For the first time ever, women in Iowa will be able to buy birth control pills without a prescription by April 1. Can you believe it?
It's no April Fool's Joke. It's also no thanks to Republican members of the Iowa House.
After all, the Opill, as it's called, was approved for use 50 years ago. It's been sold in Great Britain for years, and available over the counter in many other countries around the world. Yet it's the first over-the-counter birth control pill ever sold in the U.S. After nine years in the FDA approval pipeline, Opill's safety and effectiveness is backed by the American College of Obstetricians and Gynecologists, the American Medical Association, and the American Academy of Family Physicians.
It's not the same combination estrogen and progestin birth control pill that became available by prescription in 1972 when the Supreme Court ruled that unmarried people had the same constitutional right as married people to contraceptives. Sometimes called the "mini-pill," it contains only progestin. If taken properly, it's 98% effective in preventing pregnancy – more effective than condoms, spermicides, and other nonprescription products.
An estimated 45% of the six million pregnancies in the U.S. each year are unintended, according to the FDA. The Opill holds promise for sexually active teens who haven't been seen by a doctor, and for women who aren't able to make timely doctor appointments because of work or logistical conflicts. It's also affordable, at $19.99 per month, so it's a good alternative for women without insurance. It will be sold at most pharmacies. Or, it can be ordered at Opill.com from Perrigo Company, its Irish manufacturer. Perrigo also offers a cost-assistance program for qualified low-income and uninsured individuals.
What's not to like?
Women's Rights Under Siege
Isn't it about time for women to reclaim some autonomy when it comes to reproductive health decisions? On June 24, 2022, Roe vs. Wade, the landmark decision guaranteeing a constitutional right to abortion access for all American women, was overturned after 50 years. The Dodd decision set off a race to the bottom, as many state legislatures scrambled to pass the most restrictive abortion laws on the books.
Many states already had begun starving Planned Parenthood of America of funds, and dismantling its role as a resource for safe and effective family planning. Six years ago former Iowa Governor Branstad signed a bill blocking Planned Parenthood from state funds, and discontinuing the federal Medicaid family planning network waiver. In 2017, there were 12 Planned Parenthood Clinics in Iowa; today there are six.
Iowa's 2018 six-week abortion law was blocked in 2019 by a district court ruling that it violated Iowa's state constitution. In 2022, the Iowa Supreme Court reversed its 2018 decision affirming Iowa's constitutional right to abortion. But its split decision on June 6, 2023 left a lower court's decision to block the law in place. So Governor Reynolds called a special one-day session in July 2023 to pass another six-week abortion law. Now, she's appealing a 2023 injunction to the Iowa Supreme Court. A decision is expected by the end of June.
The Governor launched a MOM (More Options for Maternal Support) program two years ago to provide nonprofit crisis pregnancy care centers without any licensed medical providers on staff. After it failed to attract a qualified third-party administrator, the state is taking it over. Iowans already have contributed over a million of taxpayer dollars, with little to show for it.
Across the country, restrictive state abortion laws and curtailed Planned Parenthood funding have driven demand for an abortion medication, mifepristone, delivered through the mail. After two decades of effective and safe use, now the Supreme Court will be ruling this spring whether to restrict its access.
Iowa House Ignores Voter Support
Clearly, most of Iowa's legislative focus and funding has been aimed at forcing women to give birth. However, since 2018, Governor Reynolds has proposed legislation allowing Iowans ages 18 and older to obtain various birth control products: pills, birth Control patches and vaginal rings, directly from a pharmacist. (An appointment would be required to see a physician within two years.)
Last year, the Iowa Senate finally passed this bill, but the House never brought it to a vote. The Governor's tepid support doesn't compare to her ruthless drive to fund private schools with public taxes. After all, she never has endorsed any primary challengers of Republican incumbents who opposed her over-the-counter birth control bill, has she?
This year the bill was back again. House File 2584. Only a three-month supply of pills would be dispensed initially; followed by a one-year supply. Pharmacists would screen patients for risk factors. The bill would require insurance companies to cover birth control over the counter. Once again, the Iowa Senate passed it. Crickets from the House.
