Iowa U.S. Rep. Ashley Hinson recently unveiled a companion bill in the House to expand access to over-the-counter oral contraception as Republicans seek to beat back what they see as “fearmongering” in the wake of controversial abortion and in vitro fertilization court rulings.
It comes amid a growing partisan clash over reproductive rights in the United States in the wake of a 2022 U.S. Supreme Court decision overturning a federally protected right to abortion.
Senate Republicans over the past two weeks have blocked Democratic-led efforts to provide nationwide protections for birth control access and federal protections for in vitro fertilization.
Iowa’s U.S. Sens. Joni Ernst and Chuck Grassley joined GOP colleagues Thursday to block the Democratic-led bill prohibiting states from imposing restrictions on IVF and making it more affordable.
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Republicans, who maintain they are supportive of IVF and access to over-the-counter birth control for adult women, said the provisions were too broad and prefer narrower bills.
On Wednesday, Senate Republicans offered their own legislation that would ban states from getting access to Medicaid funding if they bar IVF services.
The GOP senators signed a statement accusing Democrats of waging “a partisan campaign of false fearmongering intended to mislead and confuse the American people.”
“We strongly support continued nationwide access to IVF, which has allowed millions of aspiring parents to start and grow their families,“ Ernst and other senators said in the statement.
Hinson
‘Legal in 50 states’
Hinson, speaking to reporters Friday, said there is no risk to contraception, and said Democrats were trying to politicize the issue.
“It is legal in all 50 states,” she said.
Several states, though, have restricted access to contraception by defining abortion broadly enough to include some forms of contraception, allowing health care providers to refuse to provide services related to contraception based on their personal beliefs and blocking abortion providers from publicly funded family planning services that offer birth control pills, pelvic exams, pregnancy tests and other related services.
Iowa Republican Attorney General Brenna Bird recently lifted a 17-month pause on reimbursements for emergency contraceptives for victims of sexual assault after conducting a review of the office’s victim services program. The office will resume covering those expenses for victims, but the state will not pay for abortions.
Democrats, too, argue legislation is needed because the U.S. Supreme Court cannot be trusted to uphold its precedent on protecting the use of contraceptives in the 1965 case Griswold v. Connecticut.
They note that when the court invalidated federal abortion rights in 2022, Justice Clarence Thomas wrote separately that the court “should reconsider” other precedents like Griswold.
Companion bills
Hinson, of Marion, recently introduced the Allowing Greater Access to Safe and Effective Contraception Act in the House, which seeks to increase the availability of birth control options on the market.
Ernst introduced the bill in the Senate last week. Grassley and Iowa Republican U.S. Rep. Mariannette Miller-Meeks, R-Ottumwa, signed on as co-sponsors of the legislation in the House and Senate.
- Allow over-the-counter purchase of FDA-approved, routine-use birth control pills for women ages 18 and older. It would not grant the speedy approval process to emergency contraception like Plan B.
- Allow the Food and Drug Administration to more quickly approve applications for oral contraceptive drugs that can be purchased without a prescription.
- Require the Government Accountability Office to conduct a study of federal spending on contraception, provider training and patient education in the last 15 years.
“Millions of American women safely use these drugs, and it’s just common sense to ensure adult women can access oral contraceptives at their local pharmacy,” Hinson said Friday. “This is especially important for women who live in rural areas and may have to drive an hour or more to see their doctor.”
Democrats and reproductive rights advocates contend the bill would do nothing to improve the accessibility of over-the-counter birth control, as it does not address insurance coverage and an over-the-counter birth control pill already exists.
There is one daily oral contraceptive that has gained FDA approval for purchase without a prescription, which became available this year.
Hinson said there should be more options for women seeking birth control.
“My bill is focused on speeding up the FDA approval process, which would help increase options on the market, which will lower costs for women,” she said. “So this does not impact someone’s ability to access birth control using their insurance. Plain and simple, they can already use their insurance to do this.”
Democrats, however, note oral contraceptives are not the best form of birth control for everyone and that access to the full range of contraceptive methods, devices and medications — including oral and emergency contraceptives — is important, including for teenagers. The age of consent in Iowa is 16.
