Nikki Haley wants ‘consensus’ on contraception. It’s not that easy.

Nikki Haley seeks a GOP “consensus” on birth control that is increasingly hard to find

Nikki Haley, the last candidate standing between Donald Trump and the GOP presidential nomination, insists that being “unapologetically pro-life” doesn’t make her anti-birth control.

“Let’s find consensus,” she urged at a GOP presidential debate in November. “Let’s make sure we make contraception accessible.” 

If only consensus were that easy. In some conservative circles, contraception is nearly as controversial a topic as abortion. And since the fall of Roe v. Wade almost two years ago, calls from the fringes of Haley’s party to also restrict birth control have gotten louder. Haley’s campaign did not respond to requests for comment.

At the same time, support for birth control remains strong among Democratic, Republican and independent voters, according to pollster and former Trump adviser Kellyanne Conway. Conway was among the GOP strategists pressing Republicans last year to adopt a pro-birth control message.

The modern antiabortion movement was launched in the United States in the late 1960s, led mostly by the Catholic Church, which opposes both abortion and most birth control. But it was in the late 1990s and early 2000s when conflation of the two issues began, said Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association, which represents publicly funded family planning organizations around the nation.

“So now if you oppose abortion you effectively oppose contraception, too,” she said.

Some of that reflected confusion. In 1998, the Food and Drug Administration approved the first “morning after” pill, a regimen of high-dose birth control pills that can prevent pregnancy if taken soon enough after sex. In 2000, just before President Bill Clinton left office, the FDA approved the abortion pill mifepristone, which — unlike the morning-after pill — can end an established pregnancy in its early stages.

The two medicines are regularly confused 2½ decades later, even though the FDA in 2022 changed the label on the most common morning-after pill to emphasize that it does not cause abortion.

Contraception has also come under increased fire due to the federal Title X family planning program, which provides low-cost birth control, sexually transmitted infection testing and treatment, and other preventive services at more than 3,000 clinics nationwide. While Title X funds have never been allowed to be used for abortion, among its main grantees for decades have been Planned Parenthood affiliates, some of which provide abortion services (using nonfederal funds).

Planned Parenthood’s participation helped make Title X such a target for antiabortion forces that Congress has not formally reauthorized the program since 1985. Funding has continued in annual appropriations bills, but at declining levels. 

Fights over the program have been heated. The Supreme Court ruled in 1991 that a Reagan-era regulation could require federally funded Title X clinics to stop referring patients for abortion, but the rule never took full effect. Former president Donald Trump imposed a regulation to effectively kick Planned Parenthood out of the Title X program. The rule was reversed by the Biden administration in 2021.

Not all the controversy over birth control has been directly attributable to abortion, however. In the mid-2000s, some pharmacists began to refuse to fill prescriptions for morning-after pills, and even regular birth control methods, because they said providing the medications violated their beliefs. In some cases, pharmacists refused to return written prescriptions to patients, making it harder to get the medications elsewhere.

But those fights were skirmishes compared with the conflagration over language in the Affordable Care Act requiring insurance companies to cover FDA-approved contraception at no upfront cost to patients.

Although churches and other religious entities were not subject to the mandate, and the Obama administration altered rules numerous times so religiously affiliated entities such as schools and hospitals would not have to directly pay for contraception, there were at one point more than 100 separate lawsuits making their way through federal courts.

Eventually, the Supreme Court ruled that not only are religiously affiliated entities exempt from the mandate, but also some private firms could refuse to cover birth control over religious objections.

Fast-forward to 2024. Efforts to establish in state or federal law that life begins at conception — known as “personhood” legislation — would redefine many forms of contraception, including IUDs and many birth control pills, as murder. Late last week the Alabama Supreme Court ruled that frozen embryos are “persons” and those who destroy them can be held liable for their demise.

“Embryos, to me, are babies,” Haley said in response to the ruling during an interview with NBC News yesterday. 

Even some Republicans who don’t outright promote the fallacy that contraceptives cause abortion have questioned the value of birth control.

“Widespread use of contraception has in my view come with a cost,” Hadley Heath Manning of the conservative Independent Women’s Forum wrote in the New York Times last summer, “facilitating a culture of cheap sex that has created mass confusion, pain and regret in the world of dating and family formation.”

