Condoms, IUDs removed from Indiana bill seeking to expand birth control access

Republican lawmakers on Tuesday removed condoms and long-acting contraceptives from a proposed Indiana program that seeks to increase access to birth control, instead replacing those options with “fertility awareness based methods” like menstrual cycle tracking — also known as the rhythm method.

The underlying legislation, House Bill 1169, would establish a statewide, taxpayer-funded “Access to Birth Control Program” to expand birth control options for Indiana residents earning at or below 185% of the federal poverty level.

Bill author Rep. Jim Lucas, R-Seymour, said his goal is to increase birth control access for low-income Hoosiers, specifically. That roughly half of Indiana births were covered by Medicaid since 2017 “is not only tragic, but unsustainable fiscally,” he said.

“I started looking at ways that we could approach and deal with this issue and prevent unplanned pregnancies,’ Lucas said before the House Public Health Committee on Tuesday. “There are currently 1.8 million Hoosiers on Medicaid. That number also is unsustainable, and for every unplanned birth that is brought into this world, chances are you’re going to have that mother join that child on Medicaid.”

In the original draft of his bill, the proposed program would have covered the costs of condoms, intrauterine devices (IUDs), implants, prescription birth control pills, and other family planning options.

But an amendment offered by Rep. Joanna King, R-Middlebury, changed that birth control list to only include hormonal contraceptive patches and self-administered hormonal contraceptives, defined as a federally-approved hormone drug that a woman has been prescribed to administer to herself. That includes birth control pills, according to the amendment.

King’s revision additionally changed qualification requirements for the access program to include just Indiana residents who are eligible for Medicaid.

The changes were accepted by the House committee Tuesday morning before the amended bill advanced 9-3 to the Ways and Means Committee. Lawmakers on that panel will decide how much — if any — state funding to earmark for the bill. If the proposal passes out of that committee, it will then head to the full House chamber for further consideration.

King told the Indiana Capital Chronicle the intent behind her amendment was “making sure we get information, good education, out for women.”

She referred further questions to Lucas and said her change didn’t prioritize one form of contraception over others.

“We’re just looking at Medicaid and making sure we have great information out there for people that are looking,” she concluded.

Lucas said in the health committee that he “appreciated” King’s work on the bill.

“This is a very simple bill. I wanted to keep it simple, and I wanted to leave this mostly at the local decision — with the individual. There is no force, there is no mandate here,” Lucas said. “This is merely an option for the individual to work with their health care provider to develop a plan that is best for them.”

Health care providers push back

Democrats originally said they were on board with the bill, but after the definition of birth control was narrowed, they withdrew their support.

“I think if we’re going to have a conversation about contraception, we need to have the whole conversation,” said Rep. Maureen Bauer, D-South Bend. “We are doing a disservice to (men and women) of the Medicaid population. And while I supported the original bill, I can’t support the amended bill, and I think it’s telling people what we prefer them to choose as contraception.”

Multiple advocacy groups — including Planned Parenthood, Indiana’s Good Trouble Coalition and the Indiana chapter of the American College of Obstetricians and Gynecologists — said they, too, flipped their position on the bill after it was amended.

Haley Bougher, the Indiana director for Planned Parenthood Alliance Advocates, emphasized that the exclusion of IUDs from the bill “is a slippery slope based on anti-science misinformation, and viewed as an attack on contraceptives” in a state where nearly 25% of counties are maternal care deserts. Indiana, she added, continues to have one of the highest maternal mortality rates in the country.

“Additionally … fertility awareness should be offered only in conjunction with all other options of contraception to ensure the best outcome possible for all futures,” she said. “This approach does not serve the best interests of Hoosiers, particularly young people who deserve accurate, comprehensive information about their own reproductive health.”

Also in contention was a new provision limiting local health departments. Those participating in the new program could only prescribe and educate Hoosiers on the limited list of birth control options in the bill. Condoms and IUDs would be off limits.

“My fear is that this bill significantly limits women’s access to comprehensive education on contraceptive options, which is not only a disservice to our patients and an infringement on women’s reproductive liberty and rights, but it’s also going to actively contradict the intent of this bill, which is to reduce unintended pregnancies,” said IU Health OB-GYN Dr. Amy Caldwell. “We know that the most effective forms of contraception and reducing unintended pregnancies are long-acting reversible contraceptives, and that these methods are highly sought after by patients.”

King, however, maintained that the amended bill “creates a little bit more awareness for people that are wanting access to birth control.”

“I think the premise of this bill is really being able to give more education out to women in our communities, and giving kind of a guardrail for the health departments — this is what we would like you to do, and this is how we would like you to do it, so that it’s the same in every community,” King said.

Other means of birth control

She further pointed to benefits of increased education around “fertility awareness based methods,” which she described as “looking at a woman’s cycle, and measuring your temperature, and taking into account when you are fertile, when you are not fertile.”

Rep. Cindy Ledbetter, R-Newburgh, pointedly referred to “the rhythm method,” a natural family planning method that involves menstrual cycle tracking to predict when a woman is most likely to get pregnant.

“I think that’s respectful of faith. We’re trying to include every possibility. We have a large Catholic population in Indiana, and I think for them to be able to be educated on that would be important, as well as the other types,” Ledbetter said. “I’m excited in the fact that this is bringing contraception to the forefront of the health department, and making it more prominent to have those discussions, and to be able to address people of all faiths and all types and all creeds.”

And while critics of the bill worried the exclusion of condoms from the proposed state program would also stymie efforts to reduce sexually transmitted infections, Rep. Matt Hostettler, R-Patoka, assured that local health departments already “seem really proficient” at providing free condoms.

Although the bill limits condoms from being provided via the new access program, health departments and other providers could still make those and other contraceptives available through existing avenues.

“I mean, I stopped at a package store on Super Bowl Sunday in Posey County, and there was a gallon jug of condoms that said ‘Courtesy of the Posey County Health Department,’” Hostettler said. “So, they’re raining condoms down. They’re already doing that.”

The Indiana Capital Chronicle is an independent, nonprofit news organization that covers state government, policy and elections.