“We are focused on making sure adult women can access this because there can be challenges with younger patients, and we want to make sure women are consulting with their doctors,” Hinson said. “But, again, this is about making it as easy as possible for women, no matter what their ZIP code is, to have access to these medications.”
Election issue
Hinson, who is running for re-election to a third term representing northeast Iowa’s 2nd Congressional District, told reporters it’s her hope the legislation puts to rest any accusations from Democrats that Republicans seek to ban contraception.
Democrats have made access to abortion and reproductive care a central issue in the upcoming November election, warning access to contraception and IVF are at risk due to the conservative-led Supreme Court’s decision reversing federal abortion rights.
They point to court rulings in Alabama and Arizona that placed possible roadblocks to women’s reproductive health regarding IVF and abortion, respectively.
The Alabama Supreme Court ruled in February that frozen embryos can be considered children under state law. The ruling prompted providers to halt fertility treatments. Alabama state lawmakers later approved a bill to protect IVF in the state.
Many congressional Republicans, including Hinson and Miller-Meeks, have signed on to legislation that would give a fertilized egg the rights of a person.
Reproductive rights advocates worry such laws could result in criminalizing actions perceived to threaten fertilized eggs, including the use of contraceptive methods people wrongly believe prevent the implantation of a fertilized egg, such as oral emergency contraceptives and intrauterine devices (IUDs).
“My goal is to make sure women can access affordable birth control over the counter,” Hinson said. “And if (Democrats) were more focused on actually solving that problem, instead of creating fear for women, we could work together on these issues and get these bills across the finish line.”
Caleb McCullough of the Lee Des Moines Bureau contributed to this report.
IVF: What to know after Alabama frozen embryo ruling
What is IVF?
Pictured: An embryologist works on a petri dish Aug. 14, 2013, at the Create Health fertility clinic in London.
In vitro fertilization offers a possible solution when a woman has trouble getting pregnant. It involves retrieving her eggs and combining them in a lab dish with a man’s sperm to create a fertilized embryo, which is then transferred into the woman’s uterus in an attempt to create a pregnancy.
IVF is done in cycles and may take more than one to create a successful pregnancy, according to The American College of Obstetricians and Gynecologists. The procedure can use a couple’s eggs and sperm or those from a donor.
How are embryos made?
Pictured: An embryologist works with an embryo Aug. 14, 2013, at the Create Health fertility clinic in south London.
The treatment often uses hormones to trigger ovulation so multiple eggs are produced and a needle is used to remove them from the ovaries, the American College of Obstetricians and Gynecologists said.
Eggs can be fertilized by adding the sperm to the eggs in a lab, or a single sperm can be injected into each egg.
“We culture that fertilized egg over a period of time — usually five to six days — to create developmental stages called the blastocyst. And those are either transferred or stored for future use,” said Dr. Jason Griffith, a reproductive endocrinologist in Houston.
A blastocyst is the early stage of an embryo, which is defined as the state of development that starts at fertilization and lasts up to eight weeks.
Griffith said that on Day 3 after fertilization, an embryo is anywhere from six to 10 cells. By Day 6, it’s between 100 and 300 cells.
“So you’re talking about something that’s still microscopic,” he said, adding that a person contains more than a trillion cells.
How are embryos frozen and stored?
Pictured: Containers holding frozen embryos and sperm are stored in liquid nitrogen Oct. 2, 2018, at a fertility clinic in Fort Myers, Fla.
The freezing process involves replacing the water in embryo cells with a protectant fluid and flash freezing with liquid nitrogen, according to Johns Hopkins Medicine. Frozen embryos can be used for future pregnancies, and the vast majority survive the thawing process.
Frozen embryos are stored in tanks containing liquid nitrogen at hospital labs or reproductive medicine centers. Griffith said they can also be kept in storage facilities that health care facilities contract with, especially when they are stored for many years. Frozen embryos can be safely preserved for a decade or more.
Griffith said conditions are monitored in these facilities and there are physical security mechanisms to safeguard the tanks and backup generators in case of power outages.
Dr. John Storment, a reproductive endocrinologist in Lafayette, Louisiana, said his state has a unique law that prohibits doctors from discarding any viable embryos that are still dividing — meaning they must be preserved and stored. So he and other doctors ship embryos out of state to a secure storage facility once a patient has finished using them for a particular IVF cycle.
