Tennessee is a deeply Republican state—61 percent of voters there cast ballots for Donald Trump, and the GOP dominates the state legislature and governor’s mansion. Like many Republican-controlled states, Tennessee has recently been chiseling away at women’s access to abortion. In May, the state passed one of the most draconian abortion laws in the nation, requiring any woman seeking an abortion 20 weeks or more into her pregnancy to consult a physician to determine whether the fetus is viable.
So it might seem surprising that just a year earlier, Tennessee lawmakers had voted to ease access to contraception in the state by granting prescriptive privileges to pharmacists, allowing women to get a birth control prescription without spending time and money on a doctor’s visit.
In fact, the move wasn’t as anomalous as you might think. Even as the abortion debate remains as polarized as ever—with red states continuing to roll back abortion access—an understated strain of bipartisanship persists at both the state and federal level regarding birth control and family planning.
The Tennessee bill, sponsored by Republican state Senator Steve Dickerson, was signed by the governor in April 2016. “I saw that California and Oregon has passed similar legislation and thought it was worth looking into,” Dickerson, a practicing physician, told me between patients. Dickerson said his interest in facilitating access to birth control emerged from a concern about the risks of unplanned pregnancies, which include delayed or inadequate prenatal care, low birth weight, and a higher rate of maternal and infant mortality.
The Tennessee rule isn’t perfect. Not all pharmacists will be able to prescribe birth control, and patients must pay an annual administration fee to receive the pill directly from a pharmacy (though it’s still significantly less than the cost of a doctor’s visit.) The legislation hasn’t yet been implemented as it inches through the regulatory process.
For good reason, access to birth control has developed a reputation as a polarizing issue with clear partisan divisions. For years, the right has objected to Obamacare’s contraceptive mandate, which requires insurances plans to provide coverage for birth control. Rush Limbaugh famously denigrated Sandra Fluke, a law student at Georgetown who testified in Congress in support of the rule, as a “slut” and a “prostitute.” Mitt Romney’s campaign in 2012 described the contraceptive mandate as a “direct attack on religious liberty [that] will not stand in a Romney presidency.” Earlier this month, Trump followed through on Romney’s promise, announcing an executive order that allows employers with moral or religious objections to birth control to refuse contraception coverage in the insurance plans they provide to their employees.
Yet, despite the president’s announcement, promoting access to contraception isn’t just supported by liberals. 75 percent of adults, including 66 percent of Republicans, favor continuing the Title X Program, which supplies free or significantly discounted birth control to Americans making $30,000 or less. And 85 percent of adults believe the government should keep its current funding levels for the Teen Pregnancy Prevention Program and the Personal Responsibility Education Program (PREP), evidence-based initiatives that aim to reduce teen and unplanned pregnancy rates by helping adolescents delay sexual activity and promoting and improving the use of contraception.
Republican-dominated states like Georgia, Ohio, Tennessee, and West Virginia are using PREP funding for projects to target young people in the foster care and juvenile justice systems, demographics that are especially at risk for youth pregnancy and sexually transmitted diseases. Georgia uses its grant to provide information and resources on healthy sexual relationships and sexual health to foster caregivers; West Virginia has a similar program. Several Southern states, including Louisiana, Mississippi, and Alabama, have rewritten their state Medicaid policies to supply “Long-Acting Reversible Contraception” (LARC) methods like IUDs to women immediately after giving birth.
“Some of these programs are much less controversial than you might think when listening to debate in Washington,” said Andrea Kane, vice president of policy and strategic partnerships at the National Campaign to Prevent Teen and Unplanned Pregnancy, an advocacy organization.
In September, the U.S. Senate Appropriations Committee voted by a wide margin to sustain full funding for the Teen Pregnancy Prevention Program. This came two months after grantees were abruptly notified by the Department of Health and Human Services that funding would prematurely be revoked at the end of next year.
“The House eliminated funding for this program,” Kane said, “the Senate has restored it, and the Senate version has prevailed in every other past year. Obviously, this is not like every other year.” And while programs like those in Georgia, Ohio, and West Virginia are signs of progress, their survival is contingent on continued federal support.
The economic argument in favor of maintaining funding for the Teen Pregnancy Prevention Program and PREP is clear. According to the National Campaign, only about half of teen mothers achieve a high school diploma by the age of 22. For women who become mothers before they turn 18, it’s only about 10 percent. An overwhelmingly majority of teen mothers who move out of their family homes fall below the poverty line, which can lead to dependence on welfare programs like Medicaid and Temporary Assistance for Needy Families (TANF).
“I also did a little research and found that 30 to 50 percent of pregnancies in Tennessee are thought to be mistimed,” said Steve Dickerson, the Tennessee state senator. “This can be especially inconvenient for women who need to work, get pregnant unintentionally, and get pulled out of work prematurely at a time that might not be ideal for their family.” Birth control is as much an economic issue as it is a public health one.
Beyond Tennessee, some of America’s reddest states are already implementing programs and policies that facilitate access to birth control and promote practical sex education that goes beyond just advocating for abstinence. The real question is whether the Trump administration will listen to the evidence-based, bipartisan rationale for birth control going forward, or instead continue to appease the strain of the Republican Party that ignores its economic and public health benefits. Progress for women’s access to contraception will likely be stunted by this administration, but there’s hope that initiatives at the state level will fill the void. State legislators are still sometimes practical, even if our president isn’t.