Iowa House lawmakers approved a bill to allow pharmacists to dispense self-administered hormonal contraceptives to women at least 18 years old. The pharmacist would be able to dispense up to a one-year supply of a self-administered hormonal contraceptive.
The patient is required to fill out a questionnaire for a self-screening risk assessment, which the pharmacist would review.
The pharmacist is provided immunity from criminal and civil liability arising from any damages caused by the drug.
The bill would not include any drug intended to induce an abortion, but pro-life advocates took issue with what hormonal contraception does or doesn’t do in that regard.
Rebekah Oleson of The FAMiLY Leader Foundation said the group is registered undecided but has concern many forms of hormonal contraception may be abortifacients. Though the drugs are primarily intended to prevent fertilization, the FDA and Mayo Clinic noted that hormonal birth control may also work by thinning the uterus and preventing implementation.
“The FAMiLY Leader Foundation is committed to protecting life beginning at conception and opposing any abortion, including those that prevent implementation,” Olson said.
Mike St. Clair with CVS Health spoke in support of the legislation.
Tom Chapman of the Iowa Catholic Conference said the organization is opposed to the bill because it undercuts the physician/patient relationship.
“Any prescription medicine carries some risk, which is why it requires a prescription,” Chapman said. “Different types of birth control pills contain different levels of hormones.”
Currently the medicine is prescribed fits the health profile of the woman. A pharmacist, Chapman said, does not have access to the patient’s medical records and is relying on a questionnaire which may or may not be answered accurately.
Keeping in mind the power of the drugs as well as their failure rate, Chapman said there should be penalties in the bill for pharmacists who provide the drug to a minor.
“Overall we question whether this goal the change of policy hopes to achieve, especially in view of the dangers it might pose, ultimately protects the best interest of women,” Chapman said.
Maggie De Witte of Iowans For Life spoke against the bill for several reasons.
“This bill states it does not include any drug intended to induce an abortion, unfortunately, oral contraception can be abortifacient in nature,” she said. “It’s a medical fact most, if not all hormonal birth control drugs can act to terminate a pregnancy by chemically altering the line of the uterus so a newly conceived child is unable to implant into the womb.”
De Witte said that is referred to as pre-plantation chemical abortion.
“Oral contraception is unsafe,” she said.
The World Health Organization classified hormonal contraceptives as a Group 1 carcinogen, De Witte said, the same as tobacco. Women who use contraception for 11 years or longer have a 210 percent increase in the risk of breast cancer. The birth control pill is a steroid, which is banned for professional athletes due to health concerns. Contraception has been proven to increase the risk of potentially fatal blood clots and heart disease. Lawsuits have been filed against the patch for several deaths from blood clots, heart attacks and strokes. The FDA has cautioned the patch carries a higher risk of blood clots than the pill.
“These medicines should not be prescribed by anyone except a medical doctor who has access to accurate medical records and necessary medical tests,” De Witte said.
She also expressed concern with the STD epidemic.
“Hormonal contraception does not prevent the spread of these infectious diseases, which in some cases is incurable,” she said.
It also provides an “ineffective false sense of security. The New York Times reported a fail rate of 38 percent by year five and, by year 10, 61 out of 100 women who use the pill become pregnant.
“If the intent of this bill is to reduce abortion, hormonal contraception given out by a pharmacist over the counter is dangerous and it puts women’s lives at risk,” De Witte said.
Casey Ficek of the Iowa Pharmacy Association said the model has worked successfully in other states as it has expanded access to the service.
Anne Roth said Hy-Vee supports the bill as it increases women’s ability to access care in rural parts of the state.
Logan Shine, who represents the Governor’s office, said it aims to make contraceptives more accessible and those modern contraceptives are 91 percent effective. He added it provides health benefits that go beyond just unintended pregnancies.
Tamara Scott testified as a mom and grandma in Iowa. She said a one-year supply to a patient not required to see a doctor for 24 months is quite a period of time when something could be taking place.
When the bill surfaced a couple of years ago, an OB/GYN testified that undiagnosed medical conditions would really be a “great concern” under these situations.
Liability seemed to be a point of interest from those on the subcommittee. Republican Rep. Ann Meyer, who chaired the subcommittee, asked Shine to discuss the liability aspect.
“I would be surprised if there isn’t already some sort of liability issue with prescribing medicine to someone who would be ineligible under Iowa law,” he said.
Fisack said there would be potential discipline for pharmacists from the board.
Democrat State Rep. Beth Wessel-Kroeschell said she supports the bill but would like to see it extended to younger women in Iowa. She cited the loss of the Iowa Family Planning Network waiver as the reason Iowa has seen an increase in STDs and teen pregnancies.
“I find some of the conversations here interesting around abortions,” Wessel-Kroeschell said.
She then asked Meyer if, in her opinion, the birth control pill causes an abortion.
“I understand the concept that some people are talking about,” she said. “There are several different types of birth control. Some types of birth control, what it does, it allows conception but again it affects the wall of the uterus and all of the uterus rejects it. That in theory is what they’re discussing.”
Republican State Rep. Shannon Lundgren said she has some concerns with the bill but hopes to see the things she is “kind of hung up” worked out as the bill advances.
Meyer said she appreciated everyone’s concerns, but would sign it to go to the full committee.
“The bottom line is, if we are going to prevent abortions, we need to prevent unplanned pregnancies,” she said. “And this is one way to address that issue.”