What's the rationale for the Iowa House's refusal to pass an over-the-counter birth control bill? Fake concerns about women's health? Surely our legislators are aware that pregnancy isn't risk-free, and that research shows unintended pregnancies are associated with delayed access to pre-natal care, increased child abuse, and neglect.
What are House legislators afraid of?
Apparently not their voters. A recent Iowa Poll shows that eight in 10 Iowans support this bill. It isn't a partisan issue. Twenty-eight other states and the District of Columbia allow over-the-counter birth control.
How About Life After Birth?
Can someone explain why it doesn't make more sense to increase contraceptive access than to double down on restricting abortion, possibly endangering the lives of women confronted by medical emergencies? Why wouldn't greater access to birth control help reduce abortions?
But if Iowa legislators want women to give birth, no matter the circumstances, are they making mothers and children their priority? Not really. A 2024 report by the Center for Healthcare Quality and Payment Reform documents that 61% of Iowa's rural hospitals no longer are delivering babies. Insurance and Medicaid don't reimburse the remaining Iowa hospitals adequately to cover the cost of births. University of Minnesota research indicates that the loss of labor and delivery units in rural counties corresponds to a decline in prenatal care and an uptick in out-of-hospital births.
The Dobbs decision ending the constitutional right to abortions also is making it difficult to recruit OB-GYN providers because of the threat of lawsuits in cases of medical emergencies.
Single Issue, Minority Overrules Iowa Majority
The Iowa House's refusal to act on H.F.2854 is indefensible. But the Opill soon will be available to Iowa women. Unlike the combination pill, it poses no risks of high blood pressure or blood clots. (Women with a history of breast cancer are not advised to take Opill.) Breastfeeding moms have been prescribed the progestin only mini pill as a back-up for many years, since combination pills can suppress a woman's breast milk supply.
The Opill must be taken daily at about the same time to be effective. That's why some claim it would lead to more unintended pregnancies among young women. News flash: Young women already are inadvertently becoming mothers. I personally know of three in the past year.
To date, the Opill isn't covered under the Affordable Care Act. Three U.S. Democratic senators – Patty Murray, WA, Mazie Hirono, HI, and Catherine Cortez Masto, NV – are working on passing The Affordability is Access Act.
The positive impact of contraception on the lives of American women and the U.S. economy cannot be overstated. During the 50 years that Roe vs. Wade was the law of the land, maternal and infant health improved, and women were able to achieve their potential in education and the labor market. In 1970, about 8% of women 25 years and older had earned bachelor's degrees; by 2022, 39% of U.S. women had four-year college degrees. The labor force participation rate of married women in the U.S. was 38% in 2013, and it rose to 51.7% in 2020, according to the U.S. Census Bureau.
Why do many Republicans (mostly men) want to turn back the clock on these milestones? After all, contraception isn't new. Throughout history, women have resorted to many forms of contraception, including drinking lead and mercury, which often sterilized or killed them. During Medieval times, women were advised by magicians to wear the testicles of a weasel on their thighs. Other methods included wearing wreaths of herbs, desiccated cat livers, and shards from the bones of pure black cats. If all else failed, women always had one sure bet: walking three times around the spot where a pregnant wolf had urinated.
Do Iowa lawmakers recommend bringing back any of these "remedies," along with their traditional values?
"We see you. We hear you." This Republican response to the President's State of the Union address last week by Sen. Katie Britt made it abundantly clear that Republicans don't. The concept of reproductive autonomy is at the core of a woman's rights to equality and privacy.
Yes, Britt is a mom. She's also an attorney who won a landslide victory in 2022 as the first woman ever elected to the Senate from Alabama. Yet she was directed by her Republican leadership to deliver her historic message seated at a table against a kitchen backdrop.
The camera angle didn't reveal to viewers whether Britt was barefoot, or not. And there's no word yet if she is pregnant.
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Thank you, Cheryl. It is so hard to believe that we are reading stories like this in 2024. Women in Iowa (and across our country) need to get out and vote. Our vote has always been, and will always be, our most powerful tool when it comes to standing up to the dangerous nonsense coming from the legislature these days.