On Friday night, Emily Blackshire was eating homemade pizza with her family when her phone buzzed with a push notification. She looked down and learned Supreme Court Justice Ruth Bader Ginsburg had passed away. “My first thought was, ‘Oh my God, this is grim,’” the 26-year-old law student says. Her second thought? It might be time to finally get that intrauterine device (IUD) she’s been considering for a year.
Blackshire, who lives in South Carolina, knew that if another conservative justice was appointed and confirmed to the Supreme Court, it could be bad news for both the Affordable Care Act and the landmark 1973 Roe v. Wade decision that legalized abortion in the US. It could ultimately mean more restrictions on access to abortion in the future, and insurance coverage of birth control.
“I don’t want to bring a child into a world that’s on fire,” Blackshire says, referring to several of the disturbing issues currently at the forefront of the nation's consciousness: the pandemic, the ongoing incidences of racial violence, and the recent allegations of mass hysterectomies being performed on detained people at the U.S. Immigrations and Customs Enforcement. “I’m actively seeking a gyno to get an IUD."
Blackshire isn’t the only one thinking about long-acting reversible contraceptives (LARCs) right now. Since Ginsburg's death, many people on (and off) social media are encouraging each other to “get ur IUDs now,” before it’s too late.
A similar thing happened after the 2016 election, when it seemed like Trump could do away with the Affordable Care Act and its mandate that calls on insurance plans to cover all methods of birth control. There was a measurable increase in the insertion of long-acting reversible contraceptives in the 30 days after the 2016 election, compared with the same time period in 2015, the Journal of the American Medical Association reported. Anecdotally, Heather Bartos, MD, an OB/GYN based in Texas, says she saw a similar uptick in inquiries to get or replace IUDs right after the election.
"I actually rushed to my OB/GYN and got a new IUD when Trump was elected," Annmarie Colonna, 34, of New Jersey, tells Refinery29. "And while this one is still good for a few more years, I'm recommending it to all my friends and won't hesitate to get a new one should things go Handmaid's Tale."
“It is clear that people’s decisions about their birth control method can be influenced by fears about what’s happening in politics,” says Rachel Fey, the senior director of public policy at Power to Decide.
"And right now, the threat to the Affordable Care Act is acute,” Fey adds, referring to the Supreme Court case California v. Texas, which threatens the Affordable Care Act and questions its constitutionality. Oral arguments will be held on November 10 to decide the future of the ACA as we know it. “And we've already seen the Supreme Court uphold the Trump birth control rules,” Fey continues. In July, the Trump v. Pennsylvania ruling came down saying that employers could deny birth control coverage under the ACA due to "moral" or religious objections, a decision that affected as many as 126,000 employees. “Already, because of who they work for, some people don’t have coverage of the birth control they need,” Fey says. “In general, without insurance coverage, even the pill can cost hundreds of dollars a year and an IUD without insurance can cost as much as $1,000.”
Blackshire, and many folks in their reproductive years, are savvy to this. “Right now, an IUD would be covered by my school insurance plan, but that won’t be the case in seven months when I graduate,” Blackshire says. “The possibility of not having options scares me.”
When you consider that the future of both abortion rights and the ACA could hang in the balance, it’s not hard to explain the drive on social media encouraging folks to get IUDs. But should you really get one? After all, birth control is a personal choice, and what works well for one person might not be the best fit for another.
Everyone I spoke to for this story talked about the perks of the “set it and forget it” aspect of LARCs. They can be extra-effective and are user-friendly, because you don’t have to remember to pop a pill at the same time every day. They can also last between three and 12 years, which can be reassuring if you think you could find yourself without coverage in the near future and want to avoid pregnancy.
Still, LARCs aren’t the best option for everyone, and some women can’t use them for medical reasons, for example, if they have a blood clotting disorder, Dr. Bartos says. “I think IUDs can be a great choice for many," Dr. Bartos says. "But they can cause irregular bleeding for some, and if you use the non-hormonal ParaGuard, it can cause heavier periods for some. Not every option works for everyone.”
It’s worth having a conversation with your doctor about what contraception method is right for you. “Just because everyone is wearing Manolos, it doesn’t mean that those are going to fit your feet,” Dr. Bartos says. “Birth control is like that. It shouldn't just be about how long it will last or what your friends are doing. You don’t want to get a method that you don’t love or that doesn’t work for you. You might just end up taking it out in a year because of side effects.”
Still, it’s undeniable that if you’re worried you won’t be able to pay for birth control, making the best choice for your body is less of an option.
“One of the many important things the ACA did was cover all FDA-approved methods of birth control without co-pays so that [people] could make the right decision about the method that works for them without having to make that decision based on what they could or could not afford,” Fey says.
Another thing to consider: “There’s a long history of coercion in which IUDs have been pushed on particular women, women of color, low income women, in a means to restrict their fertility,” Fey says. And, in general, it’s the folks with fewer resources who’ll be suffering the most if birth control and abortion access are stripped down.
And the best thing you can do right now to prevent that from happening? Become a birth control advocate, Fey says. No, that doesn’t just mean tweeting that everyone should get an IUD, ASAP. It means emailing your Congressperson. Or donating to a nonprofit to help someone else afford contraception. It means making sure the people in your life know where they can go to access free or affordable birth control.
“We’re in an era where the threats to both birth control and abortion access are huge,” Fey says. “The conversation about IUDs is like a warning sign — a flare going up saying that people are very concerned about their reproductive rights, given the political environment they’re in. And ultimately, the best way to respond to that environment right now is to be an activist.”