NEWS: Sexual and reproductive health: trends in the states (1st quarter 2016)
Trends in the States: First Quarter 2016
First published online: April 13, 2016
State legislatures came into session in January and quickly focused on a range of sexual and reproductive health and rights issues. By the end of the first quarter, legislators in 45 states had introduced 1022 provisions. Of the 411 abortion restrictions
that have been introduced so far this year, 17 have passed at least one chamber and 21 have been enacted in five states (FL, IN, KY, SD and UT).
This year’s legislative sessions are playing out on a crowded stage. The U.S. Supreme Court is considering a case involving a package of abortion restrictions in Texas; that decision, when handed down
in June, could reshape the legal landscape for abortion at the state level. Moreover, just as the state legislatures were hitting their stride in late March, the U.S. Food and Drug Administration revised the labeling for mifepristone, one of the two drugs
used for medication abortion. That decision immediately put the issue back on the front burner by effectively counteracting policies
restricting access to medication abortion in a handful of states. (Notably, the Arizona legislature moved within days to enact a measure limiting the impact of the FDA decision in the state.)
Progress on Several Fronts
Despite the ongoing attention to restricting abortion, legislators in several states are looking to expand access to sexual and reproductive health services and education. By the end of the first quarter,
legislators in 32 states had introduced 214 proactive measures; of these, 16 passed at least one legislative body and two have been enacted. (This is nearly the same amount as was introduced in all of 2015, when 233 provisions were introduced.)
Although the proactive measures introduced this year span a wide range of sexual and reproductive health and rights issues, three approaches have received particular legislative attention:
Allowing a 12-month contraceptive supply. Legislators in 16 states have introduced measures to allow pharmacists to dispense a year’s supply of contraceptives
at one time; these bills would also require health plans to reimburse for a year’s supply provided at once. (In addition, a bill pending in Maryland would cover a six-month supply.) Legislative chambers in three states (HI, NY and WA) have approved measures.
Similar measures are in effect in Oregon and the District of Columbia.
Easing contraceptive access through pharmacies. Legislators in 12 states have introduced measures to allow pharmacists to prescribe and dispense
hormonal contraceptives. As of March 31, bills have been approved by at least one legislative chamber in Hawaii and Iowa and enacted in Washington. The measures in Hawaii and Iowa would require pharmacist training, patient counseling and coverage by insurance;
the Hawaii measure would apply only to adults, while the Iowa measure would apply to both minors and adults. The new Washington law directs the Pharmacy Quality Assurance Commission to develop a notice that will be displayed at a pharmacy that prescribes and
dispenses self-administered hormonal contraception. Under current state law, a pharmacy may prescribe and dispense these contraceptives under a collaborative practice agreement with an authorized prescriber. Oregon has a similar measure in effect. (California,
the only other state with a law, issued regulations in early April.)
Expanding education on sexual coercion. Measures are pending in 17 states to incorporate education on dating violence or sexual assault into the
sex or health education provided in the state. A bill has been approved by one legislative chamber in New Hampshire and in New York. The measure approved by the New Hampshire Senate would require age-appropriate education on child sexual abuse and healthy
relationships for students from kindergarten through grade 12. The measure approved by the Senate in New York would mandate education on child sexual abuse for students from kindergarten through grade 8. And finally, in March, Virginia enacted a comprehensive
new law requiring medically accurate and age-appropriate education on dating violence, sexual assault, healthy relationships and the importance of consensual sexual activity for students from kindergarten through grade 12. Virginia will join 21 other states
that require instruction on healthy relationships (Sex and HIV Education).
Ongoing Assault on Access to Sexual and Reproductive Health Services
Even as many legislators are working to expand access to services, others are continuing their now years-long assault on sexual and reproductive health services and rights. Restricting access to abortion
continues to garner significant attention. However, last year’s release of a series of deceptively edited sting videos targeting Planned Parenthood has swept both the family planning safety net and biomedical research involving fetal tissue into the fray.
Abortion bans. Legislative attempts to ban abortion fall along a broad continuum, from measures that seek to ban all or most abortions to those
aimed at abortions performed after the first trimester of pregnancy or those performed for specific reasons.
Banning all or most abortions. Legislators in nine states have introduced measures to ban all or most abortions in the state, generally by either granting
legal personhood to a fetus at the moment of conception or prohibiting abortions at or after six weeks of pregnancy. Only one of these measures, a bill in Oklahoma that would put performing an abortion outside the bounds of professional conduct by a physician,
has been approved by a legislative chamber.
