more of a guarantee.

“If we’re going to have an abortion ban, don’t you think we need to start getting contraceptives to people who need it? Right now?” asked Kristin Adams, the president and CEO of the Indiana Family Health Council, in an interview. 

“A lot of our abortions are due to failed contraceptives or no contraceptives, particularly in that younger population. … I think we’ve got a huge chance for a disaster coming if we don’t get access for these individuals,” said Adams, who on Tuesday pressed House and Senate committees to consider expanding the state’s existing contraceptive network and address its contraceptive deserts.

But some funding has already shrunk, imperiling the organization’s health care and family planning mission.

Adams’ organization receives the state’s allotment of Title X funds, which provides comprehensive family planning and preventive health services to low-income Americans. Last year, the state’s portion dropped from just over $5 million to $4.6 million, curbing plans to expand beyond the 27 funded clinics. The organization will expand with a mobile clinic inside of a box truck, but delivery isn’t anticipated until 2023.

Services provided by the clinics, some operated by the Indiana Family Health Council and some operated by healthcare providers such as Eskenazi Health, include pap smears, long-acting reversible contraception (LARC) insertion and preconception counseling for parents.

The Indiana Family Health Council’s 27 clinics performed 133 LARC insertions in the days since the Supreme Court overturned Roe v. Wade, an increase that indicates the potential demand for contraceptive services in states without abortion access.

Adams said clinics didn’t offer tubal ligations or vasectomies because of financial costs. Planned Parenthood, whose main website offers a guide to tubal ligations, said its Indiana locations didn’t offer the services either. 

“We know that supporting pregnant individuals in need of services is the right thing to do but we cannot be siloed in our approach — we need comprehensive prevention efforts for unintended or untimed pregnancies,” Adams told the House’s Ways and Means Committee Tuesday.

Adams noted that bills in both the Senate and House provided funding for contraception through the state’s Safety PIN program but warned that would only reach women who were already mothers, not those attempting to prevent their first pregnancy. 

The Safety PIN program aims to reduce infant mortality through parenting programs and limited services for families. 

But the committee didn’t act on Adams’ request, rejecting several other amendments offered by Democrats that sought to address contraceptives in Indiana. 

Adams said one dollar in Title X funding saved $7.09 in Medicaid spending and that state rules surrounding LARCs for Medicaid recipients cost money when working devices had to be abandoned, rather than reallocated, because one person didn’t use them. 

Same-day discussion

Contraceptive experts have also focused on same-day access to birth control, arguing that it enables service to Hoosiers who don’t often interact with the state’s health care apparatus. 

Indiana has a shortage of primary care physicians and many counties are contraceptive deserts, meaning there are few to no providers capable of addressing reproductive needs for that community. And some people just can’t get transportation, child care or time off work for anything but an emergency.

Fleming recalled working as an obstetrical hospitalist and serving women who came to the hospital to give birth without any prior prenatal care. Often, she said, the new mothers had positive drug screenings.

“They would ask for birth control,” Fleming told the Capital Chronicle. “They didn’t want to repeat this cycle of having babies when they were in the grip of drug addiction. And the best I could do for them was a Depo[-Provera] shot — three months of birth control.”

Dr. Tracey Wilkinson, a pediatrician with the Indiana University School of Medicine, pushed the Senate Appropriations Committee to remove existing barriers to contraceptives. 

Wilkinson, speaking on behalf of the Indiana Chapter American Academy of Pediatrics, shared her research on reproductive healthcare access, finding evidence in support of offering same-day treatment for long-term birth control methods. 

“We found that close to a third of patients did not return for a second appointment and 28% of these patients ended up having a subsequent pregnancy within a year of our study,” Wilkinson said. 

Funding should be prioritized for clinics that promote comprehensive care, rather than focusing on one type of birth control, Wilkinson said. Pressuring patients to choose one form — or demanding a high fee for removal — were forms of coercion, she said. 

“Legislation increasing access to contraception should be hailed as pro-life, as birth control gives people the ability to control the trajectory of their lives and does so by giving people the ability to decide when pregnancies will happen,” Wilkinson said. 

Fleming, who’s long angled for legislation allowing more-accessible pharmacists to prescribe birth control, also suggested expanding same-day access at hospitals and syringe exchange programs, or creating mobile units — though she emphasized the importance of informed consent. 

The special session will end mid-August, but some Republican leaders have indicated they’d be open to considering contraceptive-related abortion during a longer, budget-writing session that begins in January.

Adams said that might be too late for some people.

“I think if an abortion ban goes into place today… January is a long way away because those monies won’t become available until July,” Adams said in an interview. “So we’ve now delayed access to women who are truly in need or are fearful because they absolutely cannot get pregnant.”THE