The day after President Donald Trump’s inauguration, millions of women of all ages marched in the streets of major cities. In the past few months, there’s been another, quieter march that’s far more personal, yet still political.
If you’re not a woman of childbearing age or a health care provider, you might not have noticed it. Since the election, women have been seeing their gynecologists and visiting Planned Parenthood offices specifically to ask about birth control.
Why the rush? For starters, if the Affordable Care Act is repealed, as Trump has promised, contraceptives could get a lot more expensive. Since 2012, the ACA has required that private health insurance plans cover prescription contraceptives with no cost-sharing for patients.
But cost isn’t the only concern. Women see a Congress that is threatening to defund Planned Parenthood, a vice president who has promised to restrict access to abortion, a Supreme Court nominee who could be hostile to women’s health care — and they want to do whatever they can to avoid an unplanned pregnancy in the next few years.
For some, the best options are an IUD, a small T-shaped device that is inserted into the uterus, or Nexplanon, a hormonal implant that goes in the arm. Aside from being the most effective forms of reversible birth control on the market — with failure rates of under 1 percent — they have another attractive selling point. For most women with health insurance, they’re free. And certain versions can outlast a presidency.
Dorothy, a 25-year-old law student in Washington who spoke on condition that only her first name be used, got an IUD for the first time last week. “I keep joking that what I’m doing is Pence-proofing my uterus,” she said.
Health care providers and analysts are quick to note that the use of IUDs and Nexplanon — which can last from three to 12 years — was growing long before Trump was elected. But, health providers add, a lot of women are concerned about losing benefits and are making long-term decisions as a result. When faced with uncertainty over coverage and access to care, they’re choosing the most certain yet reversible option.
A report last month found a 19 percent increase in the number of doctors’ visits related to IUDs from October to December 2016. Planned Parenthood notes that IUD use has grown 91 percent in the past five years, with a steeper spike recently: “In the first week after the election, Planned Parenthood saw a significant increase in appointments for birth control, with a nearly tenfold increase in people seeking IUDs — and we continue to see higher than average numbers,” Raegan McDonald-Mosley, chief medical officer at Planned Parenthood Federation of America, said in a statement.
It’s a personal decision that lots of women are being public about. They’re sharing links on Twitter about how much an IUD would cost if the ACA were repealed (around $1,000 in most states); they’re posting images of their IUDs and prompting their Facebook friends to AMA (or “ask me anything”) about what it’s like to get one inserted. The short answer: Insertion can be painful, side effects vary, and they’re not for everyone. Among women in their 20s and 30s, birth control decisions have become part of everyday “How’s it going?” conversation.
Whether or not they’re keeping data, doctors’ offices are also anecdotally reporting an IUD rush. Julian Safran, a doctor at Capital Women’s Care in Washington, says that demand for IUDs since the election has been “huge,” estimating that his offices has been doing about three to four times as many insertions as compared to before the election. Dana Shanis says her gynecological practice in Philadelphia, which has a high concentration of professional women in their 20s to 40s who are delaying childbearing, has also seen a “huge bump” in women getting IUDs and Nexplanon. “Women in my practice are definitely concerned about what’s going to happen to their insurance,” Shanis said, noting that her office used to order 15 to 20 IUDs at a time and now they’re placing orders of 50 at a time.
Some women who were on the daily pill, monthly Nuvaring or quarterly hormonal injection have decided to move to long-term birth control while it’s still covered. For the past five years, Rebecca Ullrich, a 28-year-old policy analyst in Washington, was on the Nuvaring, a contraceptive ring that sits inside the vagina and is replaced every month. “I really liked the medication I was on,” Ullrich said, but the Nuvaring would be about $90 per month if it weren’t covered by her insurance.
The week after the election, she had her annual exam and asked her gynecologist about getting an IUD. The next month, she got a Mirena, an IUD that lasts for five years. Mirena was completely covered by her insurance. “It’s just nice to know that I’m not going to have to worry about that expense,” she said, but added that Mirena isn’t quite as good at controlling her menstrual cramps as the Nuvaring was.
How likely is it that the no-cost coverage of birth control, one of the hallmarks of ACA, will disappear? It’s a popular policy. Seventy-one percent of Americans support laws requiring health insurance plans to fully cover the costs of birth control, according to a survey from the Kaiser Family Foundation. But there’s no guarantee it will stick around. Rep. Tom Price, R-Georgia, Trump’s nominee to lead the Department of Health and Human Services, could take actions to roll back birth control coverage. “It’s definitely at risk,” said Usha Ranji, the associate director of women’s health policy at KFF, while also noting that required coverage of birth control has made quite an impact in the short amount of time it’s been in place.
Dorothy, the law student, acknowledges that many others are worse off than she might be. “A lot of people — including me — are worried about losing basic bodily autonomy. Even if Roe v. Wade were struck down, I could probably figure something out,” she said. “I think there’s a lot of uncertainty in a lot of communities right now. People are scared.”