By Megan Carpentier
After Donald Trump won the presidency, Marivic Valencia promptly made an appointment with her gynecologist. The 44-year-old Madison, Wisconsin marketer decided that it was time to get her intrauterine device (IUD) replaced, and like thousands of women across the United States, figured there was no time to waste. Since November 9, there has been a monumental increase in interest in the birth control devices.
“I’d had one for the last 10, 11 years. It was time to either renew or think about something else,” she said. “I was looking at other options, and I just didn’t really feel like I had the time to explore all those other options.” Those included a vasectomy for her long-term partner or getting a tubal ligation, before the new administration took office. Unlike those options, an IUD—a small device inserted into the uterus through the cervix to prevent pregnancy—is an outpatient procedure that doesn’t require anesthesia.
Valencia isn’t worried that the U.S. is going to turn into some The Handmaid’s Tale-style dystopia under Trump; her concern is that Trump and the GOP will live up to their promises to repeal the Affordable Care Act, i.e. Obamacare, the health reform legislation President Barack Obama signed into law in 2010. After years of bouncing between being uninsured and getting health care coverage through employers, Valencia’s been using the statute to maintain consistent health insurance coverage. She’s one of an estimated 20 million Americans affected by Obamacare—including about 12.6 million who are using the health insurance exchanges.
“I’m on a health care exchange, and that’s a target. My whole family is on it,” she explained. “My concern was what my plan might look like.”
Valencia’s concerns are valid: Senate and House Republicans inserted legislation to defund many parts of the Affordable Care Act as part of January’s budget reconciliation process (a legislative maneuver that allowed them to avoid a Democratic-led filibuster in the Senate) even before President Trump took office, though it’s a non-binding resolution that doesn’t require his signature. They also defeated an amendment by Senate Democrats that would have required that the birth control mandate be maintained regardless of the status of Obamacare.
The budget resolution directs four committees to begin writing a full repeal, and Trump has promised to reveal his replacement plan soon—though his pick to run the Department of Health and Human Services, Rep. Tom Price of Georgia, isn’t scheduled for a confirmation hearing until Tuesday. Meanwhile, Trump signed an executive order immediately after his inauguration ordering his agencies to begin preparing for the Act’s repeal, and authorizing them to act to minimize its reach within the extent permissible by law.
But because the contraceptive coverage provisions have no budgetary impact and are a codified regulation with only a minimal religious exemption, the Obama Administration’s mandate that birth control must be offered with no copay through insurance plans as preventative care will not be affected by the first part of the Obamacare rollback.
However, there are other changes that Trump could make that could further impact women’s health care coverage, via the regulatory process or executive order—like the birth control mandate—long before Congress gets around to the “replace” element of Trump’s promise to “repeal and replace” Obamacare. Plus, it’s broadly expected that Republicans will somehow eliminate the birth control coverage mandate. Price, the pick to run the agency overseeing the law, said in 2012 that the mandate was a violation of the First Amendment right to freedom of religion, and not necessary to ensure any woman’s access to contraception. That mandate has been controversial among anti-abortion activists over the past six years. In 2014, it was subject to a successful Supreme Court suit involving the craft retail chain Hobby Lobby, which allows closely-held, for-profit companies with religious convictions to refuse to provide such coverage.
The possibility that the Trump Administration and a cooperative, Republican-led Congress will soon drastically alter birth control options has many women worried. “I used to pay about $30 a month prior to Obamacare, and that was with insurance,” Sarah Burris, a 31-year-old journalist in Washington, D.C. explained. She’d been mulling swapping her monthly birth control pill regimen for an IUD for months after reading several articles about their safety and efficacy, but opted to stay on the pill for medical reasons.
After the election, she called up her healthcare provider and made an appointment to get Mirena, one of four hormonal IUD options on the U.S. market. Mirena can remain in place for 5-7 years, while the Paraguard IUD, the only non-hormonal option, can remain in place for 10-13 years.
“Knowing it was something I would not have to worry about for the next 5 years was important,” she said. “But hopefully after 4 years I won’t really have to worry about it.”
IUDs Are Growing in Popularity
The number of women using IUDs in America has increased over the last 15 years, rising from just 2 percent of contraceptive-using women in 2002 to 10 percent in 2012. That’s lower than the international average of 14.3 percent of all women of reproductive age—and much lower than 17.1 percent of contraceptive users of reproductive age in Europe.
At least part of that usage gap likely comes from a lack of knowledge about IUDs and other long-term methods of birth control, which is particularly pronounced among women of color and low-income women. Researchers also attribute part of their unpopularity to the ongoing stigma among patients and medical practitioners caused by the defective Dalkon Shield IUDs in the 1970s, which caused widespread harm to users. The initially-popular Dalkon Shield’s defective removal string tended to encourage the spread of bacteria into the uterus, ultimately killing 17 women and causing 200,000 other women to get infections, become infertile, have miscarriages, and require hysterectomies. The current models have no such known defects but, until the no-copay contraception coverage of Obamacare went into effect, concerns about the safety of the devices were exacerbated by many insurance companies’ refusal to cover them.
Dr. Raegan McDonald-Mosley, the Chief Medical Officer at Planned Parenthood Federation of America, the largest women’s health care provider in the U.S., says that IUD use increased when the regulations implementing no-copay coverage for contraception went into effect.
“We have seen an increase in IUDs over the last few years, thanks to the Affordable Care Act, and growing public awareness of their safety and efficacy, and we expect that trend to continue,” she said. “Planned Parenthood health centers nationally have seen the total number of patients using IUDs increase 91 percent over the last five years.”
That increase has been dwarfed by the number of inquiries they’ve received since November 9. “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,” she added.
Kelly Baden, the 37-year-old state policy director at the pro-choice Center for Reproductive Rights in New York, was in the same boat as Burris. She’d been mulling having the device inserted prior to Trump’s victory, but she decided to take the plunge after his surprise win. “IUDs are pretty expensive,” she said. “The fear that we will lose no-copay contraceptive coverage some time in 2017 was the catalyst.”
Prior to the contraceptive coverage mandate, many insurance plans didn’t cover (or fully cover) IUDs for all female customers, leaving some women on the hook for the cost of the device and its insertion —which could be $500 to $1,000.
Her colleague, Kate Bernyk, the 34-year-old senior communications director at the Center, had the same experience prior to the passage of the Affordable Care Act. “The only reason I only got my IUD when the ACA regulations went into effect was because I couldn’t get the $700 up-front cost together beforehand,” she said. “Even though you know it’s cost-effective in the long run, that doesn’t mean you have the money.”
The rush to get IUDs now, while women still have coverage under Obamacare and the no-copay mandate is still in effect, is just one part of a growing concern among women who believe the Trump Administration will be uniquely detrimental to reproductive rights and health care access. From Republican promises to “defund” Planned Parenthood—which would prevent mostly low-income women from using their Medicaid insurance plans to access services, as well as restrict Planned Parenthood’s ability to get block grants to provide services—to their hostility to Roe v Wade, many are increasingly concerned that the next four years could result in significant rollbacks to reproductive rights.
“Every single woman that I know is thinking about reproductive rights and the challenges to it,” said Valencia. “Every person that identifies as a woman is thinking about how to medically defend and support their reproductive choices for the next four years.”