House Bill 1426 was stripped of IUDs. Here’s what could happen next.
By MARY CLAIRE MOLLOY – MIRROR INDY
An Indiana birth control bill is the latest flash point in an ongoing battle over reproductive rights. This time, the fight is over IUDs — with some Democratic lawmakers and medical professionals concerned about false claims that the devices cause abortions.
Here’s everything we know about House Bill 1426 and what’s coming next:
What would the bill do?
HB 1426, authored by Rep. Rita Fleming, D-Jeffersonville, would require hospitals to offer women on Medicaid a long-acting reversible contraceptive — specifically a subdermal implant — after they give birth. Hospitals with religious objections would be exempt. A new amendment would sunset the law in June 2025 — leaving it up to lawmakers to decide if they would like to reintroduce it in the future.
Fleming said the legislation is meant to expand access to birth control for mothers in vulnerable situations who may not attend their six-week postpartum doctor’s visit. It also would save the state billions of Medicaid dollars spent on unintended pregnancies, she said, and reduce Indiana’s high maternal mortality rate.
“This should not be politicized,” Fleming wrote in a letter to fellow lawmakers. “It is the optimal way to help women who need it most.”
What is a long-acting reversible contraceptive?
A long-acting reversible contraceptive is a form of birth control that lasts for years without requiring daily upkeep and can be removed if a person decides they would like to become pregnant. There are two types: IUDs, which are small, flexible T-shaped devices inserted in the uterus; and subdermal implants, which release hormones after being placed in the upper arm. It’s up to a patient and their doctor to decide which type of birth control works best for them.
Long-acting reversible contraceptives are considered the most effective birth control methods for preventing pregnancy. The American College of Obstetricians and Gynecologists recommends offering them to women at the hospital immediately after they give birth. This practice prevents unintended pregnancies and protects mothers from the risks associated with becoming pregnant again in a short period of time — a goal of Fleming’s bill.
Why were IUDs excluded from the bill?
HB 1426, as originally written, would have required hospitals to offer both IUDs and subdermal implants to Medicaid patients after they give birth. However, an amendment added in a House committee changed the bill to specify hospitals would onlybe required to offer the subdermal implant.
Fleming, a retired OB-GYN, said subdermal implants are the best choice for patients in vulnerable situations, such as people who have diseases spread through sex. She cited statistics about IUDs falling out more often when they are inserted right after a person gives birth.
“With this legislation, I could have offered these women a reliable, safe, long-acting contraceptive in the form of a subdermal implant,” Fleming wrote in a Feb. 23 letter sent to all Senate Democrats. “It takes five minutes to achieve three years of protection.”
By only listing subdermal implants in the bill, Fleming’s legislation gained support among lawmakers who might otherwise be opposed because of concerns from an anti-abortion group behind the state’s near-total abortion ban in 2022.
“Right to Life came in and said they don’t believe in IUD because it is an abortion,” bill co-author Rep. Cindy Ledbetter, R-Evansville, testified last month during a Senate Health and Provider Services Committee meeting. The devices were removed from the bill, she said, “because we are a strong pro-life state.”
How is Indiana Right to Life involved?
Indiana Right to Life met with lawmakers last year about an identical birth control bill, lobbyist Jodi Smith told Mirror Indy.
“They were very willing to make concessions on anything that could be construed as an (abortion drug) because their bill was not about abortion,” Smith said.
It’s unclear which lawmakers, though. Through a spokesperson, Fleming said she did not meet with the group.
Either way, the group holds sway in the Indiana General Assembly, where both chambers are controlled by supermajority Republican caucuses.
Indiana Right to Life has not publicly testified about Fleming’s bill this session. But their false claims about IUDs — which prevent fertilization and are not a form of abortion — seem to have influenced the legislation. As a member of the super minority, Democrats like Fleming need wide Republican support to advance any policy goals.
Still, critics say the bill could be used as precedent for stripping Medicaid funding for IUDs or chipping away at birth control access in the future.
“If we give in and say it’s OK for Indiana Right to Life to make decisions for thousands of patients across the state, then we are creating a system in which lobbyists get to choose what type of birth control people are using,” Dr. Caitlin Bernard, an Indianapolis-based OB-GYN who became a national figure after the Supreme Court eliminated the constitutional right to abortion, told Mirror Indy. “That is not a health care system I want to work in.”
Haley Bougher, the state director for Planned Parenthood Alliance Advocates, said she sees the Indiana bill in the context of a national movement to limit access to birth control and in vitro fertilization.
“This isn’t new,” Bougher said.
What do hospitals currently offer? What would the bill change?
It is not entirely clear what HB 1426 would do besides requiring hospitals to offer one type of long-acting reversible contraceptive. Critics fear that hospitals would stop stocking or offering IUDs if they’re mandated to offer subdermal implants instead.
“Not every person can have every single type of birth control, so this just limits their options and makes the bill ineffective,” Bougher said.
Mirror Indy asked major hospital systems across the state if they’re currently providing IUDs and subdermal implants to women after they give birth. Here’s what they said:
- IU Health offers both IUDs and subdermal implants to all patients who deliver at their hospitals. A spokesperson said hospital officials cannot speculate about the bill’s effects without knowing the final details, but IU Health will continue to use “evidence-based medicine” in clinical decisions.
- Community Health Network has IUDs and Nexplanon, a type of subdermal implant, available to women on Medicaid who request them after giving birth. A spokesperson said the hospital system will continue to provide IUDs even if HB 1426 passes.
- Eskenazi Health provides IUDs and subdermal implants to women after they give birth. Eskenazi did not immediately answer questions about whether it would continue to provide IUDs if HB 1426 passes.
- Deaconess Women’s Hospital in southwest Indiana offers the subdermal implant to women in the postpartum period upon request. A spokesperson said the hospital offers several contraception options but would not say if that included IUDs.
- Franciscan Health does not offer subdermal implants or IUDs as a form of birth control. The Catholic hospital system uses IUDs only when necessary to treat a medical condition, a spokesperson said.
- Ascension St. Vincent does not provide IUDs or subdermal implants. The hospital follows ethical guidelines from the Catholic Church, a spokesperson said.
What’s next?
The bill passed out of the Senate Appropriations Committee on Thursday, Feb. 29 — but not without some concerns from Republicans.
Sen. Liz Brown, R-Fort Wayne, questioned the potential cost of the legislation and the state meddling in women’s choices about when to have children because of their financial status.
“It seems like we are suggesting because a mom is on Medicaid or Medicaid-eligible… we need to make sure she doesn’t have a baby again for, frankly, quite a while,” Brown said.
During that meeting, Sen. Shelli Yoder, D-Bloomington, also introduced an amendment to add language about IUDs back into the bill. It failed along party lines.
“They’ve told us who they are,” Yoder said of Indiana Right to Life in an interview with Mirror Indy. “They are coming for birth control.”
Yoder said she will take the fight to the Senate floor this week and call the amendment again.
Mirror Indy reporter Mary Claire Molloy covers health. Reach her at maryclaire.molloy@mirrorindy.org. Follow her on X @mcmolloy7.
