Lawmakers are working to find alternative ways to prevent unwanted pregnancies while Indiana’s abortion ban is currently on hold pending a decision from the state’s Supreme Court.
Two Indiana bills, House Bill 1224 and House Bill 1568, would allow pharmacists to prescribe and dispense oral contraceptives and contraceptive patches, increasing access to birth control. Currently, Hoosiers must first get a prescription from their healthcare provider to obtain birth control. Rep. Rita Fleming, who authored House Bill 1224 and co-authored House Bill 1568, said allowing pharmacists to prescribe birth control would save Hoosiers time and energy by providing more options about when and how they access care.
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Under Senate Bill 1, clinics like Planned Parenthood would lose their licenses but would remain able to offer birth control and emergency contraceptives. The Supreme Court decision does not directly affect access to contraception, and lawmakers said last June the bill would not affect access to birth control.
The process to obtain a prescription would look similar to the current process — except a person would be able to go directly to the pharmacy to obtain a prescription rather than having to first go through a medical provider. A patient would be asked questions about their medical history, she said, but a pelvic exam or other physical exam would not be needed to get a prescription. Under current procedure, a pelvic exam is not always required to get birth control except under certain circumstances, such as to get an intrauterine device.
Indiana is not the first state to consider pharmacy-prescribed birth control; currently, 20 U.S. states allow pharmacists to prescribe birth control, according to the American Society of Health-System Pharmacists and Healthline.
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The two bills would allow people at least 18 years of age to obtain the contraceptives, regardless of whether the person has a previous prescription from a primary care provider.
While the bills are mostly similar, there are a few differences. House Bill 1568, authored by Rep. Elizabeth Rowray, R-Yorktown, proposes a prescription may not be made for more than six months, and a pharmacist may not issue another prescription after 12 months unless the patient has been seen by a physician. House Bill 1224, authored by Rep. Rita Fleming, D-Jeffersonville, does not state this provision.
Additionally, under House Bill 1224, nonprofit religious employers do not have to prescribe birth control. House Bill 1568 adds to this idea, stating that pharmacists are not required to dispense contraceptives if they object on ethical, moral or religious grounds. An amendment to House Bill 1568 also says a pharmacist who knowingly prescribes a drug to cause abortions commits a level 5 felony and will have their license revoked.
A level 5 felony is the second-lowest felony charge in Indiana and carries imprisonment terms of one to six years.
Prescribing a drug to cause an abortion for reasons outside of rape, incest, lethal fetal anomalies and danger to a pregnant person’s life is already illegal under Senate Bill 1, Indiana’s abortion ban. Senate Bill 1 is currently being litigated and is not yet being enforced. The bill was halted in September 2022 after concerns were raised about the constitutionality of the bill and potential infringement on religious freedom.
House Bill 1224 was referred to Indiana’s Committee on Public Health on Jan. 10. House Bill 1568 passed a third reading in the House and will now be sent to the Senate. Rep. Rowray could not be reached for comment by the IDS.
Rep. Fleming used to work as an OB-GYN before retiring in 2020. Fleming said she saw how a lack of access to birth control led to major consequences.
Indiana is one of the worst states to give birth, Fleming wrote in a column for the News and Tribune. Indiana has the third-highest maternal mortality rate in the country, according to the World Population Review. According to the Indiana Maternal Mortality Review Committee's 2022 report, there were 111.7 maternal deaths per 100,000 live births in the state.
In preparation to prescribe birth control, Fleming said, Indiana pharmacists are currently undergoing required training. This includes professionals learning about the biochemistry of contraceptive products, the pharmaceutical effects and the hormonal content of different types of contraceptives. They are also undergoing training in aspects of patient care to effectively work with patients to decide what type of contraceptive would be best for them.
“It’s not just knowing about the method and all the details, but it's how to safely prescribe and dispense it,” she said.
Fleming has been pushing for increased birth control access since 2020, when she introduced a bill similar to House Bill 1224. During last year’s special session, she offered an amendment to Senate Bill 2 that would have allowed pharmacists to prescribe birth control to patients, but the amendment failed by one vote.
Fleming said she hopes her bill, if passed, would create healthier outcomes for people by preventing unwanted pregnancies, allowing them to space out their pregnancies as desired and making contraception more easily accessible for people with busy lives.
“Most women work, most women have to take time out from work and childcare to make an appointment to a doctor’s office during working hours,” she said. “If a woman can go to a pharmacy on weekends, during the holiday, during the evenings – pharmacies are much more available. That’s what I want people to take away from it — there is something outside of the traditional model of how we usually get birth control.”
Rep. Sue Errington, D-Muncie, who co-authored Fleming’s bill, said last summer’s special legislative session was a major catalyst for the development of the bill.
“When abortion was basically banned in our state, there was a realization that that wasn’t going to stop people from having sex,” she said. “We needed to do a much better job in preventing pregnancy.”
Errington said she worked for Planned Parenthood for 17 years before becoming a state representative, an experience that showed her how essential contraceptives are to prevent unwanted pregnancies.
Not everyone seeking birth control has equal access to reproductive care, she said, a problem she hopes the bill would help alleviate.
"Traditionally where we get them is from a doctor, either at a clinic or at a doctor's office,” Errington said. “But there are many parts of Indiana, particularly in rural areas, where they're living in sort of a healthcare desert. Women and girls may have to go an hour to get to someplace where they can get their healthcare needs taken care of."
Errington also authored House Bill 1066, which would require schools to provide comprehensive sexual health education. Errington said medically accurate sex education is a major factor in preventing unwanted pregnancy.
She said the contraceptive bill is an important step for families because easier access to contraceptives can help prevent the financial strain that can result from unintended pregnancies.
“There are a lot of people that will struggle when they have another child – or a first one,” Errington said. “If it was a pregnancy that was not intended, then we’re much better off if we can prevent that.”