At first glance, Gov. Bobby Jindal seems an unlikely politician to pen an op-ed piece advocating "The End of Birth-Control Politics."
Wasn't it Jindal's fellow conservatives who'd made access to contraception an election year issue in the first place? Didn't congressional Republicans fight to keep employers from being mandated to cover prescription birth control at no cost to the patients? Didn't commentator Rush Limbaugh famously label Georgetown University law student Sandra Fluke a slut and a prostitute, and frame her argument that her Jesuit university should cover contraception for students who wanted it as one in which Fluke expected the taxpayers to pay her to have sex? Weren't conservatives the ones who'd opened this latest front in the culture wars, the people who'd made access to birth control for women suddenly seem tenuous?
And until he wrote as much in The Wall Street Journal in a December guest op-ed column, who knew Jindal had such strong feelings on the subject? It's not as if he'd ever spoken out before.
Of course, the improbability of Jindal's post-presidential election column, just one in a recent series of grand gestures to position himself as a new brand of national GOP leader, is what made it noteworthy.
Let's start by stipulating that Jindal's motivation for writing the column was political — because he says as much. The gist of his argument is that making birth control pills available to adults over the counter would effectively end the battle over mandated insurance coverage. It's a fight, he concedes, that Republicans already lost at the polls last November, when single women voted for President Barack Obama and other Democrats in droves.
"As a conservative Republican, I believe we have been stupid to let the Democrats demagogue the contraceptives issue and pretend, during debates about health care insurance, that Republicans are somehow against birth control," he wrote. "It's a disingenuous argument to make."
Jindal's beef is not with the idea of birth control, he wrote, but with "government health care edicts" that would force "anyone who has a religious objection to contraception" to purchase it for others. The simple solution, he continued, is to take birth control pills out of the insurance realm and make them available for direct purchase by women 18 and older, just as so-called morning-after pills already are.
The governor's right about one thing: People across the political spectrum advocate depoliticizing the issue — including Fluke herself, who said as much to a New Orleans audience last month. Fluke spoke at a packed January fundraiser for Planned Parenthood Gulf Coast New Orleans Health Center at the Roosevelt Hotel.
But the devil, as always, is in the details. And Jindal's specific proposal is in line with an influential neutral source, the American College of Obstetricians and Gynecologists (ACOG).
A December committee opinion issued by ACOG, which Jindal cited, notes that unintended pregnancy is a significant public health challenge in the U.S. and argues that lack of access to prevention contributes to the problems. The ACOG committee acknowledged concerns over side effects from over-the-counter birth control pills, but argued that the likelihood is relatively low and that women can "self-screen for most contraindications" using checklists. The cost for patients purchasing birth control pills should be addressed as part of any change, the opinion says.
Despite the timing of the committee opinion, one of its co-authors said ACOG never intended to wade into the political debate.
"This was just very coincidental," says Dr. Kavita Nanda, a Durham, N.C., medical scientist. The recommendation was data-driven, she says, in the works for several years, and intended as just one step toward changing the many conditions that lead to unintended pregnancy — such as making it less likely that women will simply stop taking pills because they run out. It was based in part on the experience of women in countries where birth control pills are available without prescription, including places in Latin America. Women "haven't seen all these risks or all these complications," Nanda says. "They're more likely to have complications if they get pregnant."
Yet the question remains: Could the sea change Jindal proposed actually happen in the United States? If Jindal had hoped his piece would start some sort of groundswell, he seems to have fallen short of his goal.
Reaction from women's health care advocates ranged from moderate enthusiasm to caution to outright skepticism — in part over Jindal's commitment and motivation, and in part reflecting a genuine lack of consensus over the idea's merits.
Planned Parenthood President Cecile Richards welcomed Jindal's support for increased access, but called him out on his party's recent past.
"We welcome Gov. Jindal's thoughtful contributions to the conversation on women's health," she said in a statement. "Unfortunately, his remarks stand in contrast to some of his colleagues in Congress who have tried repeatedly to eliminate the nation's family planning program, which helps provide low-income women with access to affordable birth control."
Closer to home, Tamara Kreinin, a longtime New Orleans women's health care activist who is now director of population and reproductive health for the Packard Foundation, struck a more suspicious tone.
"I think the last election said to us that there's an overreach. The cynical part of me says that's what's going on," she says.
