Access to contraception is coming under attack, and reproductive-health advocates are scrambling to find ways to protect it. In December, Obama did what he could to protect Planned Parenthood from losing its ability to serve Medicaid patients. In New York, the state’s attorney general has moved to ensure that New Yorkers will continue to receive no-copay birth control as part of their insurance benefits, and Massachusetts moved to defend Medicaid patients’ right to use Planned Parenthood’s services in the event of federal interference. And, across the country, people at risk for unintended pregnancy are clamoring for highly effective, long-term birth control to see them through the next four tumultuous years.
IUDs and implants can help you and your uterus make it through the Trump administration.
Tom Price, who was confirmed as secretary of health and human services last month, represents the most immediate threat to our birth-control access. As HHS secretary, Price has the power to declare that contraception is not a “preventive” service insurers must make available to their customers with no copay. In one fell swoop, Price could undo the enormous progress the Obama administration made in expanding access not just to all forms of contraception, but to highly effective forms of contraception that had for so long been out of reach to so many.
Before the Affordable Care Act, long-acting reversible contraception (LARC) methods like IUDs and implants were known to be highly effective — not just cost-effective, but also simply the most effective in terms of preventing pregnancy. However, the high upfront costs closed the door to many potential users. Let’s do some quick-and-dirty math: A copper IUD could set you back anywhere from $500 to $932, but it lasts for 12 years. That means it costs $3.50 to $6.50 per month, compared to the Pill, which can cost $10 to $50 a month out of pocket. Clearly, the IUD makes the most financial sense, but for many of us, a medical bill charging upward of $500 doesn’t fit into our budgets. Better to rely on methods like the Pill, which cost more over time, but aren’t as hard on the wallet of someone living paycheck to paycheck or on an otherwise tight budget.
The Pill is great, of course, but for many of us, IUDs and implants can be even better. According to the Centers for Disease Control and Prevention, the implant has a vanishingly slim 0.05 percent failure rate, while hormonal IUDs have a 0.2 percent failure rate, and the copper IUD has a 0.8 percent failure rate. Compare that to the Pill, which with typical use has a 9 percent failure rate. Put another way, over the course of a year, a typical birth-control pill user is 180 times more likely to get pregnant than an implant user, 45 times more likely to get pregnant than a hormonal IUD user, and 11 times more likely to get pregnant than a copper IUD user.
Because unintended pregnancies lead to so many extra health costs, it made sense on a societal level to give people at risk for pregnancy easier access to far superior contraceptive methods like LARCs. A population-wide shift away from methods like the Pill and toward LARCs could mean a significant decline in unwanted pregnancies — an outcome that should delight both abortion opponents as well as those of us interested in our ability to control our own fertility and future.
The good news is that, for the time being, zero-copay birth control is likely safe throughout the remainder of 2017. The repeal of the ACA is likely to be a long and tedious process, and unless Congressional Republicans and the Trump administration can find a loophole, they won’t be able to make changes to it until 2018. That means that obtaining a LARC might be a good candidate for a (belated) New Year’s resolution. And, for a lot of folks with fertile wombs, November’s election results spurred them to make appointments with their gynecologists for IUDs and implants — methods that can see them through the Trump administration. Planned Parenthood reported a 900 percent increase in appointments for IUDs in the wake of the election!
Contemporary IUDs are one of the most effective birth-control methods out there, with failure rates of less than 1 percent. They are inserted into the uterus, where they release their active ingredients. They’re the most popular type of birth control among female health care providers, and the general population is following suit, with more and more of us choosing IUDs over other types of birth control every day. IUDs work by preventing sperm from meeting the egg, and are rapidly gaining popularity as access expands and word of mouth spreads like wildfire.
IUDs come in two “flavors”: nonhormonal and hormonal. Nonhormonal IUDs are made with copper, while hormonal IUDs contain levonorgestrel, a type of progesterone. The copper IUD (Paragard) can last for 12 years, which will protect you throughout the nightmare scenario of eight years of Trump followed by a single Pence term. There are two hormonal IUDs: Mirena and Skyla. Mirena is approved for five years, but a recent study found that it’s actually effective for seven years — meaning it can get you through nearly two terms of a Trump administration. If you’re feeling more optimistic about the results of 2020’s election, you can check out Skyla, which lasts for three years.
But if you’re optimistic enough for a three-year birth-control option like Skyla, you might want to get acquainted with Implanon. The birth control implant also lasts for three years but is even more effective than the IUD, making it an excellent choice for those of us who are optimistic about what 2020 will bring — or who think they will be ready to start or continue their families by then. During a minor outpatient surgery on your arm, a skilled provider will place a matchstick-sized implant under your skin.
Most of us hope the 2020 presidential election will put us back on the upward trajectory toward justice that we were proudly marching on during the Obama years. When the Oval Office is once again occupied by someone who values people’s ability to make their own decisions about their lives, futures, and bodies, we will all be better off. Until then, a LARC might offer you some peace of mind during the next four years, when our access to birth control, abortion, and affordable health care might slip through our fingers.
To learn about IUDs, the implant, and other types of birth control, make an appointment at your local Planned Parenthood, where a health care provider can review your options with you and help find something appropriate for your lifestyle and preferences. If you have health coverage through Medicaid or private insurance, you should be able to obtain birth control at no cost to you.