Legislation would increase birth control access for postpartum women
For their own health, as well as for the health of the baby, women are generally advised by medical professionals to wait at least 12 months after giving birth before becoming pregnant again.
That means birth control for postpartum women is critical, since it is possible to get pregnant again within weeks of giving birth. Yet, hospitals in Nevada typically do not carry one of the most effective birth control options available.
Senate Bill 280, which on Tuesday received its first hearing in the Senate Committee on Health and Human Services, seeks to change that. It would require hospitals to have on hand intrauterine contraceptive devices, commonly known as IUDs, which birthing women can then request be inserted during their hospital stay. The bill would also require Medicaid and other insurers to cover the insertion of an IUD immediately after birth.
“Providers cannot place devices that are not available to them,” said Dr. Sandra Koch, an obgyn who presented the bill.
IUDs are a long-acting, reversible contraceptive (LARC) that can be inserted in a uterus and prevent pregnancy for upwards of a decade, depending on the type. They are 99% effective at preventing pregnancy and safe for women, including those who are currently breastfeeding.
Women who cannot access a LARC immediately after giving birth are forced to make separate appointments. It is a medically unnecessary delay that allows for new barriers to emerge — such as potentially having to find childcare for a newborn, getting additional time off work, or losing insurance because Medicaid coverage for pregnant women ends 60 days after they give birth.
Birth control simply may not seem like a priority for a new parent — even if it is.
Koch told lawmakers that 70% of pregnancies occurring in the first year after delivery were unplanned.
“It’s just very unfortunate,” she added. “These short interval pregnancies are at higher risk for preterm delivery and adverse neonatal outcomes.”
SB280 is supported by a variety of health care groups, including the Nevada Public Health Association, Nevada State Medical Association, Nevada Advanced Practice Nurses Association, and Planned Parenthood.
Dr. Tim McFarren, an obgyn, said in his support testimony that, while the federal Affordable Care Act and state legislation in Nevada have attempted to make LARCs accessible at no cost, insurance companies found a loophole by only covering it only as an outpatient service and not as part of an inpatient care.
“This is denying women access to long-acting contraceptives,” he added.
SB280 was overall warmly received by the committee, but there are some concerns about the feasibility of implementing it in rural counties.
The Nevada Rural Hospital Partners is opposed to the bill as introduced. Joan Hall, the alliance’s president and a registered nurse, described the position as “sadly opposed” and emphasized that she believes in the premise.
Only three of Nevada’s 13 rural hospitals have obstetrics units, she testified, meaning births at other rural hospitals are happening at emergency rooms.
“I’m not sure it would be safe for the ER providers to do the insertion (of an IUD),” said Hall.
State Sen. Robin Titus, a longtime rural doctor, expressed similar concerns, adding that she “conceptually supports” the bill but believes it might be unreasonable to expect IUD placement to be handled by a physician assistant “who has never caught a baby before” but just did because a rural setting demands it.
Hall suggested amending the bill so it only applies to hospitals with obstetrics units.
State Sen. Rochelle Nguyen, the bill sponsor, acknowledged early in the hearing that the legislation needs additional fine tuning, but added she wanted lawmakers to “have the policy discussion.” She suggested one path forward might be to expand the bill’s scope beyond IUDs and include birth control options like implants or shots to give doctors some flexibility.
Added Nguyen, “I will say, we would love for it to be in these rural communities where there is a lack of access to health care.”