Sex ed, birth control, Medicaid: Republicans’ ‘new pro-life agenda’

Republicans in staunchly conservative states are championing some atypical legislation this session — promoting sex education, government welfare and more birth control.

The proposals are part of what some governors and lawmakers have referred to as a “new pro-life agenda” for the post-Roe era — one that is increasingly breaking with their party’s socially conservative approach to maternal and reproductive health in favor of one more commonly pushed by Democrats.

The flurry of legislation stands to extend health insurance to tens of thousands of low-income people, boost access to contraception and rethink how sex is discussed in public schools. And it could help Republicans soften their image with moderate voters now that abortion is illegal in nearly all circumstances in a quarter of the country and after the issue helped Democrats win several key midterm races.

In Iowa, Republican Gov. Kim Reynolds is pushing legislation to allow pharmacists to dispense hormonal contraceptives without a prescription. Indiana and Oklahoma are advancing similar GOP-sponsored bills.

In Indiana and South Carolina, Republican lawmakers proposed lawmakers proposed bills that would require comprehensive, medically accurate sex ed to be taught in the states’ schools starting in grade 5 or 6 — instead of their current abstinence-based approach.

And in Wyoming and Mississippi — two of the 10 states that have not expanded Medicaid — Republican Govs. Mark Gordon and Tate Reeves recently signed 12-month extensions of Medicaid postpartum benefits into law, in what Reeves referred to as a “philosophically uncomfortable” move that overcame fierce conservative opposition to boosting government welfare.

“What I can tell you is that the governor was more vocal in his support for [postpartum extension] and was much more outwardly supportive of this idea in the wake of the Dobbs decision,” said Gordon spokesperson Michael Pearlman. “He is a pro-life governor and supports life, but Governor Gordon wanted to emphasize that being pro-life, to him, goes beyond simply being pro-birth.”

Some GOP-controlled states embraced these policies before the fall of Roe v. Wade last summer, and Republicans argue there isn’t anything inherently liberal about them.

“The most important thing for people to realize is we need to be pro-life and not just pro-birth. That means investing in our families. That means taking a more meaningful approach to policy and forget about the politics. Let that go out the window and let’s actually do things that help people have successful families,” said Oklahoma state Sen. Jessica Garvin, a Republican who sponsored two birth control bills this year that passed the state Senate last week. “If we’re going to say we can’t have abortion for women in Oklahoma, what are we going to do to help support these women that can’t have an abortion?”

Some Democrats chafe at Republicans for taking credit for proposals they have long supported, particularly those aimed at underserved communities.

“This has been a long time effort specifically led by Black women in the legislature,” said Florida Democratic Rep. Anna Eskamani. “Republicans are trying to give off the impression that they’re championing issues for women and families while they strip away our bodily autonomy and rights.”

And while some maternal health advocates welcome the growing number of conservatives backing these policies, they also argue that these broader maternal and reproductive health policies can’t undo the harm being caused by the lack of abortion access in these states.

“In my career — I’m in my mid-40s — I can probably count on one hand Republicans that have been out in front on access to contraception,” said Jamila Taylor, president and CEO of the National WIC Association and a longtime women’s health advocate. “So yes, we are pleased with some of the progress that we’re seeing even in red states, but that’s never going to replace the need or, quite frankly, our fight to ensure abortion rights in this country.”

‘A good thing’

Anti-abortion groups said they are happy to see lawmakers introduce legislation focused on helping families and have endorsed some of these policies, such as postpartum Medicaid extension, alongside the usual types of bills that accompany abortion bans, such as funding for crisis pregnancy centers.

“This kind of legislation that protects pregnant women and new moms, this is one of our key focuses of 2023, and it’s been awesome to see momentum in a lot of pro-life states this year,” said Kelsey Pritchard, director of state public affairs for Susan B. Anthony Pro-Life America. “We’ve been really happy to see states step up the plate and say, ‘Yeah, we need to do more to help pregnant women and to help our new moms in the state.’”

Several female Republican lawmakers told POLITICO that while they’ve long understood the need to increase access to contraception, Roe’s fall provided an opening for them to talk with their male colleagues about the importance of such policies.

“It’s not necessarily that they’ve been against it. They didn’t know they needed to be for it because they didn’t know it was a problem,” said Garvin, the Republican state senator from Oklahoma.