Jindal's proposal may offer a ray of hope for progress, but her experience leaves her with plenty of doubts. "I've watched the culture wars for a long time," Kreinin says. "I've seen it inch forward, then go backwards."
As for the proposal itself, Kreinin worries such a change might wind up steering young women in the wrong direction.
"You want them to have access to pills, which is a very good start," she says. "You also want them to have access to condoms, to injectables, to IUDs, so they have a wide range of choices. You really have to make sure, one, they know what they're doing, and two, that they've got a choice that works for their lifestyle."
Dr. Janifer Tropez-Martin, an OB/GYN at Tulane University School of Medicine, called Jindal's position a "suave move" and agrees, "You do want to take the politics out of it." But she worries that his recommended policy would "hinder the ability to get contraception even more" because it assumes the free market would keep costs down. She also believes patients should be counseled on risks and the full range of options.
"I really think it's important for the physician to guide the decision-making on certain pills," she says. "There are choices that require a level of expertise — why do you pick certain pills over others?"
If Jindal was really hoping to convert skeptics, it probably didn't help that he couched his recommendation in overtly ideological terms — asserting, for example, that women go to the doctor before they buy birth control in part because "big government says they should." In fact, the column can be read as one more attack on the Affordable Care Act he opposes so adamantly that he's refusing to take federal money to significantly expand Medicaid (i.e., public health care) in Louisiana.
Reaction from some of Jindal's traditional allies has been even less enthusiastic.
The Archdiocese of New Orleans said it couldn't back the governor's proposal "because, as the Catholic Church teaches, contraception is always wrong." One well-known conservative commentator, Erick Erickson of redstate.com, who was a CNN contributor at the time, said Jindal was talking sense, but Jindal's fellow Republican officials stayed conspicuously mum — perhaps in part because the Newtown, Conn. elementary school massacre, which happened hours after Jindal's piece was posted, quickly diverted the political and media worlds' attention.
Perhaps more telling is that Jindal has said little on the subject since his initial splash. Through a spokesman, he declined to elaborate on his thought process or how he came to embrace the issue in the first place. And he didn't bring it up in his January keynote address to the Republican National Committee, during which he laid out what he called a "big picture" view of how the party can reclaim relevance. Still, his office said recently that "nothing about his position has changed."
Then there are practical speed bumps, if not outright roadblocks, to any such change. While the government theoretically could start the ball rolling, Nanda said, the process to convert a prescription drug to over-the-counter status usually starts with an application from a pharmaceutical company, which then triggers a lengthy approval protocol. She said she knows of no such attempt in the pipeline.
Meanwhile, opposition to the part of the health care law that prompted the whole debate remains vocal, even though the Obama administration recently issued revised regulations designed to provide free contraceptive coverage even for employees of religious organizations, including some religiously affiliated hospitals, universities and social service agencies. The insurers, not the institutions, would cover the costs.
The move did little to calm hardcore critics, and it's not expected to derail numerous legal challenges from both religiously affiliated organizations and some private employers. Questions about the matter are expected to reach the U.S. Supreme Court.
Still, Jindal's proposal — and his bow to political reality — offers some hope that the temperature on these issues could dial down. At least one local supporter of greater access is willing to give him the benefit of the doubt — and says that if the governor is serious, she'll work with him to help make his ideas a reality.
New Orleans political and communications consultant Cheron Brylski said she hasn't worked on contraceptive equity issues for about 10 years, ever since a bill to mandate insurance coverage for birth control failed to make it through the Louisiana Legislature.
"It's something I gave up on," Brylski says.
So Brylski was heartened to hear the proposal from "someone who's considered to be a conservative, who's considered pro-life," because it suggests a potential return to the days when the women's health care movement was more ideologi- cally diverse.
Brylski says she disagrees with Jindal on many issues, but found a lot to like in his appeal to personal freedom for patients and thinks there's merit to his argument that market forces could keep patient costs down.
While some see Jindal simply positioning himself for a national audience, Brylski says he rarely raises a subject without having a plan.
"I don't consider him someone who just shoots from the hip. This was a real risk-taking move for him," she says. If he's serious, she adds, "I'm ready to work with him on this in whatever manner he wants. I think it's an exciting idea."
Click here for an excerpt from Gov. Bobby Jindal's Dec. 14, 2012 guest column in The Wall Street Journal.