Banning D&E abortions. Legislators in 13 states have introduced measures to ban the most common technique used in second-trimester abortions.
Of these, a bill in West Virginia was enacted in March over the veto of Gov. Earl Ray Tomblin (D) and a similar measure was approved by both houses of the Mississippi legislature and is being considered by a conference committee. (Kansas and Oklahoma enacted
similar laws last year, but enforcement of both has been blocked by court action.)
Banning abortion at 20 weeks postfertilization. South Dakota and Utah both enacted measures seeking to block abortions at 20 weeks during the first quarter
of the year. The new South Dakota law explicitly bans abortions at 20 weeks postfertilization (which is equivalent to 22 weeks after the woman’s last menstrual period). The Utah measure requires the use of anesthesia for the fetus when an abortion is performed
at or after that point, something that providers would be extremely unlikely to do because of the increased risk to the woman’s health. In addition to these new measures, 12 other states ban abortion at 20 weeks postfertilization (seeState
Policies on Later Abortions).
Banning abortion for specific reasons. In March, Indiana enacted a sweeping measure banning abortions performed because of gender, race, national origin,
ancestry or fetal anomaly; no other state has adopted such a broad measure. The Oklahoma House approved a measure to ban abortion in the case of a fetal genetic anomaly; the state already bans abortion for purposes of sex selection. Currently, seven states
ban abortion for the purpose of gender selection, including one state that also bans abortion based on race selection and one that also bans abortion due to fetal genetic anomaly (seeAbortion
Bans in Cases of Sex or Race Selection or Genetic Anomaly).
Family planning funding restrictions. In the wake of the Planned Parenthood videos, several states have sought to limit funding to family planning
health centers that provide or refer for abortion or that are affiliated with abortion providers. These efforts are taking different forms across states.
Medicaid. Measures to exclude abortion providers (e.g., Planned Parenthood affiliates) from participating in Medicaid have been introduced in five states, despite the clear position of the federal
Centers for Medicare and Medicaid Services that such exclusions are not permitted under federal law. In March, Florida Gov. Rick Scott (R) signed a Medicaid restriction into law. By the end of the first quarter, measures had passed one chamber of the legislature
in Arizona, Mississippi and Missouri; a measure introduced in Washington has not been considered. (A related measure enacted in Wisconsin in February limits reimbursement for contraceptive drugs for Medicaid recipients.)
Similar attempts by six other states have been blocked by court action since 2010. These measures include laws adopted by Indiana and Arizona as well as administrative actions taken in Alabama, Arkansas, Louisiana and Texas.
Other family planning funds. Legislators in 13 states have introduced measures to prevent state or federal funds that flow through state agencies from being distributed to organizations that provide,
counsel or refer for abortions; the measures would also deny funds to any organization that is affiliated with an entity engaging in these activities. Of these, measures in three states have received significant legislative attention. In February, Wisconsin
enacted a measure directing the state to apply for Title X funds (the state is not currently a grantee under the program); if the state’s application were approved, the measure would ban this funding from going to organizations that engage in abortion-related
activity. A measure that would deny funds to organizations engaged in abortion-related activity passed the Kentucky Senate in February. A similar measure in Virginia, which would both prohibit an abortion provider from receiving funding and give priority to
public entities (such as health centers operated by health departments) in the allocation of state family planning funds was vetoed by Gov. Terry McAuliffe (D) in March.
Related funds. In February, Ohio Gov. John Kasich (R) signed a measure barring abortion providers or their affiliates from receiving federal funds passing through the state treasury to support
breast and cervical cancer screening and sex education as well as efforts to prevent infertility, HIV in minority communities, violence against women and infant mortality.
Fetal tissue research. The Planned Parenthood videos have also led to legislation in 28 states aimed at research involving fetal tissue. Measures
have passed one legislative chamber in four states (AL, IA, ID and KY), and new laws have been enacted in four states (AZ, FL, IN and SD) in the first quarter alone. All four laws ban the donation of fetal tissue for purposes of research. These new laws are
the first to ever ban the donation of fetal tissue (see Fetal Tissue Research:
A Weapon and a Casualty in the War Against Abortion). The Arizona law also bans research using fetal tissue and the new South Dakota law strengthens the state’s existing
ban by now considering fetal tissue research as a felony; four other states (Indiana, North Dakota, Ohio and Oklahoma) have similar provisions in effect.