“Whenever they’re ready for embryos again, they can just ship them back here,” he said. “But we don’t keep them stored here.”
In other states, he said, patients can choose to use them, discard them or donate them to other couples or for research.
What’s next?
Pictured: A container with frozen embryos and sperm stored in liquid nitrogen is removed Oct. 2, 2018, at a fertility clinic in Fort Myers, Fla.
Lawmakers began scrambling for ways to protect Alabama in vitro fertilization services after multiple providers paused treatment in the wake of a state Supreme Court ruling that frozen embryos could be considered children under a state law.
Facing a wave of shock and anger from the decision, legislators prepared separate proposals in the House and Senate that would seek to prevent a fertilized egg from being recognized as a human life or an unborn child under state laws until it is implanted in a woman’s uterus.
Senate Minority Leader Bobby Singleton, a Democrat, said Republicans helped create the situation in their push to enact some of the most stringent anti-abortion laws in the country. The result, he said, was eliminating a path for people to become parents.
Former President Donald Trump joined the calls for Alabama lawmakers to act and said he would “strongly support the availability of IVF.”
State Republican lawmakers said they were working on a solution.
Alabama Gov. Kay Ivey said the state wants to foster a culture of life and that includes “couples hoping and praying to be parents who utilize IVF.”
Alabama Attorney General Marshall does not intend to prosecute IVF providers or families based on the state Supreme Court ruling, Chief Counsel Katherine Robertson said in a statement.
What happens to embryos after divorce?
Pictured: An embryologist uses a microscope Oct. 3, 2013, to view an embryo, visible on a monitor, right, in New York.
Currently, they could remain in storage indefinitely. Many embryos do — for myriad reasons.
Even before the Alabama ruling, what to do with embryos that are not implanted was a conundrum, including for people who used IVF to become parents.
Some can’t bring themselves to donate embryos for research or have them destroyed – and don’t want to continue paying storage fees. Thousands are abandoned in clinic freezers already.
What happens as a result of the new ruling is murky, said Rachel Rebouche, dean of the Temple University Beasley School of Law in Philadelphia. She noted that employers sometimes pay to store embryos for employees.
“If you’re in Alabama, is that benefit now meaningless,” she asked, “because if you choose not to implant those embryos, you’re going to be accused of a tort?”
One movement calls for people who don’t plan to use embryos for further pregnancies to do what they call “compassionate transfer” and implant them into women’s uteruses at a time when the pregnancy is unlikely to occur.
How could the Alabama ruling affect IVF?
Pictured: Embryologist Rick Slifkin demonstrates fertilization techniques on a nonviable embryo Oct. 11, 2013, at Reproductive Medicine Associates of New York, in New York.
The U.S. Supreme Court’s decision to overturn Roe v. Wade in 2022 sparked speculation about how the ruling could lead to problems with fertility care, said Greer Donley, an associate professor at the University of Pittsburgh School of Law.
“This is one of the first places that is proving that,” she said.
Donley expects that IVF will remain available in Alabama but embryos will not be stored there. And moving them to other states for storage will increase the cost, logistical challenges and risk associated with the procedures.
“This opens up the possibility of using the child welfare laws more holistically for criminalizing doing anything that could harm the embryo,” Donley said.
Donley said that push could continue: “The future the anti-abortion movement wants to see is one in which fetuses have federal constitutional protections from the moment of conception.”
Since 2022, four states have amended their constitutions to protect access to abortion, and several others are considering ballot measures for this year. In many, the language goes beyond allowing abortion to give people rights to reproductive freedom more broadly, which could ensure access to IVF.
What are doctors’ concerns?
Pictured: The Alabama Supreme Court building is seen Feb. 20, 2024, in Montgomery, Ala.
Doctors outside Alabama are worried about possible national implications of the recent court decision.
It could “substantially restrict access to a very vital fertility treatment that has helped countless folks today expand their families,” said Dr. Jason Griffith, a reproductive endocrinologist in Houston. “When you look at the percentage of pregnancies in the United States that result from in vitro fertilization, it’s around 2%.”
