When it became clear in the early morning hours of November 9 that Donald Trump was the president-elect, Google searches for the term "IUD" spiked to all-time highs. Related searches, like "IUD options" and "should I get an IUD," increased by 800 percent and 200 percent, respectively. On social media, urgings spread for anyone capable of getting pregnant to get a long-acting form of contraception—immediately.
IUDs and contraceptive implants, together known as LARC (long-acting reversible contraception), can last anywhere from three to 12 years, meaning they could outlast potential cuts to reproductive healthcare and abortion access under a Trump-Pence administration. They're expensive upfront—running anywhere from $500 to $1,000—but the Affordable Care Act's (ACA) contraceptive mandate requires that most health insurance plans cover them completely. Now, while the ACA still stands, is the perfect time to get one.
But that rush has put a strain on clinics that lack both the materials and healthcare providers to keep up with the demand.
In the aftermath of the election, Planned Parenthood has been inundated requests for IUDs. Its health centers have seen a 900 percent increase in online appointments made for birth control, specifically IUDs, from this time last month. Other reproductive health providers across the country have seen a similar uptick in interest.
"We definitely saw a quick increase in calls first thing in the morning after the election," said Dr. Anne Davis, consulting medical director of Physicians for Reproductive Health and a professor at Columbia University.
The interest is not entirely new: Use of LARCs, especially IUDs, has risen dramatically in the US over the last two decades. After a deeply flawed IUD called the Dalkon Shield caused extreme complications for hundreds of thousands of users in the 1970s, IUD use ceased almost entirely in the US. But safer and more effective IUDs, along with research disproving the misconception that IUDs were only appropriate for those who had already had children, led to a renaissance. According to the Centers for Disease Control, 11.6 percent of women currently using contraception in the US rely on a LARC, up from just 2.4 percent in 2002. A 2015 study estimated that in the absence of barriers, like cost and lack of properly trained providers, 25 to 29 percent of contraception users would choose a LARC.
Clinicians point out that the Affordable Care Act played a crucial role in the LARC's rise. "Five years ago before the ACA was fully implemented, there was hesitation to include long-acting methods in discussions with patients because a lot of the time they weren't covered," Davis told me. "The average young woman doesn't have $800 or $1,000 upfront to get her birth control. Now, usually they are covered, so the conversation has really been focused on what's right for the patient."
While the ACA expanded access to LARCs and other reproductive health services, aggressive state-level attacks on abortion providers simultaneously created new problems. More than 280 state-level abortion restrictions have been enacted since 2011, and at least 162 abortion clinics have closed in that time. In addition to providing abortions, these clinics also tend to be frontline providers of birth control—so when they go, so do the people who can insert IUDs.
Susan Rawlins, the director of education for the National Association of Nurse Practitioners in Women's Health, has seen this firsthand. She treats patients at the Greater Texoma Health Clinic in Denison, Texas, a primary care practice that serves uninsured and underinsured patients, where she is one of only two practitioners trained to place IUDs and implants. There is no family planning clinic in the area, so the primary care clinic where Rawlins works is the only place to get a LARC aside from far more expensive private OB/GYN offices.
"In primary care settings there are often limited providers who have the knowledge and skills to place LARCs," Rawlins, who trains other health care practitioners in LARC placement, told me. "What concerns me is that we may not have enough skilled and capable providers to meet the need."
Dr. Leah Torres, an OB/GYN in Salt Lake City, Utah, echoed that sentiment. "My biggest concern is about those providers who don't normally provide LARC. Where will their patients go? Will those who have patients in need seek training, or start providing them despite personal beliefs that might conflict with that practice?" she told me.
In 2011, only 56 percent of gynecologists, family practitioners, and adolescent medicine specialists in private practice offered onsite IUD placement, and only 32 percent offered implants. Those numbers have likely increased at least somewhat since then, given urgings from several medical associations that LARCs be recommended as the most effective contraceptive method for teens and adults. But in many communities, already embattled reproductive health clinics are still the place to go if you need a LARC. In the event of changes to the ACA, those who lose coverage will likely fall back on these clinics as well.
Though Trump has eased off on his threat to repeal the ACA, he could still scrap the contraceptive mandate. The law relies on the Department of Health and Human Services to decide what counts as preventive care, so the Trump administration could potentially remove birth control from the list of preventive services, even without Congressional approval.
"Donald Trump hasn't held elected office before, so we don't know exactly what his presidency will look like. But we do know what a state under our governor, and now vice president-elect, Mike Pence looks like," Ali Slocum, communications director for Planned Parenthood of Indiana and Kentucky, told me. Pence's greatest hits as Indiana's governor include repeated attempts to defund Planned Parenthood and harsh abortion restrictions.
Nearly all of the providers I spoke with said that, on one hand, anything that gets more people to consider LARCs is a potential positive. But no birth control method is right for everyone, and no one should feel the need to make an important health decision solely based on fear.
"I can't blame people. We've seen attacks on access to contraception before due to dogma that has no basis in medical practice," said Torres. "But instead of making a rash decision about contraception, take ten minutes to contact your legislators and tell them that you do not want your health care compromised."
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