LOSING CONTROL

American women are getting birth control that will outlast Donald Trump

Obsession
2016
Obsession
2016

Late on the night of the US election, as Donald Trump’s victory was looking increasingly certain, a nurse in Colorado tweeted some advice to her female followers: “Get your IUD.”

Since then, many women in the US have done exactly that, or at least thought about it. In the first week after the election, Planned Parenthood saw a 900% increase in patients seeking IUDs. Women across the country are posting their IUD plans on social media, and exhorting their friends and peers to do the same. Indeed, as America gears up to inaugurate Donald J. Trump, a lot of Americans are considering birth control that could outlast his presidency.

“OB/GYNs…you know we’re a small community,” says Dr. Sarah Yamaguchi, a gynecologist at Good Samaritan Hospital in Los Angeles. “Everyone’s been getting a ton of calls from patients who want their IUDs.” Yamaguchi says there is “absolutely no question” the increase is tied to the election.

An IUD is a small, T-shaped device that gets inserted into the uterus, and can prevent pregnancy for up to 12 years. Although they’ve been around since 1909 (when a German physicist developed the first IUD made of silkworm gut), severe side effects from some of the first widely available models caused a lasting stigma, and IUDs were never wildly popular. It’s only in the past five years that use of long-term reversible contraceptives has commanded double-digit market share from any segment of US women (those aged 25-34, 11.1% of whom used an IUD in 2011-13).

Some of that increase can be attributed to pragmatism—IUDs’ efficacy doesn’t rest on remembering to take a pill every day, and they are statistically more effective than the pill, the patch, or hormonal injections—but some is also due to cost. Under the Affordable Care Act, insurance providers are required to cover a woman’s birth-control method of choice for free; at around $1,000 for insertion and follow-up visits, the IUD was price-prohibitive for many women before Obamacare.

Preparing for fewer options

“It just becomes about fear of having to make a decision that I don’t want to have to make ever again,” says Geneva, a 28-year-old artist and web designer in Los Angeles, who has had two abortions (“one because my birth control failed, and one because I was careless”). A freelancer, Geneva is worried that she’ll be unable to afford contraception if the ACA is repealed, which would put her at greater risk of an unwanted pregnancy.

Anxiety around reproductive rights is rational. Trump, vice president-elect Mike Pence, and House speaker Paul Ryan want to defund Planned Parenthood. Trump has tossed around the idea of punishing abortion patients. And on Jan. 13, the House passed a budget that clears the way for Congress to dismantle the ACA. New York Senator Kirsten Gillibrand had proposed an amendment to protect the birth-control benefit, but Republican senators shot it down.

The loss of the birth-control benefit could have far-reaching consequences. Politically, 77% of women (and 64% of men) approve of this component of the ACA. Financially, in 2013 the ACA helped women save more than $1.4 billion on the pill alone. Public health-wise, the proliferation of effective contraception has driven unwanted pregnancies in the US to a 30-year low. And economically, socially, and demographically, decades of research shows that access to effective birth control helps women finish their degrees, advance their careers, and narrow the wage gap. Moreover, couples with control of their reproductive futures are more likely to get along and stay together, and have good relationships with their children.

Still, birth control is meant to be a personal choice, not a political one.

“Women should not be coerced into choosing a method because they’re afraid that access to birth control is going to be taken away from them,” says Susan Berke Fogel, director of reproductive health at the National Health Law Program. “You can’t remove an IUD by yourself, you don’t have control over it…. There are women that feel uncomfortable with the idea that there’s a foreign object inside them. Those women shouldn’t have to get an IUD, right?”

To be sure, there’s a hard line between suggesting long-term birth control, and mandating it. Just last year, California governor Jerry Brown repealed a program that withheld income from welfare recipients who had additional children unless they had an IUD. An oped in Dame Magazine last week also reminded readers of the US’ dark and recent history with targeting low-income women and women of color for forced sterilization.

Whether or not everyone considering an IUD ends up getting one, it’s clear that anxiety over the next administration has reached American women (along with Muslim Americans, the LGBTQ communy, immigrants, the CIA, China, and so forth.)

“My first thought when Trump was elected…,” says Charlotte Hitz, a 21-year-old student in Los Angeles who has had an implant since last year. “I was really glad I already had my birth control in place.”

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