Widespread restrictions on abortion across the United States are already having major ramifications for reproductive health care. President-elect Donald Trump’s next administration is likely to tighten restrictions on abortion, and contraception could be next. This double whammy has led some people to urgently consider long-acting reversible contraceptive methods, such as intrauterine devices (IUDs), and permanent contraceptive methods, such as sterilization. Ta.
“I definitely noticed a change.Dobbs” said Rachel Frink Bochacki, an obstetrician-gynecologist practicing in New York state, referring to the 2022 Supreme Court ruling. Dobbs v. Jackson Women’s Health Organization It abolished abortion rights nationwide. In particular, Frink Bochacki has noticed an increased interest in sterilization among patients. “It was a common conversation among obstetricians and gynecologists. We all said, ‘Does anyone feel like they’re seeing more consultations on this?'”
Xiao Xu, a health economist at Columbia University Irving Medical Center, said the data suggests there is some truth to this perception. In a recent report, Japan Automobile Manufacturers AssociationShe and her colleagues found a statistically significant increase in sterilizations nationwide in the immediate aftermath of the pandemic. Dobbs decision, overturned 1973 Roe vs. Wade Judgment legalizing abortion. The study also found that states with abortion restrictions continued to have higher sterilization rates six months later. Other studies have shown an increase in the use of long-acting reversible contraception and sterilization. Dobbs. These measures can prevent pregnancy for years at a time or even for a lifetime. It is also less likely to fail than daily pills and other short-term, temporary contraceptive methods.
About supporting science journalism
If you enjoyed this article, please consider supporting our award-winning journalism. Currently subscribing. By subscribing, you help ensure future generations of influential stories about the discoveries and ideas that shape the world today.
The results of the 2024 election appear to have further amplified this interest. A report from family planning organizations that provide family planning and other reproductive health services shows a surge in bookings for vasectomies, IUDs and contraceptive implants at centers across the country. That’s not surprising. “If abortion becomes more difficult, women may turn to contraception to prevent the need for an abortion,” Shu says. “Policies targeting abortion can have far-reaching effects than abortion care itself.”
long-acting contraceptives
Three methods of long-term contraception are currently available: arm implants, several types of IUDs, and sterile procedures. All are highly effective, with fewer than one pregnancy per 100 users per year. In a survey conducted from 2017 to 2019, when abortion remained legal nationwide, about 24% of women relied on their own or their partner’s sterilization to prevent pregnancy, and 10% used IUDs or arm implants. depended on. People interested in either of these approaches should first consult their doctor before inserting an IUD, implant, or scheduling surgery. All of these are usually done on an outpatient basis.
Sterilization includes procedures such as vasectomy, which cuts or blocks the tubes that carry sperm from the testicles, and bilateral salpingectomy, which removes the fallopian tubes that carry eggs to the uterus. Both procedures are performed under anesthesia and are usually minimally invasive. They are also irreversible. Dr. Frink Bochacki said that while the examination process involves a doctor assessing that the person has made a well-considered decision, some doctors refuse to perform such procedures on people who do not have children. It has been pointed out that there are some. In the wake of DobbsShe points out that reproductive health advocates have created an online list of doctors willing to perform these procedures on childless people.
Arm implants and IUDs only work for people who can get pregnant, and while their effects are long-lasting, they are not permanent. “They’re a phenomenal option and they’re reversible, so if you don’t like them, obviously you can remove them. Then your fertility will come back and there will be no long-term effects. ” says Frink Bochacki. (She points out that IUDs and implants are the most popular contraceptive methods among gynecologists themselves.)
The arm implant, which is about the size of a matchstick, is inserted and removed under local anesthesia. Although they are allowed to last up to three years before needing to be replaced, data suggests they can last up to five years, according to Frink Bochacki. It contains a type of hormone called progestin that stops ovulation and thickens cervical mucus, making it less likely that sperm will reach the uterus. Similar to the pill, which stops or reduces ovulation and prevents fertilization and implantation, the arm implant steadily releases progestin throughout the body, albeit at lower levels than the pill. For some people, arm implants are associated with irregular bleeding patterns, warns Frink Bochacki.
