Dr. Stacey Leigh Rubin has noticed a change in her obstetrics and gynecology practice since Election Day. Before Donald Trump beat Hillary Clinton in the presidential race, Rubin saw two to three women a week at her Baltimore office who wanted long-acting reversible contraceptives. But with the chance that contraceptive care could become more expensive and less accessible under a new administration, that number has increased fivefold.
Rubin isn’t alone. It’s too early to round up concrete data telling us how many women have decided to switch from methods such as birth control pills to long-acting reversible contraceptives since Trump’s election, but multiple stories like hers have come to light.
In 2012, a mandate under the Affordable Care Act went into effect requiring that all health care plans cover contraceptives. Opponents of the rule say it isn’t the government’s or employers’ job to pay for birth control, but according to a 2013 survey by the Journal of the American Medical Association, most Americans support the mandate. Still, the president-elect and the GOP lawmakers in control of Congress could amend the ACA to remove this coverage — though it’s unclear what changes are coming for the ACA and what they’ll mean for contraceptive access.
“These are real concerns that women have,” Rubin said of her patients. “They’re scared and anxious. They want to talk about it.”
Long-acting reversible contraception, or LARCs, have grown more popular since the early 2000s, and that trend has continued since the mandate went into effect. This category includes intrauterine devices, or IUDs, and hormonal implants, which are options for women who don’t want to get pregnant in the near future (they can last three to 12 years).1 According to a report from the American Congress of Obstetricians and Gynecologists, LARC methods are 20 times more effective than birth control pills, patches or rings over the long term. About 12 percent of women who use contraceptives were using one of these methods in 2011-13, the most recent data available from the National Survey of Family Growth shows.2
These birth control methods have never been nearly as popular as shorter-term methods. According to 2012 figures from the Guttmacher Institute, a policy and advocacy organization focused on reproductive health, 25 percent of women who used contraception used a birth control pill, 25 percent had undergone tubal sterilization and 15 percent used condoms.3 But this represents a comeback for LARCs. In 1982, 4 percent of all U.S. women ages 15 to 44 reported using LARCs, according to the survey data. These were the early days of LARCs. The big issue in this arena in the 1970s was an IUD called the Dalkon Shield, which was taken off the market after it was found to be dangerous, causing pain, infection and, occasionally, infertility or death. By 1988, LARC use had dropped to 1.4 percent. There was no change from 1988 to 2002, but then the LARCs that women use now started popping up, more comfortable and less problematic IUDs and implants. The share of women of reproductive age who used LARCs doubled from one study in 2002 to another in 2006-10, which brought it back to 1982 levels. Then it nearly doubled again for 2011-13.
Part of this trend results from the increase in availability and quality of LARCs, but it’s also tied to affordability. Out-of-pocket costs for LARCs — without the coverage provided by the contraceptive mandate under the ACA — can hit $1,000 and the birth control pill can cost up to $50 a month. Under the ACA, both have to be provided for free (with some exceptions).
According to multiple research articles, the increase in LARC popularity under the ACA is simple: Women use LARCs if they can afford them. And one report shows, unsurprisingly, that a woman’s willingness to pay more for different birth control options depends on her financial stability.
We still don’t know if, how or when a Trump administration would limit access to birth control. It won’t happen immediately, if it happens at all. But many women aren’t taking any chances.