9/18/20 Pharmacy building

The Purdue Pharmacy is easy to find immediately on the right as you walk into the Pharmacy building.

A bill Democratic representatives strive to bring before the Indiana House of Representatives in January would allow Purdue students to receive birth control from the Purdue Pharmacy without first seeing a doctor.

The pharmacy began offering birth control consultations for the first time this semester. But students can only sign up for one if they’ve visited the Purdue University Student Health Center at least once previously.

The rule allows the pharmacy to work around Indiana law, which requires medical providers to prescribe birth control.

If the bill passes, Indiana will join 13 other states and Washington, D.C., in allowing pharmacists to prescribe most forms of birth control. The bill aims to make contraception more accessible, prevent unintended pregnancies and lower maternal and infant mortality rates.

“(A lot) can be helped by increasing access to contraception,” said Ashley Meredith, a Purdue professor and clinical pharmacist. “If you’re preventing pregnancies, then No. 1: they’re not unwanted. And No. 2: there are less women and babies to have complications.”

Unintended pregnancies are detrimental to entire families, according to Rita Fleming, the Democratic representative in Southern Indiana who’s authoring the bill. As a former obstetrician-gynecologist, Fleming said the pregnancies lead to delays in critical prenatal care, and greater social and educational challenges for the children who are ultimately born.

Fleming also worries the state’s birth rate will increase as the COVID-19 pandemic continues to limit activities and drive couples indoors. She’s waiting to receive numbers of unintended pregnancies from the Medicaid office to see if her suspicions are true.

“We know that when we have a blackout, and people are home for two or three days, the birth rate goes up,” she said. “Well, this is a lot more than the typical blackout.”

Moreover, busy work schedules and physical distance from providers can make it difficult for women to visit a doctor, and the pandemic further complicates in-person visits. Pharmacies exist within two miles of almost every person in Indiana, Fleming said.

“We point fingers at women and blame them for being careless or unprepared when for many women, it’s an access problem,” Fleming said. “They can’t get the birth control that they want and need.”

The nonprofit group United Health Foundation finds in its research on unintended pregnancy rates that about 95% occur because women use contraception inconsistently, incorrectly or not at all.

“Women’s right to access reproductive care should be a basic right that they have, it shouldn’t be something that is really difficult to access,” Meredith said. “This is one more way to make access to that care a little bit more convenient.

“If you’re a male and you want medication for erectile dysfunction or balding, you just need to go to this website and you can essentially order it online. So why can’t women do the same thing for birth control?”

Companies like Nurx do prescribe birth control online without an in-person doctor’s visit, but the safety of their services has come into question in recent years because telemedicine is not yet subject to the same regulations as traditional pharmacies.

Republican Rep. Cindy Kirchhofer, who chairs the state’s Public Health Committee, chose not to hear an earlier version of the bill last year. Meredith said advocates of the policy weren’t informed why, but she wasn’t surprised given the majority-Republican makeup of the House.

“It didn’t go through because of politics,” she said.

In a 2018 press release from the Indiana House Republicans announcing Kirchhofer’s reappointment as committee chair, Kirchhofer said the health committee plans to “continue working to make Indiana a healthier state and ensure Hoosiers have better access to the health-care services they need.”

Kirchhofer, who represents part of Marion County, is running against Democrat Mitch Gore in District 89. She was unavailable for comment last week.

Democratic Rep. Chris Campbell, who represents West Lafayette, said she has the impression that helping women avoid unwanted pregnancies is not a top priority for the Republican-majority House.

But Fleming is confident the bill will receive a hearing this year.

“There’s always people who are opposed to contraception of any sort,” Fleming said. “And I certainly respect their own personal beliefs. But we’re here to establish good public policy, and this is good public policy.”

Meredith said the group is in discussion with an experienced Republican state senator who might be willing to support the bill. They are also seeking the support of the Indiana State Medical Association, whose opinions legislators trust, according to Meredith.

The association tends to represent the interests of doctors, who Meredith said are hesitant to expand the scope of services provided by other health-care professionals.

Some believe pharmacists lack the training necessary to prescribe medication. If the bill passes, Meredith said it will likely require pharmacists to complete several hours of online training before they can prescribe contraception.

Meredith said the medical association also worries that if pharmacists are allowed to prescribe birth control, they will eventually have the power to prescribe stronger medications without patients having to consult a doctor beforehand.

Fleming thinks pharmacists are more than capable of dispensing birth control to those over 18.

“As an obstetrician-gynecologist, I know that an office visit does not necessarily have to be part of providing birth control,” Fleming said. “A good health history and blood pressure check will suffice. And pharmacists are very capable of doing that.”

A research team Meredith works with investigated the other side of the equation: how well people are able to understand and communicate their own health history. The Adolescent Capacity for Contraception Self Screening Project surveyed 400 women between the ages of 14 and 21.

The women filled out a self-screening medical questionnaire similar to what they would fill out if seeking birth control from a pharmacy, Meredith said. Their medical providers completed the same form. The two responses were compared for accuracy, and the researchers found that the majority of young women were able to accurately identify their own medical history.

One major exception was that women were not able to describe migraines as accurately as their providers, which could be dangerous because hormonal birth control can exacerbate certain types of migraines.

The researchers also led 60 women through a simulated birth-control-prescribing scenario to see how the women could apply general information provided to their personal circumstances. Meredith said scores in this section were high.

“That is probably the bigger piece of what will likely drive legislative change,” she said. “We show that they can accurately understand what it means for them.”

Campbell said the bill will call attention to an issue becoming vital as access to reproductive measures and affordable health care in the state dwindle. The number of Planned Parenthood locations has decreased in recent years, and Campbell said the Franciscan Health network does not allow its providers to prescribe birth control.

She’s working on a related bill that would require the state to provide birth control if an employer refuses to for moral or religious reasons. She was also part of a summer study committee that seeks to redefine the terms “consent” and “rape” in the Indiana rape statute.

As a conservative U.S. Supreme Court majority looms, Campbell said access to birth control is even more critical. She fears a world where women can’t legally control their reproductive health.

The freedoms women now experience in the workplace rest heavily on access to reproductive measures, Campbell said.

“I went to school in the ‘80s. … One of my first jobs, I got asked what my family situation was — which it’s supposed to be illegal to even ask that question – and this was the ‘90s,” she said. “They wanted to know if I had children or was going to have children because this was going to interfere with my life as a woman in the workforce.”

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