The Washington PostDemocracy Dies in Darkness

They rushed to get IUDs before Trump took office. Five years later, would they do it again?

Fear of a Republican crackdown on access to birth control prompted major decisions about family planning

Palmira Muñiz at home in Los Angeles. (Allison Zaucha for The Washington Post)

When Kelli Russell Agodon scheduled her IUD insertion for a Friday in January 2017, she didn’t initially put together that she had made the appointment for the same day Donald Trump would be inaugurated as president. In fact, she had forgotten all about it until she turned on the radio in her car on the drive from her home in Port Ludlow, Wash., to her gynecologist’s office.

“All of a sudden I realized I had made the appointment at the exact time,” said Agodon, 53.

In the months after the 2016 election, many made the same decision Agodon did. One study estimated that in the 30 days after the election, insurance claims for intrauterine devices across the United States rose more than 21 percent among women with commercial insurance. (That’s some 21,000 more IUD insertions than usual that month, according to the New York Times.) Cecile Richards, then the president of Planned Parenthood, said in January 2017 that the organization had seen a 900 percent increase in demand for the devices — which are more than 99 percent effective at preventing pregnancy and can be left undisturbed in the uterus for several years — in the weeks since Trump had won.

Agodon had been experiencing irregular menstruation and a progesterone deficiency, and when switching to a hormonal IUD for her birth control emerged as a potential solution she figured she would need to act fast. Somberly, she chatted with the assistants assigned to her room as they prepped her for the procedure. “We were talking about, you know … ‘Will women have less options for reproductive health?’” Agodon said. “We were just fearful, for so many different reasons.”

Agodon, who is a poet and a professor at Pacific Lutheran University, later published a piece titled “Getting an IUD on the Day of 45’s Inauguration.” “My body is a flag across the table,” it begins. A few lines later: “From above, what you see are three women / in a room, two fully clothed, one in a paper / gown on a table. The one in a paper / gown is a flag, her feet in metal stirrups. / What she doesn’t know is tomorrow.”

The IUD rush: Why women are seeking out birth control that can outlast a presidency (from 2017)

Five years later, the future many feared hasn’t materialized. The Affordable Care Act’s birth control mandate might have been weakened by the 2020 Supreme Court decision upholding the Trump administration’s policy allowing employers to opt out of contraceptive coverage for religious or moral reasons, but it still stands. So does Roe v. Wade, for now. The Biden administration has stated a commitment to preserving reproductive rights.

So, how do the people who rushed out to get long-acting contraceptives five years ago feel about that decision now?

For some, it’s a complicated question.

In early 2017, getting an IUD was a trendy thing to do and a practical reaction to political uncertainty. The incoming administration had both the ACA, which had made contraceptives cheaper and more accessible, and Roe v. Wade, which protects the right to abortion, in its crosshairs. The Food and Drug Administration had approved the Mirena hormonal IUD for up to five years of pregnancy prevention and relief from heavy periods. It was unclear whether, by 2022, the devices would become luxury goods many people could no longer afford — or whether future IUD seekers would have to make off-the-books appointments to get them. (The Mirena has since been approved for up to seven years.)

Ashley Luciano, an information technology specialist for a law firm who now lives in the Washington Heights neighborhood of Manhattan, was 22 when Trump was elected. She was finishing up college, living at home and working at an H&M. In her early teen years, Luciano had debilitating trouble with periods. “I had really intense pain,” Luciano said. “Constant nausea. Vomiting. To the point where I was missing school.” A doctor prescribed Luciano the birth control pill when she was 15. “My quality of life improved drastically,” she said.

After the 2016 election, Luciano began to read news reports about how Trump’s plans could affect birth control access. “I kind of panicked,” she said. “Despite the fact that I live in New York City, which is very progressive … I was still unsure of what was going to happen, like on a federal level, to make it really difficult to get birth control pills, something I’m refilling every month, you know — that uncertainty scared me.” She had the Mirena device inserted that December.

Palmira Muñiz, a writer and producer at a podcast studio who is now based in South Central Los Angeles, was 24 at the time, working part time and living with their dad in Anaheim. Back then, Muñiz had a boyfriend and did not aspire to ever have children.

Muñiz, whose family is Puerto Rican, knew just how easily reproductive rights could be disregarded. For decades in the 20th century, female sterilization surgery was common in Puerto Rico. Many scholars argue that poor women there were pressured and even coerced into undergoing what was often referred to simply as “la operación.”

Muñiz had no trouble believing, then, that people in power could ignore the best interests of half of a population, or that governments could take away an individual’s ability to end an unwanted pregnancy. “Things like ‘The Handmaid’s Tale,’ they’re scary because they don’t happen to White people. But those things happen to Black and Brown people,” Muñiz said. The day after the 2016 election, Muñiz called Planned Parenthood and scheduled an appointment to get a Mirena IUD.

Agodon remembers an argument that winter among her husband, herself and their nonbinary child, then a teenager, about what the new administration might do to reproductive health-care access. “I remember my husband just being adamant,” she recalled. “He said: ‘You don’t have anything to worry about. That’s never going to happen.’”

The expanded birth control access the ACA created remains mostly in place (despite Trump’s efforts to replace the ACA with a health-care plan that would have threatened contraceptive access by defunding Planned Parenthood). And while the Supreme Court that Trump built may yet overturn Roe (and thereby potentially hamper contraceptive access), the 1973 decision has outlasted his administration.

Looking back, the IUD owners wished they had known more about what they’d signed up for. Luciano spent an hour after her IUD insertion curled up in an anguished ball on the exam table, even vomiting: “I basically went into shock because of the pain,” she said. “I wish I had been better prepared.”

Muñiz, too, remembered nearly fainting from the surging pain involved in what they had been reassured was a simple, mildly uncomfortable procedure. “I had to be the one to tell my friends,” they said.

None of the IUD owners interviewed for this report, however, said they regretted getting the IUD.

“I don’t think it was an overreaction, considering we saw how unpredictable Trump could be before and during his presidency,” Luciano said. “A lot of people feel strongly about being better safe than sorry, myself included.”

Muñiz playfully gave the overall five-year experience a passing grade of C-plus — maybe even a B-minus, on second thought, “because it did the job.” (That said, Muñiz plans to switch to a Nexplanon, a birth control arm implant with a slightly shorter life, when their IUD expires.)

Luciano feels less worried now than she did in 2017 about her access to contraception. She likes the Mirena IUD enough that she plans to get another one. Given her memories of last time, she has been putting off the appointment to do so.

Agodon is nearing menopause, and she acknowledged that birth control is fading out of relevance for her. But she worries about younger people and their access to reproductive health care through institutions such as Planned Parenthood. She said she is heartened by recent efforts in states such as New Jersey to proactively protect abortion rights, “but there’s another part of me that really worries about the future.”

Muñiz is worried, too. “I think I’m more scared now than I was,” Muñiz said. Contraceptive access seems to be more secure now than it was five years ago. But the right to an abortion in the United States “is so fragile,” they said, “and I see its fragility even closer now.”

“People are like, ‘Oh, nothing happened,’” Muñiz said. “But I’m like, ‘Nothing has happened yet.’ ”