It could also increase the cost of IVF for many families — although it’s unclear by how much — because of things like additional storage fees and liability costs, he said. One cycle of IVF, including all embryos transferred, now costs about $15,000 to $25,000, Griffith said.
Another possible ramification is fewer IVF providers, with Storment noting that fertility doctors may not want to move to or stay in Alabama.
“I don’t think that any doctor knowing that there’s a potential for criminal prosecution would even want to be in that position,” he said. “There’s 49 other states and many other countries they could practice in without the same threat.”
He said he “certainly hopes” Alabama changes its stance on this issue.
“We hope that more common sense prevails and they change the law. But if it doesn’t, I don’t see anybody doing IVF in Alabama,” he said. “I know a doc — a friend of mine who’s in Alabama — and he called me and he asked me, ‘Are you hiring?’ I’m like, ‘Yeah, but I don’t know if Louisiana is the most progressive state to move to, either.’”
Dr. John Storment, a reproductive endocrinologist in Lafayette, Louisiana, said the Alabama decision could have a ripple effect across the entire country.
“It’s one of the bigger things to happen in reproductive law in the last decade,” he said.
What about church-state separation?
Pictured: Alabama Supreme Court Justice Tom Parker speaks April 5, 2006, on the steps of the state judicial building in Montgomery, Ala.
When the Alabama Supreme Court ruled that frozen embryos are considered children under state law, Chief Justice Tom Parker had a higher authority in mind.
By citing verses from the Bible and Christian theologians in his concurring opinion, Chief Justice Tom Parker alarmed advocates for church-state separation, while delighting religious conservatives who oppose abortion.
Human life, Parker wrote, “cannot be wrongfully destroyed without incurring the wrath of a holy God, who views the destruction of His image as an affront to Himself.”
While Parker’s Christian theology-based concurring opinion does not carry the force of precedent, advocates for church-state separation fear he could inspire judges in other states to push the envelope.
“Now we’re in a place where government officials feel emboldened to say the quiet part out loud, and directly challenge the separation of church and state, a foundational part of our democracy,” said Rachel Laser, CEO of Americans United for Separation of Church and State.
THE ROOTS OF A RULING
The Alabama court’s ruling that frozen embryos are children is an extension of the ideology that undergirds the anti-abortion movement, said Mary Ziegler, a historian of the abortion debate and a law professor at the University of California, Davis.
And it points to the influence of the conservative Christian legal movement, she said. Namely, its position “that the U.S. has an intrinsically Christian Constitution” — a notion that Ziegler and many historians reject.
‘VICTORY FOR LIFE’
Some anti-abortion activists rejoiced at the ruling.
It’s “a tremendous victory for life,” said the powerful Christian legal firm Alliance Defending Freedom. “A beautiful defense of life,” said Tony Perkins, head of the Family Research Council.
The Liberty Counsel filed a notice with the Florida Supreme Court, saying the Alabama decision — including Parker’s concurrence — should be factored into a pending decision about a proposed amendment to the state constitution that would protect abortion rights.
Still, Christian perspectives on IVF are mixed, and in some cases, undecided.
While the Catholic Church condemns such reproductive technology as immoral, many Protestant churches and denominations do not have a firm stance against the practice.
JUSTICE PARKER’S MISSION
Parker is no stranger to church-state debates.
He served as former Alabama Chief Justice Roy Moore’s spokesperson during fights over a Ten Commandments monument Moore erected inside the building housing the Supreme Court.
Parker is a member of Frazer Church, a Montgomery megachurch that until 2022 was part of the United Methodist Church. The congregation, which left amid a UMC schism over the denomination not upholding its LGBTQ clergy and marriage bans, is now part of the Free Methodist Church, a more conservative denomination.
Neither United Methodists nor Free Methodists specifically condemn IVF in their church doctrines. The Free Methodist Book of Discipline emphasizes the value of human life at all stages. It notes that reproductive technologies raise many “ethical, medical, legal and theological questions even as they offer hope.”
Parker was the founding executive director of what is now called the Alabama Policy Institute, which is associated with the evangelical ministry Focus on the Family. On its website, Focus on the Family recommends that married couples not freeze or discard embryos created during IVF.
Fertility experts say IVF without the option of frozen embryos would likely increase the costs of fertility treatments and reduce the chances for patients trying to have a baby.
