After narrowly rejecting it on Monday, the Arkansas House of Representatives on Tuesday approved a measure by Rep. Aaron Pilkington(R-Clarksville) that would allow pharmacists to dispense oral contraceptives to women without a prescription from a doctor. House Bill 1290 now heads to the Senate.
The vote was 54-29, with nine members voting "present" and another eight not voting. House Republicans were split on the bill, with several speaking against it.
Under current law, women must obtain a prescription from a doctor or a nurse practitioner to obtain birth control. Pilkington said in an interview after the floor vote that expanding access to contraception would result in fewer abortions.
"As a pro-life conservative, it helps us reduce the number of abortions in the state," he said. "To me, it seemed like a simple solution. It hasn’t been a simple process, due to some of the opposition."
Pilkington, who is a health clinic administrator, also said the bill would improve women's health and save the state money. (Pregnancy and childbirth are expensive; unplanned pregnancies cost Arkansas Medicaid millions of dollars each year, he said.) Increased contraceptive access could reduce Arkansas's infant mortality rate, in part because teen pregnancies are more likely to result in complications. Arkansas has among the highest infant mortality and teenage pregnancy rates in the country, according to the Centers for Disease Control and Prevention.
The legislation would require a pharmacist who dispenses birth control to first complete a training program approved by the state pharmacy board. Participating pharmacists would be required to ask patients if they've seen a primary care doctor or obstetrician/gynecologist in the last six months. If not, the pharmacist would need to refer the patient to a local doctor and could dispense no more than six months' worth of the drug.
A pharmacist could only dispense birth control without a prescription to patients 18 or older. The bill would apply just to the oral contraceptive regimen and would not affect "morning-after" pills.
House Democrats all supported the bill, but only 30 out of 76 House Republicans voted yes. The Family Council, a conservative advocacy group, had urged a vote against HB 1290 in committee. However, Arkansas Right to Life, an anti-abortion organization, took a neutral position.
Rep. Mark Lowery (R-Maumelle) spoke against the measure, questioning whether it would reduce abortions. He cited a 2014 study by the Guttmacher Institute, an organization advocating for reproductive rights, that indicated 51 percent of abortion patients in the U.S. had used contraceptives the month before their procedure. That indicates patients "need more medical counseling" before taking birth control, he said.
"If we saw a spike in contraceptive use, especially by those who are not being counseled by an OB/GYN, we can automatically conclude that there would also be a spike in abortions, and that is certainly not a direction that we want to go," Lowery said.
But the Guttmacher Institute study does not say contraception increases abortions. It draws the opposite conclusion. "Between 2000 and 2014, the overall number of abortions in the United States declined significantly, and available evidence suggests that improvements in contraceptive use contributed to the abortion decline. ... evidence from decades of research has found that contraception is effective at pregnancy prevention," a news release accompanying the study says.
The report says an estimated 37.8 million women aged 14-55 used contraception in 2014. Meanwhile, "only 471,000 abortions were provided to patients who reported they were using contraception in the month they became pregnant." Out of the population of women using contraception in 2014, therefore, no more than 1.2 percent of the total received an abortion. (The study also includes condoms in tallying contraception use; of women who received an abortion in 2014, only 13 percent reported taking birth control pills the month before the procedure.)
Pilkington pushed back against Lowery's conclusion. "Most studies show the complete opposite: That access to birth control actually leads to a reduction in the amount of abortions," he said in closing for his bill. "In these states that have already passed legislation, they’ve seen a 25 percent decrease."
Rep. Dan Sullivan (R-Jonesboro) said Pilkington's measure would amount to "lowering our expectations" and predicted it would result in increased costs to the state. "When we start making it easier to escape the real consequence of what happens when we offer an easy way out, we’re going to get what we expect," he said.
Rep. Vivian Flowers (D-Pine Bluff), who supported the bill, said in response to Sullivan's comment that she had "raised expectations that grown women who wish to utilize contraceptives have the access and the freedom to do so and be responsible in that vein." As for teenagers, she added, the state should "provide opportunities for them to act responsibly as well."
"Somehow, women’s health, women’s body parts, are often made the subject of policy and discussed in the vein of 'the marketplace' and 'efficiency,' and we don’t do that when we have conversations about men’s relationships with their urologists," Flowers said.
Rep. Joe Cloud (R-Russellville), who is himself a retired OB/GYN, opposed the bill. He questioned whether pharmacists were qualified to dispense birth control medication and whether there was truly a problem with a lack of access to providers who could write prescriptions. Two new medical schools are soon to open in the state, Cloud noted.
"We’re going to increase the number of physician graduates … so I hope that answers the access issue," he said.
After the vote, Pilkington said the measure had the support of most doctors, though he acknowledged "certain factions" of physicians were opposed. The American College of Obstetricians and Gynecologists supported the bill, he said.
Pilkington said he expected HB 1920 would be sensitive, both for ideological reasons and because bills that seek to change the "scope of practice" for a class of medical provider can draw fire from other providers. Still, he said, he was surprised at the level of opposition.
"It did shock me in some regards," he said. "Some people, I think, needed to have been more upfront and honest that they were just against birth control in general. If that’s how they believe, then that’s OK — I just think that’s what they need to address their argument as. And, I think some people don’t understand the complexity of this issue and that what we’re trying to do is not something extremely radical. I mean, a majority of foreign countries have [birth control] over the counter."
On Monday, the bill fell three votes short of the 51 necessary for passage, but after it failed, the chamber approved a motion to expunge the vote. That allowed it to be reconsidered on Tuesday afternoon.
This reporting is courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan news project dedicated to producing journalism that matters to Arkansans. Find out more at arknews.org.