Indiana lawmakers passed a near-total abortion ban on Aug. 5, which Gov. Eric Holcomb signed into law quickly after. The ACLU and several abortion care providers are challenging the new law in court, but unless it is halted, the ban will take effect Sept. 15.
We asked members of the Indiana Two-Way for their questions about the ban. To join the Indiana Two-Way, text “Indiana” to 73224.
What does the law do?
The law bans abortion in Indiana, with a few, narrow exceptions.
Abortions would only be allowed if the pregnant person’s serious health or life is at risk; if there’s a lethal fetal anomaly up to 20 weeks post-fertilization; and in cases of rape or incest, but only up to 10 weeks.
It also limits abortion to only hospitals and surgical centers owned by hospitals – and specifically bans abortion clinics.
During testimony on the measure, Sen. Sue Glick (R-LaGrange) emphasized contraceptives and emergency contraceptives like Plan B would not be banned by this bill.
However, the legislation signed into law leaves much of this promise up in the air, said Jennifer Drobac, an Indiana University law professor.
She said that language in the law could “conceivably” outlaw certain forms of birth control, including IUDs, that can interfere with the implantation process.
“The problem with all of this is, how is a normal human being, person who's pregnant, supposed to know whether or not they're taking a medication or using a contraception that is actually prohibited – because they honestly think that what they're doing is OK, and, under the law, is not prohibited,” she said.
She added this vague language leaves room for interpretation. Drobac said the law does not go far enough in detailing what is acceptable, leaving contraceptive users potentially vulnerable to accidentally doing something illegal.
“So that's the problem with the Indiana law, is it's dealing in an area of science that is sophisticated, with law that is not sophisticated,” Drobac said.
A lot of Hoosiers wanted to know why there’s not a public question about abortion on the ballot this November – especially after a high-profile Kansas referendum in early August.
Ballot questions (other than school funding referendums) are fairly rare in Indiana. There is no legal avenue for what’s known as a “citizen-led” initiative – for instance, gathering enough signatures to put a question on the ballot.
Still, there’s nothing in state law stopping legislators from creating one on abortion. But House and Senate Republicans rejected efforts from Democrats to do so.
Senate President Pro Tem Rodric Bray (R-Martinsville) said that crafting such a question is difficult.
“Could you say – should abortion be legal? Should it be legal for the first trimester?” Bray said. “Should abortion be illegal with exception of the life of the mother, or the life and health of the mother, or the life and health of the mother and rape and incest? And if you say rape and incest or life of the mother, how do you define life of the mother?”
Jody Madeira is a law professor at Indiana University Bloomington. She said this new law may affect access to these medications.
“Pharmacists have to honor all prescriptions, but they are immune from criminal prosecution or civil liability if they refuse to honor prescriptions because in their professional judgment, it would be contrary to the law or a patient's health and safety are against the patient's best interests,” she said.
She said in some states, women have been refused medication treating conditions like arthritis.
In Indiana, pharmacists are typically expected to prescribe as the doctor ordered. But a 2019 law expanded protections for medical professionals who object to abortion on “ethical, moral, or religious grounds” to refuse to participate in abortions, to include pharmacists who refuse to dispense abortion-inducing drugs.
“There's nowhere in the abortion bill where it addresses pharmacists, refusals. Nor does it necessarily give pharmacists leave explicitly in the bill to sign off on prescriptions for abortion medication,” she said.
Dr. David Ingram is IU’s Health chief medical officer. He said IU Health, Indiana’s largest health care system, has spent the past few months deciding how to best provide support for health care providers.
“All of our sites are prepared for that and we’re determining what’s the best access point, based on a number of factors for our patients seeking care,” Ingram said.
Ingram said the cost of abortion in Indiana will increase due to the ban.
Maternal-fetal medicine specialist Dr. Caroline Rouse said IU Health has also created a 24-7 rapid response team that’s prepared to answer provider questions about what they are allowed to do under the ban.
“So, in the event that a health care provider has an urgent legal question related to provision of abortion services, the rapid response team can be called for an opinion and advice,” Rouse said.
The hospital will continue to provide legal abortion care through this response team, and by monitoring the impact of the abortion ban on infant and maternal mortality rates in the country.
The morning after Governor Holcomb signed a near-total abortion ban into law, one of the state’s largest employers said the new restrictions will hinder its ability to attract talent.
“Given this new law, we will be forced to plan for more employment growth outside our home state,” pharmaceutical company Eli Lilly, which is headquartered in Indianapolis, said in a statement.
The statement was the first comment Eli Lilly, which employs more than 10,400 people in Indianapolis, has made on the legislation.
Cummins spoke out the same day Eli Lilly issued its statement to oppose the ban. Both companies said the ban will make it hard to attract talent, and they will consider growth in other states.
“For Cummins to be successful it is critical that we have a safe and welcoming workplace, and communities where we embrace our differences and enable all employees to thrive,” the Cummins statement said. “As we continue to grow our footprint with a focus on selecting communities that align with our values and business goals, this law will be considered in our decision-making process.”
Unlike many smaller companies in Indiana, both Cummins and Eli Lilly were publicly silent until after the decision was passed.
