Rep. Rita Fleming

Rep. Rita Fleming

I am a retired obstetrician, a Democrat, a legislator and a Catholic. These roles may seem to conflict. My advocacies might make others uncomfortable, even angry. But I’m OK with being all of the above. Catholics emphasize the value of life. I argue for respect for human life of all ages, from unborn babies to the elderly. I think my fellow legislators and my constituents know of my sincerity. I can merge my religious beliefs with my political affiliation.

I chose to become an obstetrician because I simply love babies. Being the first to hold a new baby never ceased to make me absolutely joyful, and amazed that this small person could be perfectly created.

Although Catholic, I had no qualms about prescribing safe, reliable birth control for patients who requested it, or performing tubal ligations for women who wanted to be able to responsibly care for the children they had.

I thought somewhat idealistically that, as a legislator and a physician, I could continue, on a greater scale, to help women gain access to birth control.

We could do so much better in this state. We could reduce unintended pregnancies, and abortions, but we have not had the will to do so. And the hypocrisy looms large.

In Indiana from 2018-19, over 15,000 tiny humans were lost to abortion. The overwhelming majority of these were the result of an unintended pregnancy. In fact, nearly half — 49% — of pregnancies in the state are unintended.

We often blame women for being careless or thoughtless when they experience an unplanned pregnancy. But for many, lack of access to safe, reliable contraception results in them having to make one of the most difficult decisions of their lives.

In an ideal world, women would have their comprehensive health care needs provided by a well-informed physician in a comfortable office setting. But the reality is that offices are open only from 9 to 5 on Monday through Thursday, often closing earlier on Friday. No offices are open on weekends, in evenings, or on holidays. Most women work during the day. Some rely on public transportation. Women in rural communities often do not have a provider within a reasonable distance from their homes.

However, for 90% of Indiana families, there is a potential provider within two miles of where they live, who is very capable of prescribing and dispensing birth control: a pharmacist.

Pharmacists receive in-depth education on the chemical structure, pharmacotherapeutic effects, classification, indications, side effects and contraindications of contraceptives. And more recent pharmacy curricula include patient interactions and counseling. Pharmacists’ responsibilities have expanded to include monitoring patients’ antibiotic levels in hospitals and concocting parenteral feedings.

Other professionals with far less education on the subject can legally prescribe contraceptives. Should a cardiothoracic surgeon, a gerontologist, or an orthopedic physician assistant be prescribing birth control? Because they can.

Legislators across the country — including in conservative states Tennessee, Idaho, West Virgina and Utah — have recognized the need for greater access to birth control, the potential to decrease abortions and the positive financial impact of fewer unintended pregnancies.

Indiana spends approximately $375.9 million per year on unintended pregnancy costs. When contraceptive access is improved, the money saved from fewer unintended pregnancies could fund improvements in health, education and safety for all families.

What I have been proposing for the past three years is to allow pharmacists to prescribe contraceptives for women 18 years and older, after taking a careful health history and recording a normal blood pressure. The patient is counseled about an appropriate type of birth control and given instructions about how to safely take it. Her health care provider is notified of her prescription, and she is given a list of providers if she does not have one. She is advised that these types of birth control do not protect against sexually transmitted diseases. No appointment is needed, and the service is offered whenever the pharmacy is open.

Planned pregnancies tend to be healthier pregnancies. Spacing between pregnancies helps women recover and give attention to her existing children. There is a workforce benefit. We know that — yet Indiana has an abysmal record of infant and maternal morbidity and mortality. Indiana has the shameful notoriety of being the worst state for deaths from child abuse. Is it so difficult to imagine that children who are born following a desired and planned pregnancy would be less likely to be injured or killed?

So please, fellow legislators, let’s visit again how we can increase a woman’s access to birth control. Don’t our babies deserve better?

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