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As Democrats seek to make the right to contraception an election issue amid a growing partisan clash over reproductive rights, Iowa Republicans U.S. Rep. Ashley Hinson and U.S. Sen. Joni Ernst are focusing attention on their efforts to increase birth control options for women in rural Iowa.
The pair this week wrote a letter to the U.S. Government Accountability Office requesting information on federal resources and inventory stocking of contraception options for women through federally qualified health centers, which serve rural areas.
According to the letter, in 2020 over 12,000 of the centers provided care for more than 28 million people, many of them women of reproductive age.
“While millions of women continue to pursue care through FQHCs, there are significant discrepancies in access to specific forms of contraception at each facility, many of which are associated with a lack of provider training,” the states the letter, which cites a study and 2017 survey by KFF, formerly the Kaiser Family Foundation, on community health centers’ family planning services.
The study found rural or suburban health centers are significantly less likely than urban health centers to provide a full range of contraceptive methods on-site. Based 2017 data, just 24 percent of all community health centers in the country provide a comprehensive list of contraception options for patients to review on-site, while close to half participate in mail-order prescription programs.
“Adding to inventory challenges, many CHCs do not have a provider on staff trained on IUD (intra uterine devices) or implant insertion procedures,” according to the letter. “Smaller health centers, specifically those located in rural or suburban areas, are less likely to offer IUDs or implant devices due to training barriers.”
The lawmakers requested:
- An itemized inventory of available contraception,
- Annual family planning counseling appointment requests and rates of return,
- Expenditures of federal funds to reimburse facilities for contraception methods,
- Financial resources and contraceptive options offered, and
- Any additional barriers, including geographic, to centers that wish to provide a wider range of contraceptive methods.
“Ensuring women, regardless of ZIP code, have access to safe birth control options is vital for women's health and family planning,” Hinson said in a statement. “Unfortunately, women in rural and underserved areasoftenhave fewer contraception options.”
Cedar Rapids center offers comprehensive options
Trisha Welsh, an OB-GYN nurse practitioner at Eastern Iowa Health Center in Cedar Rapids, said the federally qualified health center offers a comprehensive range of birth control options — including oral contraceptives, IUDs, birth control implant and condoms — as well as testing for sexually transmitted infection and treatment.
The center, which employs four OB-GYN physicians and surgeons and three OB-GYN advanced registered nurse practitioners, also offers free contraceptives to low-income individuals in Linn, Jones and Benton counties through the federal Title X program.
Eastern Iowa Health Center is one of 14 federally qualified health centers in Iowa. Transportation assistance is available for patients, including a bus service and telehealth options. Interpreter services are utilized for non-English speaking patients.
Welsh emphasizes the center's commitment to removing barriers to contraceptive care, including confidential visits for minors. She said the center does not require exams for birth control, making it easier for patients to get the care they need.
Financial assistance programs and a sliding fee scale are available for patients without insurance.
She also noted the health center has an outreach clinic in Vinton, but was forced to shut down a clinic in Anamosa due to decreased patient population during COVID-19.
Biden proposes rule for insurance coverage
Democratic President Joe Biden’s administration this week proposed a rule that would require insurers to cover over-the-counter birth control, including oral contraceptives, condoms and emergency contraception.
The rule would expand access to contraception and aim to reduce out-of-pocket costs, affecting up to 52 million American women of reproductive age who rely on private health insurance, the White House said.
Hinson told reporters earlier this week she supports efforts to ensure women have access to over-the-counter birth control, but raised concerns about the Biden administration proposal, according to Radio Iowa.
“My biggest concerns with the president’s proposal are the overall costs to the health insurance markets and overall costs to consumers and taxpayers,” Hinson said during her weekly news conference, “but I think it’s really important that we continue to look at ways to get access to over-the-counter birth control for more women.”
Hinson is seeking a third term representing Northeast Iowa’s 2nd Congressional District. She faces Cedar Falls Democrat Sarah Corkery and no-party candidate Jody Puffett of Delhi in the Nov. 5 election.
Corkery, speaking Friday to The Gazette, criticized Hinson’s efforts to expand access to contraception, calling it "smoke and mirrors."
She said Biden’s proposal is a “good” step to expanding access to oral contraceptives, but that over-the-counter contraception is the least effective option as it contains the least amount of hormones.
Corkery said pills that have a combination of hormones are slightly more effective than the Opill, the only oral contraceptive the Food and Drug Administration has approved for sale at pharmacies without a prescription.
Hinson said the approval process has been too slow, and that her main goal is to speed up FDA approval of more over-the-counter options. She and Ernst introduced legislation that would incentivize manufacturers of oral birth control to file for over-the-counter approval, giving those applications priority review.
Corkery argued that long-term reversible contraceptives like IUDs are more effective in reducing unwanted pregnancies and abortions.
She criticized Hinson for voting against a bill that would establish a federal right to access contraception and related information. The bill would also protect health care providers' ability to provide contraception and services.
“If that would have been put in place, at least women will sleep at night to know we're going to be able to have access to contraception, no matter how we have to beg, borrow and think to get it,” Corkery said.
Comments: (319) 398-8499; tom.barton@thegazette.com