ButHolcomb largely dismissed any impact Indiana’s near-total abortion ban will have on attracting and retaining businesses and talent to the state.
The governor insisted the state is well-positioned to continue adding jobs and investments.
“It’s because of access to talent,” Holcomb said. “And we have that access to talent – we had it yesterday, we have it today and we’ll have it tomorrow.”
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Laura Wilson is a University of Indianapolis associate professor of political science. She said getting an answer on abortion from polling is difficult as there’s often a disconnect between opinion and action when it comes to polling.
“Many people will say generally speaking, they support something," Wilson said. "Will they vote on the basis of that? Will they write their legislator on the basis of that? Will they go to protest on the basis of that?”
On abortion polling specifically, Wilson said it’s a particularly tricky issue to gauge public opinion on.
“Because there’s a lot of parameters and a lot of exceptions, explanations, context that you can add to it," Wilson said. "It’s not as simple as we often make it feel, where you’re either in support of it or against it.”
What little Indiana public polling about abortion there is available suggests a large majority of Hoosiers support at least some legal access to abortion – but exactly how much access is harder to gauge.
Lawmakers also passed a companion measure to put more money toward adoption and family supports. How adequate is the funding?
The package includes more than $70 million to help address services and programs for pregnant Hoosiers, families and children. That includes increasing the state adoption tax credit to $2,500 per child (up from $1,000) and ensuring Hoosiers no longer have to pay sales tax on children's diapers.
Monique Kulkarni is a licensed psychologist with Valley Oaks Health, a community mental health center. During testimony on the bill, she said she supports the funding the bill puts toward various maternal health services – but she said it’s not enough.
“A one-time allocation of funds, when Indiana ranks third in maternal mortality and 43rd in prevalence of mental illness and access to care, won’t even be a drop in the bucket for the many agencies referenced in this bill,” she said.
IUPUI professor Erin Macey has been studying financial support for pregnant Hoosiers.
“Indiana has a $6 billion surplus and what you’ve proposed to spend on support for moms and babies in SB 2 represents less than 1 percent of that surplus," Macey said. "Mothers are the foundation of our society and this does not show them that they are valued.”
One study through the Indiana University Richard Fairbanks School of Public Health titled “Ask the Women” spoke to people in zip codes with high infant mortality rates in an effort to understand where they experienced gaps in care.
Macy is a senior researcher for the Grassroots and Maternal Child Health Initiative, which oversees the study. She said a vast majority of the participants in the study worked over the course of their pregnancy. Roughly half of the participants experienced “significant interruptions” in their ability to do work.
“Many of our participants were pushed out of work,” she said. “Either because they couldn’t receive really basic accommodations and have bathroom breaks or go to prenatal visits.”
Sen. Ryan Mishler (R-Bremen) called the bill “bridge funding” meant to help the state get through the next several months until lawmakers write a new state budget next year.
Meg Sterchi is the executive director of Adoptions of Indiana, a nonprofit offering various education and support services for birth parents and adoptive families.
“I think that it's good that Indiana is increasing services, well, money, to provide more services to women who are pregnant. But I think we're just scratching the top of what is needed if we really want to help women who are pregnant,” she said.
One of the bill’s major changes was raising the adoption tax credit from $1,000 to $2,500.
Sterchi said this price change will “not make a big difference.” She said she feels the scope of this legislation should’ve gone further to support pregnant people.
Shannon Schumacher is the president and CEO of the Villages of Indiana, the state’s largest not-for-profit child and family services agency.
While she is hopeful that adoption tax credits could encourage others to adopt, she said other issues can arise post-adoption, including limited attention on the well-being of birth mothers.
“Oftentimes, with the birth mother, there's lots of attention on her during her pregnancy,” she said. “But once the child is adopted, we know that oftentimes the support for the birth mother wanes at that point. So to make sure that there's continued support for those birth mothers after the baby is adopted [is important].”
How will the ban affect doctors hoping to train or work in Indiana?
Indiana, like many Republican-led states, has a shortage of providers. A 2018 report from the March of Dimes found 27 percent of Indiana counties are considered maternal care deserts, with no or limited access to maternity care. The state has one of the highest maternal mortality rates in the country.
Dr. Wendy Tian, a third year resident, said lately she is scared and worried about her safety. Tian grew up and went to school in Chicago and chose to come to Indiana for residency because the program has a strong family planning focus. She was also open to practicing in Indiana once she completes her training.
“I always thought I wanted to do family planning. I'm now thinking about doing something else,” she said. “I know I still want to incorporate it. But I, for sure, don't know if I would be able to stay in Indiana postgraduation with what's going on.”
Still, she feels “guilty for giving up” on some of the most vulnerable patients in Indiana.
Even before the Supreme Court overturned Roe v. Wade, Tian said the medical climate in Indiana could be hostile and frustrating. Indiana, like other states with abortion restrictions, allows nearly all health care providers to opt-out of providing care for abortion patients.
This story came in response to a listener's question. If you have questions about abortion in Indiana, you can text us. Sign up for the Indiana Two-Way by texting "Indiana" to 73224.