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Alaska Legislature

Can long-acting contraceptives fix some of Alaska’s most vexing social problems? A state lawmaker wants to find out.

JUNEAU — Could the state of Alaska help fix one of its most costly public health problems by giving long-acting, reversible birth control to women addicted to drugs or alcohol?

Senate President Pete Kelly wants to find out.

Kelly, a Republican from Fairbanks, introduced legislation this week directing the state university to conduct a study. It would examine how long-acting birth control could help fight Alaska's high rate of babies born with complications from their mothers' drinking — as well as the growing problem of children born to mothers addicted to opioids.

Kelly, who's up for re-election this year, is a small-government social conservative who in the past has resisted the idea of expanding access to birth control.

Sen. Pete Kelly, R-Fairbanks. (Richard Mauer / ADN file)

But he's also long recognized the scope and cost of Alaska's problems with alcohol abuse, particularly among pregnant women. He described his legislation, Senate Bill 198, as a narrow effort focused on an "extreme population" that can't control drug or alcohol addiction.

"It's not just handing it out," Kelly said in an interview. "If it was broad-based I wouldn't support it. This is targeted, trying to fix a very specific thing."

He added: "This can act as part of a treatment program. It can actually prevent fetal alcohol syndrome babies. And it will provide you some data, as well."

As introduced, the legislation lacks any cash to pay for what researchers say could be a $500,000 study. But lawmakers could ultimately attach money to it, and Kelly said the bill would provide the university with "legislative direction."

The legislation has support from staff at the University of Alaska Anchorage's Institute for Circumpolar Health Studies, as well as Jeff Jessee, dean of the university's College of Health and a longtime mental health advocate. Jessee, in a phone interview, said Kelly's legislation aims to deal with a "huge social problem."

"The consequences to everyone from this problem are really significant — from the mother, who will often have the child taken away from them, to of course the child themselves," Jessee said.

Jeff Jessee (Loren Holmes / ADN)

Jessee is part of a group convened several years ago by Kelly, Empowering Hope, that's worked to reduce Alaska's high rate of fetal alcohol spectrum disorders, which stem from a mother drinking while pregnant.

New research released earlier this month found that the disorders are as much as five times more common than previously thought, affecting up to 5 percent of American children.

Kelly's legislation also targets the growing problem of neonatal abstinence syndrome — when babies go through withdrawal after being born to mothers who used opioid drugs.

Both problems are costly, with bills sometimes footed by the government.

An average hospital stay for a child born with neonatal abstinence syndrome costs about $90,000, according to state data collected through 2012. And the cost of treating a single case of FASD can exceed $1 million over a person's life.

Kelly's proposed legislation is the second high-profile effort to emerge from the Empowering Hope group. The first, in 2015, was a plan to study the effectiveness of putting free, state-funded pregnancy tests in bars, driven by the idea that most women would stop drinking if they were aware they were pregnant.

About half of pregnancies are not planned and, according to the Centers for Disease Control and Prevention, most women are unaware that they are pregnant until four to six weeks later — increasing the risk that their child could be exposed to alcohol.

The study found that FASD prevention messages paired with the pregnancy test dispensers could "effectively promote informed alcohol consumption decisions among women who are, or may become, pregnant."

But at the time, Kelly was skeptical about pairing the pregnancy tests with state-sponsored birth control — considered by many experts to be an effective preventive measure. He made national news in 2014 when he told an Anchorage Daily News reporter that birth control is for "people who don't necessarily want to act responsibly."

Kelly subsequently said that birth control could become part of Empowering Hope's efforts later. And he explained that his skepticism stemmed from the fact that birth control may not work 100 percent of the time — leaving some potential for a fetus to be exposed to alcohol if the mother is drinking.

His new legislation directs the university to collaborate with hospitals and health care providers; evaluate best practices for treating women and children with a high risk of alcohol- and drug-related disorders; create a network to share best practices; and find a group of women and children that can be followed over time to assess costs and effects of those health problems.

Participation would be voluntary, according to the legislation. It doesn't specify a type of long-acting contraceptives, and the intent is to let participants choose, a spokesman for Kelly said.

UAA's Institute for Circumpolar Health Studies is ready to start such a study, though it still needs the money to do it and is looking to the state for help, said Amanda Slaunwhite, an assistant professor there.

"There's a lot we don't know. And much of the literature around substance abuse in utero, including opioids, is really underdeveloped," she said in a phone interview. "Given how quickly and urgently the opioid epidemic has come to Alaska, we need to quickly understand the demographics, the profiles of these moms, these infants — figure out where they come from so that we can best support them."

One nurse practitioner who works with mothers and children to diagnose FASD, Marilyn Pierce-Bulger, said she welcomes Kelly's proposal and is "fascinated to see what happens." Long-acting contraceptives aren't "dependent on the user" and can be more successful than other forms of birth control, she said.

"The fact that somebody's thinking about using user-independent methods as a way to reduce FASD, that's real," Pierce-Bulger said. "That is an effective strategy."

FASD, she added, poses a risk to mothers in different social classes, including those who are college-educated and working. But for a subset of mothers who also suffer from FASD themselves, long-acting birth control can be especially helpful because it doesn't require them to remember to "do something every day."

A spokeswoman for Planned Parenthood, meanwhile, said the organization has concerns about how Kelly's legislation is specific to long-acting, reversible contraceptives instead of proposing increased access to a full range of birth control methods.

"This bill seems entirely aimed at improving a specific set of child health metrics and cost efficiency without a single mention of improving women's health," said the spokeswoman, Jessica Cler. "We know that when women have access to the full range of birth control methods and access to health care that the state does see savings."

Cler said her organization supports ideas like House Bill 25 — legislation from Anchorage Democratic Rep. Matt Claman that requires insurers, including the government-funded Medicaid program, to give a year's supply of contraceptives at once.

Kelly said his proposal doesn't address the broader issue of access to contraception.

"The larger question is a debate for another day," he said.

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