T
he day after School of Information senior Nicole Zeffer
watched president-elect Donald Trump win the general
election on Tuesday, Nov. 8, she placed a call to Univer-
sity Health Services to make an appointment for an IUD con-
sultation.
“It’s upsetting to me because it’s a step in the wrong
direction, when I thought there would be a step in the right
direction,” Zeffer said.
IUDs, short for Intrauterine Devices, along with implants,
comprise the long-acting reversible contraceptives (LARC)
category of contraception methods currently available.
According to the American Congress of Obstetricians and
Gynecologists, IUDs and implants are the most effective form
of reversible birth control on the market — more than 20 times
more effective than birth control pills, the patch or the ring.
However, a study published in 2015 by international
reproductive health journal Contraception found that just 12
percent of women were using LARC methods of contraception,
compared to 41 percent of female family planning providers
and professionals.
But in the wake of the election, that might be changing.
Zeffer is just one of many women across the United States to
take part in a sudden uptick of research and interest in LARC
contraception resources following the election of Trump. In
the hours following the election, Google saw a nationwide
spike in searches related to IUDs (in addition to upticks in
donations and interest at Planned Parenthood clinics and
gynecologists).
This sudden interest in IUDs and implants may be
explained in part by the uncertain future of President Barack
Obama’s Affordable Care Act, which included coverage for
contraception, under a Trump presidency.
The ACA, commonly known as Obamacare, requires
health insurance companies to cover at least one form of
birth control from each category of contraception, including
LARC, hormonal and barrier methods. However, during his
presidential campaign, Trump has alternately threatened to
either fully repeal or modify Obamacare, taking that coverage
away and potentially leaving women with the full cost of an
IUD, which can range from anywhere between $500 and $900
dollars.
Concerned over whether their health insurance plans will
cover contraception as soon as Jan. 20, women on campus
and throughout the country said they are seeking IUDs and
implants in particular because, once inserted, they last between
three and ten years — enough time to last at least one term of a
Trump administration.
***
Susan Ernst, an obstetrician gynecologist and current chief
of the Women’s Health Clinic at UHS, says there has been a
clear increase in interest in IUDs on campus.
Immediately following the election, Ernst, who also works
in the Medical Center’s gynecology department, said she has
seen — and continues to see — a sharp increase in demand for
LARC contraception.
“Since the election, we’ve even had patients coming in and
saying, ‘You know I’ve really been thinking about doing this for
the last six months to a year, but now I really want to get it done
because I’m worried about the coverage,’” Ernst said, adding
that she’d even seen a patient, who already had an implant
in her arm that would last for another year, request that she
have it removed and replaced with a new one because she was
concerned that in the next year, her insurance would no longer
cover the implant.
Before the election, Zeffer had been using hormonal birth
control pills, but she considered switching to an IUD after
experiencing unwanted side effects from them. After the
possibility that her health insurance plan would no longer
cover contraception as soon as January 20, Zeffer made up her
mind and scheduled a consultation.
“With Trump now being the president of the United States,
there’s the risk that Obamacare will get repealed at some point,
and then hormonal birth control pills will become unaffordable
for me and likely a lot of other people in the U.S.,” Zeffer said.
Ernst said she wasn’t quite sure whether the coverage would
go away, but noted that the concerns were valid.
“We don’t know what’s going to happen, but it is a little bit
concerning,” Ernst said.
Ernst did note one positive in the situation — she said
she was glad to see more students taking interest in LARC
contraception because the clinic had already been promoting
and counseling patients who use their sexual health services
to consider IUDs and implants long before the election. Health
care providers in the sexual health clinic favor LARC methods of
contraception, she said, because they are highly recommended
for adolescents by major medical organizations such as the
American College of Obstetricians and Gynecologists.
IUDs and implants are highly effective and require no
upkeep from women who use them until they need to be
removed or replaced — a term healthcare professionals have
coined “fit and forget,” according to Ernst. She added that
this aspect of IUDs and implants largely accounts for the
high efficacy of LARC methods in comparison to other forms
of birth control. The efficacy of the pill decreases as women
forget to take it on time, whereas an IUD or implant leaves
room for little to no human error.
Zeffer said for her, the last aspect was the most important.
