IUDs take on new urgency in the Trump era

Convenience, effectiveness and cost: all reasons women often choose intrauterine devices, IUDs, as long-term birth control. But this year, one additional incentive has been added to the list: uncertainty surrounding health care policy.

After the election of President Donald Trump, and again after the inauguration, Google searches for IUDs spiked. As Trump promised to repeal the Affordable Care Act, women encouraged their friends to consider long-term birth control.

“When I found out Trump was going to get elected — I luckily got my IUD before that — but as soon as that happened, my friends blew up my phone about IUDs,” said University of Iowa senior Lucy Korsakov.

Photo by Jordan Sellegren

Korsakov happened to have her ParaGard copper IUD, effective up to 12 years, inserted shortly before the election. The procedure was completely free to her after applying her insurance, but can cost anywhere from $0 to $1,000 depending on an individual’s plan. Under the Affordable Care Act, patients do not face out-of-pocket expenses for birth control services or supplies from providers within their network. According to one study in the journal Contraception, nearly 60 percent of women would have seen an out-of-pocket expense for an IUD in January 2012, before the act took effect, while only 13 percent would have seen out-of-pocket expenses in 2014.

Korsakov said many of the women who contacted her were scared of the perceived risk and pain associated with getting an IUD.

“It hurts like a bitch to get put in, I am not going to deny that, but it’s so worth it,” she said. “I’m covered through the Trump presidency and beyond, even if he’s there for eight years.”

Although University of Iowa Student Health & Wellness was without a gynecologist from July 2016 until early February, their clinic saw a 50 percent increase in IUD placement from 83 IUDs placed in 2015 to 124 in 2016, according to Lisa James, the student health associate director for clinical outreach. Some of the student health center’s primary care physicians were trained to place IUDs to meet the demand until the gynecologist position could be filled.

“They got refresher training just because we didn’t know how long we’d be without a gynecologist,” James said. “The demand played into that though, having more MDs who could do gynecology procedures.”

Planned Parenthood clinics in Iowa and Nebraska inserted 375 IUDs between mid-November and mid-January this year, also an almost 50 percent increase, according to Rachel Lopez, Planned Parenthood of the Heartland’s public relations manager. The clinics inserted 252 during the same time period the year before.

“We do recommend women making their reproductive health care a priority as we continue to see attacks on women’s health,” Lopez said.

Before the election, UI freshman Emily Stagman noticed posts on the social media platform Tumblr encouraging women to get IUDs placed immediately. Her mom called her the day after the election and insisted she get an IUD and then repeatedly called asking if she had scheduled an appointment.

“I think her actual words were, ‘Get off your ass, Princess,’” Stagman said.

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In January, she switched from a birth control shot, administered once every three months, to Mirena, a hormonal IUD that lasts up to five years and for which she faced no costs after insurance. Stagman encouraged her friends to do the same.

“I know my friends are on birth control, but those are just pills, and I don’t know how well that’s going to work out,” she said. “I’m still pushing them.”

IUDs, along with contraceptive implants, have been shown to be the most effective, reversible contraceptive measures, with a failure rate of less than one percent for both so-called perfect-use cases and for typical usage, according to data from the Guttmacher Institute, which advocates for reproductive health rights. This compares with pills and other options like hormonal patches and vaginal rings, which, under perfect circumstances, have failure rates of less than one percent, but typically are about 91 percent effective. Condoms, under typical use, have a failure rate of 18 percent.

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Information gathered from CDC, World Health Organization and Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs.

Advocates for women’s reproductive health care criticized political actions that have created uncertainty about future coverage.

“I think it’s sad that women feel like they need to rush to get essential medical treatment because of who is in the White House and, quite frankly, who is on the state legislature, to be perfectly honest, for fear that their access is going to go away soon,” State Rep. Amy Nielsen (D-North Liberty) said.

A bill passed by the Iowa Senate in early February would eliminate the Iowa Family Planning Network, a program that provides around $3 million to entities across the state — mostly in federal money — through a Medicaid waiver. The network would be replaced by a state-funded program, and entities that provide abortions would not receive funding.

“There’s not only Planned Parenthood but a lot of small community health clinics that are going to be in some trouble,” Nielsen said.

The bill is expected to make it through the Iowa House and be signed by Gov. Terry Branstad.

Kirkwood Community College student and full-time Hills Bank employee Liz Louis, 25, was among those whose decision to switch forms of birth control was influenced by the political uncertainty.

“I never realized how much the ACA affected me,” she said.

Louis said she was dissatisfied with her arm implant — a form of birth control that lasts about three years — but was in no particular hurry to change forms of birth control. After the election, she asked her gynecologist to replace it with Mirena.

She said she does not consider herself a political person, but studied the ACA more closely after the election. She was surprised when her gynecologist told her IUDs like Mirena and the ParaGard copper IUD, which she also considered, were free to her because of the ACA.

“I was going to wait it out for a while, but after the things that happened with the ACA, which was the reason I initially got the implant completely free, I decided it was time to switch it and go with something a lot more long-term,” Louis said.

Iowa City private gynecologist Margaret Smollen said she understands why uncertainty surrounding healthcare is leading some women to consider IUDs but believes it’s important that they ultimately make the decision for themselves.

“Their needs and risks supersede whether their insurance will cover it,” Smollen said.

Still, Smollen said IUDs are a good option for many women, and she is hopeful coverage for IUDs will still be provided, “though it may not be exactly the same.”

Carly Matthew is a soon-to-be University of Iowa Journalism School graduate. This article was originally published in Little Village issue 216.