“In the wake of this last election, we are staring down at a potentially long and dark tunnel in terms of the ability to access contraception and abortion in this country,” Andrea Miller, president of the National Institute for Reproductive Health, told me over the phone.
And so I called my doctor to make an appointment for an IUD. “I want it before Jan. 20,” I told the receptionist.
An IUD is a highly effective form of “set-and-forget” birth control that can outlast a presidential administration (they work for 3 to 10 years). The Affordable Care Act, which passed in 2010, covers women’s preventative health care without any deductibles or copays. That includes well-women visits, breast-feeding supplies and FDA-approved contraceptive methods such as birth-control pills, diaphragms and IUDs. But whether these benefits will continue to be covered in the future, or policymakers will continue to define contraceptives as preventative health care, remains to be seen.
While Miller was quick to say that no laws can be overturned “on day one or day 100 of [Donald Trump’s] presidency,” she also pointed out that the incoming administration has been “exceedingly clear and hostile toward reproductive rights.”
The president-elect has stated he wants to scrap portions of the Affordable Care Act and appoint Supreme Court justices who are antiabortion and could overturn Roe v. Wade. While he once referred to himself on “Meet the Press” as “very pro-choice,” and then flipped to being antiabortion during his presidential run, he is surrounding himself with extreme conservatives in matters of women’s health.
His recent Cabinet pick to head the Department of Health and Human Services, Rep. Tom Price (R-Ga.), has called for a complete repeal of the ACA and has been vocal in his support to defund Planned Parenthood. In 2005 and 2007, the orthopedic surgeon-turned-congressman co-sponsored a bill that would have granted equal protection for “the right to life of each born and preborn human person.” Had it passed, that bill would have criminalized abortion with no exceptions for rape, incest or a threat to the woman’s health.
While Cabinet appointees are not yet set in stone, the Vice President-elect Mike Pence is. “Mike Pence has never seen a restriction on access to reproductive health care that he didn’t like, and he’s often led the charge on the most extreme measures,” said Miller.
In Congress, Pence first sponsored a bill in 2007 — and initiated several more until it was passed by the House of Representatives — to defund Planned Parenthood. He slashed funding to Planned Parenthood of Indiana and Kentucky, forcing several clinics to close. As governor of Indiana, he signed a bill, ultimately blocked by a judge, that would have banned abortion if the fetus was diagnosed with a disability or defect. And in 2015, the Indiana legislature passed a law mandating that fetus remains — including in cases of abortion, miscarriage or stillbirth — be disposed of by burial or cremation, rather than be treated as medical waste.
Since the passage of the ACA, IUD use has skyrocketed. According to the Centers for Disease Control, there was an 83 percent increase when comparing use between 2006 and 2010, and 2011 and 2013. Planned Parenthood health centers report a 91 percent increase in IUD use over the last five years. In 2015, analysis from the Guttmacher Institute showed that 87 percent of insured women had no out-of-pocket costs for IUDs.
Should that benefit be eliminated, in terms of upfront expenses, IUDs are among the pricier forms of birth control — their cost ranges from $500 to $1,000, according to Planned Parenthood. Were women to pay out of pocket for other forms of birth control, they would be looking at more than $50 a month for birth control pills, up to $80 a month for a vaginal ring, and up to $100 for a Depo-Provera shot that lasts three months. In terms of cost and efficacy, an IUD becomes an attractive option.
This idea has resonated with women in all sorts of circumstances. Searches for IUDs spiked immediately after election night, according to Google Trends. CoverHer, a birth-control resource from the National Women’s Law Center, saw an immediate uptick in calls after the election, reported Gretchen Borchelt, the organization’s vice president for Reproductive Rights and Health.
Raegan McDonald-Mosley, chief medical officer at Planned Parenthood Federation of America, said in an email that after the election, they saw an “unprecedented surge in questions about access to health care and birth control.” Appointments at Planned Parenthood for birth control, particularly IUDs, increased by more than 900 percent compared to the same time the previous month, said McDonald-Mosley.
And it’s impossible to uncouple conversations about birth-control access from abortion. How many single-issue voters gravitated toward Donald Trump for his early “some form of punishment” stance on abortion? Or voted against Hillary Clinton for being pro-choice?
Is my outrage over the election and its potential effects on women’s reproductive rights enough reason to get an IUD? Such an immediate, reactionary response feels a little like the 2008 “Obama’s going to take our weapons!” gun-sale rush. But in this case, I don’t believe women can take the “wait and see” approach to whether this is empty rhetoric or a legitimate threat.
Ali Wunderman, a San Francisco-based writer who has been married for 12 years, is in the process of switching from birth-control pills to an IUD. “One of the lessons I’m learning is to listen to the words people say,” she said. “It’s about survival, not hoping for the best, and when Donald Trump says he’s going to make reproductive rights more difficult, I’m listening.”
Before the passage of the ACA, Wunderman paid about $70 a month for birth control pills; after it was passed, her out-of-pocket costs dropped to zero. “An IUD is a good long-term option and, most importantly, I can be in control of my body and my reproductive system,” she said.
Though I am confident that long-term birth control is right for me, it’s not necessarily the solution for others. With that in mind, I spoke with several experts about other actionable measures women can take during the coming months and years:
- “Make it clear to the new administration that [contraceptive coverage] is important to women, and there is a political cost to taking it away,” said Borchelt of the National Women’s Law Center. “We’ve heard Donald Trump talk about keeping some of the most popular provisions of the ACA, so we need to make it clear that this is one of them.”
- Borchelt also noted that states are often at the forefront of progressive legislation. California and Vermont have even expanded on federally mandated benefits: “We’re trying to make sure states are enshrining those benefits in their laws, so if the federal benefit were to go away, there would be protections in those states.”
- Miller of the National Institute for Reproductive Health said: “Our state and local legislators do not hear from us enough. Do you know who your state representatives are and what their position is on these issues? You can find the answer easily and it’s worth knowing.”
- Miller recommended an all-hands-on-deck approach. “On social media, declare your public support for women making these decisions. The more we stand up and be clear that we’re not afraid or ashamed, the sooner we’ll see our trajectory back on track.”
- Lastly, Miller said, “Those who work at independent clinics don’t always get a lot of recognition, and face a daily barrage of harassment. Send them a simple letter or card that says, ‘Thank you for being here. What you’re doing is a service to our community.’ It’s a simple and powerful act.”
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