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Iowa Republican Gov. Kim Reynolds has backed a plan to allow residents who are 18 and older to receive birth control from a pharmacist without a prescription. The Republican-controlled Senate last month approved legislation to permit it.

But the bill is moving through the statehouse as a rift is growing in the Republican Party over birth control, with some anti-abortion groups opposing access. Similar legislation, to expand or protect birth control access, has passed in both liberal and conservative states in recent years. But with the Supreme Court’s June decision ending a federal right to abortion, states have taken on reproductive health care, and some conservatives are increasingly tying abortion and birth control. 

Mary Ziegler, an abortion law historian, said Republicans used to be able to take a stance on either abortion policy or contraception policy without the issues intersecting.

“My sense in general within the anti-abortion movement — and I think to some degree within the GOP, too — there’s been a shift to the right on all of that, and more open opposition to contraception than we’ve seen in years past,” she said. “To me it’s much more eye-catching to see a Republican governor actually being this supportive of contraception, than it would have been a few years ago, just because I think there’s been a general shift toward saying, ‘Contraception is bad, too.’”

Some Republicans are working to clarify that they are not opposed to contraception. In Oklahoma, a pair of anti-abortion Republican lawmakers introduced a bill earlier this year that clarifies that state laws on abortion shall not prohibit or restrict contraceptive drugs, surgeries or other treatments by authorized health care providers. Lawmakers in the Republican-led state Senate overwhelmingly passed the measure last month.

“Being pro-family also means allowing Oklahomans the freedom to plan when to start or grow their family,” sponsor Sen. Jessica Garvin said in a statement at the time of the bill’s passage. “When people have access to contraception, they can pursue their goals and build healthy families. It’s a right we all deserve.”

Ziegler said opposition by anti-abortion groups toward birth control has become more pronounced in recent election cycles, especially after former President Barack Obama included contraception mandates in the Affordable Care Act that spurred legal action. She noted as more Christian right groups and anti-abortion organizers strengthened their financial resources and strategy, there was more invested in claims about religious liberty and its connection to birth control.

“That was when you began to see more of a tendency to say, ‘We’re OK opposing contraception, because people of faith have these religious objections to it, because they believe it’s an abortifacient,’” she said.  

A spokesperson for Students for Life of America told The 19th that the organization does not take a position against or for birth control, but it opposes federal funding to abortion providers “who use birth control programs to market life-ending drugs, devices, and procedures.” 

“Title X funds should be invested in family care, not family-ending vendors who misuse federal funds to support their abortion businesses,” Kristi Hamrick, vice president of media and policy, said in an email. 

Ziegler said it all indicates a divide among some GOP lawmakers and some anti-abortion groups on contraception, and it’s still unclear where it’s heading.

“This is kind of a fork in the road for the movement, and I think, for the GOP,” she said.

At least 17 states and the District of Columbia allow pharmacists to provide contraceptive care, according to the Guttmacher Institute, ​​a nonpartisan research and policy organization focused on reproductive and sexual health. Many of these laws have been passed since 2016, according to Elizabeth Nash, who recently tracked state policy for Guttmacher and now works for the federal government on contraceptive access. The details vary, though, and  there are practical questions now about access and education to the public.

“It’s one thing to pass the policy and say you’ve passed the policy,” she said. “The other piece is the implementation part.”

The Iowa bill to expand birth control has been years in the making. Reynolds first introduced the measure in 2019, but it did not have enough support amid opposition from local anti-abortion groups.

The proposal this year was added at the last minute to an unrelated bill about EpiPens. The provision noted that self-administered hormonal contraceptives include an oral hormonal contraceptive, a hormonal vaginal ring and a hormonal contraceptive patch. It specifies that it does not include any drug intended to induce an abortion.

Before a 45-3 vote, there was no debate on the bill. Iowa Sen. Jeff Edler, the Republican managing the bill’s passage, briefly said on the chamber floor that it was “another bill that continues to expand the access of health care to Iowans.”

But once again, it’s unclear if the bill will pass. Since advancing out of the state Senate, Republicans in the House have proposed amendments to the legislation that might complicate its chances of getting signed into law, including one that requires pharmacists who dispense birth control to share misinformation about abortion.

And once again, local anti-abortion groups have registered opposition to the bill, including the Family Leader, a politically powerful conservative group, and Pulse Life Advocates, previously known as the anti-abortion group Iowans for Life.

A spokesperson for Reynolds did not respond to a request for an interview about the bill.

The bill’s progression since leaving the Senate last month has been discouraging to Sen. Sarah Trone Garriott, a Democrat.

“It really seemed like, ‘Hey, we’re maybe going to do something that the people have been asking for and isn’t that great? A nice change of pace,’” she said. “And it’s really disappointing to hear about all these things the House is attaching to this legislation.”

Iowa has also shifted more conservative in recent election cycles, including under the leadership of Reynolds. She has asked a more conservative state Supreme Court to reconsider a six-week abortion ban that she first signed in 2018 but has been on hold.

Separately, newly elected Republican Attorney General Brenna Bird confirmed to The Des Moines Register that her office recently put on hold a long-standing practice under the previous Democratic AG to pay for emergency contraception for victims of sexual assault. In rare cases, that also included abortions.

Trone Garriott said if Republicans reduce reproductive health through other forms of policy, it’s hard to balance that out with their efforts on birth control.

“Overall, the landscape in Iowa is pretty bleak right now when it comes to reproductive care, and there’s all kinds of things that are being passed that are discouraging people from moving to our state, discouraging young people from building their lives here and discouraging health care practitioners from coming here,” she said. “So it’s a small thing that’s helpful, but overall, we’re just seeing a lot of bad policy that’s having a negative impact.”