A bill moving through the Indiana Legislature seeks to create a new state-funded birth control program for low-income Hoosiers — but would only make certain methods available. Photo from Getty Images.

By Casey Smith
Indiana Capital Chronicle

INDIANAPOLIS — Republican lawmakers on Tuesday, Feb. 11, 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.

Rep. Jim Lucas, R-Seymour. Photo from Indiana House Republicans.

“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.

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

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

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.

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.

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.

Rep. Joanna King, R-Middlebury, at a Jan. 24, 2024, Public Health Committee meeting. Photo by Whitney Downard, Indiana Capital Chronicle.

“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.”

Other Means Of Birth Control

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.

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.

Indiana Capital Chronicle Senior Reporter Whitney Downard contributed reporting.