Garvin’s two birth control bills — one that allows pharmacists to dispense hormonal contraceptives without a prescription and another that makes clear the state’s abortion law does not restrict access to contraceptive drugs — cleared the GOP-supermajority state Senate with significant support.

“I think the overturn of Roe v. Wade has forced the issue to become more of a dinner table conversation, and people are more open about sex and family planning, and I think those are becoming more of conversation pieces within families, and it’s a good thing,” Garvin said.

In Iowa, lawmakers are taking another shot at expanding access to birth control, something the governor has wanted to do since 2019. While Reynolds’ bill to allow pharmacists to prescribe hormonal contraception cleared the Senate that year, it did not receive a vote in the House that year.

“There’s some very, very far right conservatives that just really didn’t believe in birth control, period,” said Iowa state Sen. Chris Cournoyer, a Republican. Since then, “we’ve had more conversations about why it’s important and why it factors in not just for maternal health but also for women's health in general. I mean, there’s a lot of non-contraceptive reasons why you would get on birth control.”

A similar bill in Indiana also received enthusiastic support when it passed the House in late February.

“Allowing pharmacists to prescribe hormonal contraceptives is a simple, yet critical step to providing care to more Hoosier women, especially those who don't have a primary care doctor, or can't afford transportation to a different city or county,” said Indiana Republican state Rep. Elizabeth Rowray.

In two conservative states that have not passed Medicaid expansion, abortion helped Republicans who remain highly skeptical of anything that even vaguely resembles such a policy to pass legislation this year extending postpartum benefits from 60 days to a year after birth.

In Mississippi, Reeves, who is up for reelection this year, announced his supportfor the policy in February after months of opposition, calling it a part of the “new pro-life agenda” and saying that Republicans may have to do things that make them “philosophically uncomfortable” in the post-Roe era.

In Wyoming, legislation extending postpartum benefits passed by slim margins in the House and Senate — and legislative leaders in both houses attempted to kill the bill at multiple points during the session. Both GOP lawmakers supportive of the bill and the governor’s office pitched the proposal during hearings and debate on the bill as “pro-life.”

Exceptions to the rule

Not all of these proposals have reached a critical mass of Republican support. The two comprehensive sex ed bills introduced this year in Indiana and South Carolina — two states that have an abstinence-focused sex ed curriculum — have not received hearings.

But South Carolina Republican state Sen. Tom Davis said he is not giving up. He plans to bring his sex ed legislation forward as an amendment to another education-related bill.

“If we want to reduce unwanted pregnancies and, by that, reduce the number of abortions, we need to do a better job of providing factually correct scientific information that’s age appropriate,” he said.

And some Republicans are trying to separate maternal health from abortion. In Florida, for instance, the Department of Health requested more than $12.6 million in its budget this year for the Closing the Gap program, which became the centerpiece of a plan to expand telehealth postpartum services to people of color. The proposal received unanimous support from state lawmakers in 2021, and the department is now asking for a boost to its current $5.4 million budget to expand the pilot program.

But Joseph Ladapo, who oversees the state Department of Health, has emphasized that the increased postpartum funding predates the efforts pushed by Florida Republicans to tighten abortion controls. State lawmakers approved a ban on abortions after 15 weeks of pregnancy last year, and they are now poised to pass a six-week ban by the end of this year’s legislative session in May.

“For the last two decades, they’ve been taking it more seriously and the Department of Health has been involved in that area for years,” Ladapo said.

Maternal health advocates said they struggle with the fact that these advances come hand-in-hand with anti-abortion laws, which they believe threaten to worsen existing maternal health disparities.

“We’re glad that more states are starting to pay attention, but in light of the maternal health crisis, the point really is that Rome is burning, and states are not centering the full range of reproductive health needs,” said Ben Anderson, director of maternal and child health initiatives at Families USA, a consumer advocacy group.

But advocates also welcome the growing bipartisanship on these issues.

“What I do see as a pattern is reasonable conversations about some of these safety-net programs that should have long been part of the overarching public health dossier of programs, Medicaid expansion being one of them,” said Terrance Moore, CEO of the Association of Maternal and Child Health Programs. “I don’t want to go on a limb and say folks are all going in the right direction, but there’s been real education, deep education.”

Arek Sarkissian contributed to this report.