“An IUD is really nice because it’s just one of those things
that you can put in and most likely not have to worry about,”
Zeffer said.
Because LARC methods of contraception have been
increasingly promoted for adolescents by major medical
organizations, Ernst added, UHS has increased its LARC
insertion training over the past few years so that there are
currently six different providers within UHS certified to insert
implants and IUDs.
“We already increased our capacity with the hope that
people would pick up or accept this method more readily,”
Ernst said.
She pointed to a report published in 2014 by the National
College Health Assessment and the American College
Health Association that found that just 6 percent of
undergraduates used LARC methods of contraception at the
time of last intercourse. Now, she says the number is around
15 percent, simply by the word of mouth about their safety and
effectiveness.
However, she also noted that campus would not be immune
from the possible elimination of contraception from many
health insurance policies that would come with a repeal of the
ACA.
Currently, women using the Sexual Health Clinic at UHS
have all services, such as consultation appointments and STI
labs related to IUD insertion, fully covered by their tuition.
Students are only responsible for paying for the IUD, which
can be several hundreds of dollars if not covered by their
insurance.
“I’m really disappointed and concerned and hope that,
as a group, women can make their voices heard to the new
administration that we think this is something important for
the health of women,” Ernst said.
She added that this election cycle has affected more than just
women’s sexual well-being, noting she has seen an increase in
depression scores among women visiting UHS.
The University’s Counseling and Psychological Services
has similarly experienced an increase in stress and anxiety
surrounding the election.
“We’ve seen a number of patients who have had higher
depression scores or even refused to fill out the depression
scoring sheet because they say they’re so upset about the
election they just can’t even go there,” Ernst said. “They know
that it would look like they have depression if they filled it out
because they’re so upset about the election.”
***
LSA senior Shannon Stone got her IUD from UHS last
year after she decided hormonal oral contraceptives were not
for her, mostly because of her busy schedule and a fear that
she wasn’t taking the pills at the right time. She said she’s
concerned about the current policy climate surrounding ACA,
especially because her IUD will be removed one year before
Trump’s term ends.
Since Trump’s election, she said she’s served as a resource
for many of her friends who are looking into getting an IUD.
But while she is glad she decided to get an IUD, it angers her
that many women are making the decision to get an IUD not
out of choice but out of fear.
“I love my IUD, but I don’t want someone who doesn’t want
one to get one,” Stone said. “It’s an option and I’m glad that it’s
the option that I chose, but it makes me sad that other women
have to choose it out of necessity or out of fear. I think that
making decisions about our bodies out of fear is a horrifying
reality.”
Nursing senior Rachel Cannon obtained her IUD two
months before the election, mainly because of negative side
effects she was experiencing as a result of hormones in oral
contraceptives. She said she felt comfortable undergoing
the insertion procedure at UHS because she was referred
to a provider by a friend, who told her this specific provider
inserted roughly four IUDs per day.
As the reality of a Trump presidency became clear to her
on election night, she felt relieved that her IUD would last for
the next 10 years — enough time to cover a two-term Trump
presidency. However, she said she remains concerned for the
future of family planning and birth control coverage in the
United States.
“Taking away free contraception is just going to result in a
lot of unintended pregnancies, in my opinion,” Cannon said. “I
think that seems like a logical conclusion to draw, and I feel
like if it was very expensive or not covered through insurance,
some people just wouldn’t use birth control at all.”
•••
Reflecting on these past few weeks, Zeffer said although
she is upset by the sense of urgency she feels to protect herself
following Trump’s election, she is most frustrated by the fact
that there are others who don’t have the resources to protect
themselves.
“As much as it upsets me that I have to watch out for my
own personal health, it upsets me more that there are so many
other people out there that aren’t as fortunate as me and that
are being affected more by this election,” she said, citing those
who currently may not have health insurance and therefore
can’t afford an IUD.
As she prepares to take a step many other women nationwide
are considering as well, she said she is both comforted and
bothered by her upcoming IUD consultation appointment at
UHS.
“I still have the option of going to my doctor and getting a
free IUD before Trump becomes president.”
Wednesday, December 7, 2016 // The Statement
6B
Getting Covered: Before a new White House, women turn to IUDs for security
by Lara Moehlman, Deputy Statement Editor