So much for consensus.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling and journalism.

On the Hill

Freedom Caucus pushes for update on spending fight

The House Freedom Caucus is turning up the heat on Speaker Mike Johnson (R-La.) as the country barrels toward a partial government shutdown next month. 

In a letter yesterday, the contingent of far-right Republicans urged Johnson to embrace a year-long stopgap measure that would trigger a 1 percent across-the-board spending cut. The lawmakers also asked for an update on the status of nearly two dozen culture-war-style policy riders they want included in spending negotiations. 

The health policy items mentioned would gut the Pentagon’s abortion travel fund, strip federal resources from Planned Parenthood and prohibit funding for coronavirus vaccine and mask mandates across the federal government, among other provisions. Notably, the list doesn’t include a federal ban on the delivery of abortion pills by mail — a policy hard-liners pursued for months. 

The House Freedom Caucus:

In other news from the lower chamber …

Democrats on the House Oversight and Accountability Committee are intensifying their scrutiny of drug companies, seeking information on their efforts to alleviate nationwide shortages of medications crucial for treating cancer, attention-deficit/hyperactivity disorder and bacterial infections.

In letters spearheaded by ranking Democrat Jamie Raskin (Md.), the lawmakers pressed manufacturers to disclose when they became aware of the shortages, detail the measures they’ve taken to boost supplies and outline their strategies for averting future crises. The recipients include:

• Pfizer, a major manufacturer of three generic oncology drugs.
• Teva, one of the largest producers of Adderall, a stimulant medication.
• Sandoz, a leading manufacturer of the antibiotic amoxicillin.

The Democrats asked for a staff briefing on the issue by March 6. The drugmakers did not respond to a request for comment. 

Reproductive wars

Alabama hospital pauses IVF treatments following court ruling

Alabama’s largest health-care system has paused IVF treatments after the state supreme court ruled that frozen embryos are children, Kim Chandler reports for the Associated Press. 

The University of Alabama at Birmingham said it must evaluate whether its patients or doctors could face criminal charges or punitive damages for undergoing IVF treatments. In a statement yesterday, Alabama’s Medical Association warned that other health systems are likely to follow its lead. 

Key context: The Alabama Supreme Court’s decision last Friday prompted a wave of concern about the future of women’s reproductive health care in a state that already has one of the nation’s strictest abortion laws. 

The Post’s Maham Javaid and Kim Bellware, meanwhile, report that IVF doctors across Alabama met virtually Tuesday night to discuss the ramifications of last week’s decision. 

We’re watching to see if the ruling will have a ripple effect nationally. Legal experts say the decision could embolden the “personhood movement,” which asserts that unborn children should be granted legal rights beginning at conception. 

Health and Human Services Secretary Xavier Becerra:

Meanwhile, in Virginia …

Gov. Glenn Youngkin (R) says he remains committed to seeking limits on abortion access — even after his embrace of the issue seemed to work against Republicans in last fall’s legislative elections, The Washington Post’s Gregory S. Schneider reports. 

Youngkin’s remarks came during a “March for Life” yesterday outside the Virginia Capitol with hundreds of abortion protesters. He declined to comment on several bills aimed at protecting abortion rights making their way to his desk from the Democratic-controlled General Assembly. 

In other health news

• The FDA is warning consumers to avoid smartwatches and rings that claim to measure blood sugar levels without piercing the skin, saying the devices are unauthorized and could produce inaccurate results that lead to errors in diabetes management. 
• On the move: The Pharmaceutical Research and Manufacturers of America has tapped Gilead Sciences CEO Daniel O’Day to serve as chair of its board of directors. He will replace Novartis chief Vas Narasimhan, who held the position for most of last year. 
• On the move: The American Dental Association is on the hunt for a new senior vice president following the retirement of Mike Graham, who will transition to the role of executive director at the American College of Dentists next month, a spokesperson told The Health 202. 

Health reads

Study of patients with a chronic fatigue condition may offer clues to long covid (By Pam Belluck | The New York Times)

Meet the fetal surgeon forging CRISPR’s next frontier: Curing diseases in the womb (By Megan Molteni | Stat)

More dermatologists are offering skin-care services for people of color (By Marlene Cimons | The Washington Post)

Sugar rush

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