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Indiana bill aims to offer mothers on Medicaid birth control education, access

Indiana bill could require doctors to restrict birth control access

INDIANAPOLIS (WISH) — A House bill could require health care providers to discuss birth control implants with women on Medicaid directly after giving birth.

The bill could requires women on Medicaid or who qualify for it to discuss the implant with health care providers in order to receive Medicaid funding for the device.

The bill would not require health care providers to discuss and offer intrauterine devices (IUDs) but also would not ban them from doing so.

The legislation was awaiting action from the House Committee on Appropriations, an online legislative database showed Tuesday. That committee was scheduled to meet at 9 a.m. Thursday in Committee Room 431 of the Indiana Statehouse.

Democrat state Rep. Rita Fleming, an obstetrician from Jeffersonville with over 25 years of experience, authored the bill. Both Democrats and Republicans were listed as coauthors.

State Rep. Maureen Bauer, a Democrat from Portage, says, with the unintended pregnancy rate in the state at nearly 50%, the measure would be a step forward if it becomes law.

“We are now beginning to have conversations about long-acting, reversible contraception, something that is so important to help women space out pregnancies,” Bauer said.

Fleming asked senators to not allow this bill to become politicized as it is considered in the Senate. She wants this to be a step forward for women in Indiana to have more information to make an informed choice.

Bauer said, “The author of the bill, who has years of experience as an OB practicing right here in Indiana, who has had conversations with women who she only sees when they’re giving birth.”

Democrat state Sen. Shelli Yoder, from Bloomington, is concerned the bill lays the groundwork for new legislation to restrict IUD access for Medicaid patients because the bill says that Medicaid will cover the cost of the arm implant but leaves out IUDs.

“That legislation could then be used going forward to point to those as covered in the language in the Indiana code covered in (House Bill) 1426 will be covered by Medicaid,” Yoder said.

Haley Bougher, the Indiana director of Planned Parenthood Alliance Advocates, says previous lobbying has cited incorrect information that an IUD is an abortion. She is concerned that is why the bill only requires discussion about birth control implants in the arm.

“Folks should have access to the broad range of contraceptives because it’s not a one-size shoe for all people,” Bougher said. “This type of birth control stops you from becoming pregnant. It is not an abortion.”

Bill advocates say birth control implants in the arm are the best option for Medicaid patients with a lack of access to care because they are less likely to fail in postpartum mothers.

Additionally, some believe, the bill could reduce maternal and infant mortality rates in Indiana by helping mothers to space out pregnancies.

Rep. Rita Fleming’s letter to Indiana state senators

“Dear Senator,

“I know you are very busy, but please take the time to read this letter regarding HB1426.

“This bill ensures that women, prior to discharge from a postpartum unit, be offered a very effective method of long-acting reversible contraceptive. The bill does NOT prevent a hospital from stocking, or a provider from dispensing, inserting or implanting any contraceptive. This applies only to a small window of opportunity—the immediate postpartum hospitalization– to assist women to space pregnancies. We know, from Maternal and Infant Mortality Reports, that close spacing of pregnancies is a significant risk factor for poor health outcomes.

“In my 25+ years of private practice, I discussed birth control with my patients in the late prenatal period. We had a plan, and they either received a contraceptive in the hospital or at the traditional 6-week postpartum visit. But then I became an obstetrical hospitalist. I worked 24-hour shifts serving women in emergency situations and those who had no doctor or midwife. I had to gain the trust of these patients in a short period of time. | took good care of them. They came from tough circumstances—most were in the grip of a drug addiction. Some were homeless. Others had multiple sex partners, necessary to support a drug habit. Many had sexually transmitted infections. So did some of their babies. (Congenital syphilis is at its highest rate in 10 years among mothers and babies.) They ALL wanted birth control. But the
best I could offer was a 3-month duration injection of Depo Provera.

“With this legislation, | could have offered these women reliable, safe, long-lasting contraceptive in the form of a subdermal implant. It can be placed in the upper arm at the bedside. It takes 5 minutes to achieve 3 years of protection.

“Some are trying to make more about what this bill is NOT, instead of the enormous good that it can do. The rate of unintended pregnancies in this state, just short of 50%, remains unacceptably high. The cascade of untoward outcomes for babies and children that more often occur in an unplanned pregnancy have health, societal, and financial consequences for Indiana. In this part of the country, an uncomplicated prenatal, vaginal delivery, and immediate postpartum course costs about $19,000. A cesarean delivery raises that to $28,000. if we could help 100 women avoid an unintended pregnancy, the $2 million in Medicaid funds saved could go a long way in to help those mothers and children who need it.

“To repeat, this legislation does not prevent offering or providing any form of birth control. Those who raised concerns continually referred to IUDs. These are not prohibited in any way. They pointed to a preference of patients to IUDs. While it may be true in a private office setting, it is no way the choice, or even an appropriate method, for those women I cared for as a hospitalist. One in seven will fall out if placed immediately after delivery—hardly an effective method of contraception. They are contraindicated in women with multiple sex partners, with sexually transmitted infections, intrapartum or postpartum uterine infections, or uterine abnormalities. This should not be politicized. It is the optimal way to help women who need it most. Please consider them as you vote on this legislation.”