Two types of IUDs are available. Each is inserted directly into the uterus and can be quite painful. If you’re concerned about pain during insertion, you should inquire about management options ahead of time, notes Frink-Bochacki. You will also need to see a doctor to have your IUD removed.
One type of IUD relies on progestin, but unlike arm implants, the hormone is not passed throughout the body. These hormonal IUDs can be used for 3 to 8 years and can reduce menstrual pain and bleeding. There are also copper IUDs that are hormone-free and can be used for 12 years. Copper causes local inflammation, which directly interferes with sperm migration and prevents sperm from reaching the uterus. However, these IUDs can make menstrual pain worse and increase bleeding, warns Frink-Bochacki.
In addition to the steps and side effects of each contraceptive method, Frink Bochacki also points out that people may need to use it for a longer period of time than they think. You can still get pregnant until you haven’t had a period for a full year. Frink Bochacki recommends that if your birth control method eliminates your periods, as some people do, you should continue using your method until age 55.
Reproductive freedom at risk
Despite widespread support for contraception and abortion in the United States, policy experts worry that these contraceptive options could be at greater risk in the coming years.Pew Research Center According to April data, 63% of U.S. adults believe abortion should be legal in all or most cases. In another survey, 79 percent of registered voters said widespread access to contraception is good for society. In preDobbs According to the Contraceptive Survey, 65 percent of U.S. women ages 15 to 49 report currently using some form of birth control.
Despite this popularity, Trump praised Supreme Court nominees for overturning decisions during his 2024 presidential campaign. Roe vs. Wade. And Project 2025, a conservative policy initiative involving several of President Trump’s Cabinet nominees, uses an existing law called the Comstock Act to create a nationwide abortion ban without additional legislation. It shows the path to implementation. Particularly at risk are medication abortions, which will account for 63% of all abortions in the United States by 2023. Access to this treatment has already been considered by the Supreme Court, which upheld its availability but left open the possibility of future legal challenges. Additional incidents may occur.
A potential new effort by the second Trump administration to restrict access to contraception may be more subtle than the anti-abortion movement, but it could have a big impact on people’s access to contraception, the Center says. said Liz McCamman-Taylor, attorney and senior federal policy advisor. Reproduction Rights, a global nonprofit organization focused on reproductive rights policy.
In theory, far-right politicians could directly challenge court decisions protecting access to contraceptives, but Taylor believes such an approach is unlikely. “Contraception is even more popular and ubiquitous than abortion, so the mainstream strategy is not to make it de facto illegal or to deauthorize drugs in the same way,” she says. “Instead, I think we will be cut down thousands of times in the same way we were destroyed before.” egg Finally. “
These more subtle techniques include strategies to distort the definition of abortion, a tactic already used in right-wing rhetoric, said attorney and director of the American Civil Liberties Union’s Reproductive Freedom Project. Brigitte Amiri, Deputy Director of “One of the attacks we see in Project 2025 is specifically an attempt to conflate certain forms of contraception with abortion,” she says. Medically, pregnancy occurs only when a mass of cells called a blastocyst implants itself in the lining of the uterus. But right-wing extremists often talk about pregnancies starting at conception, falsely claiming that emergency contraceptives or “morning-after pills” and IUDs that prevent implantation are anti-abortion remedies.
Amiri and Taylor both predict that contraceptive opponents will start by undermining the Affordable Care Act (ACA). It includes the Women’s Preventive Services Guidelines, which dictate that insurance should cover a variety of care, including contraception, at low or no cost. President Trump may at least seek to remove emergency contraceptives and IUDs from this list, but a broader range of contraceptives could also be included. Such measures would not prohibit contraception, but would make contraception more expensive. Before the ACA was enacted, contraception could account for more than one-third of an individual’s out-of-pocket medical costs. (Those living in states with more protective health care laws may be somewhat insulated from the ACA changes because the federal government provides only minimal health benefits. (State governments may require additional compensation.)
Title X, the government program that has historically provided contraception and other health care, could also be targeted. During the Trump administration’s first term, the Trump administration banned clinics receiving Title X funding from referring people to abortion care, resulting in some clinics leaving the Title The number of people eligible for treatment has been reduced by almost half. President Joe Biden rescinded the policy, but Amiri hopes President Trump will reinstate it.
Taylor also predicts that medical professionals who oppose abortion or contraception may be more likely to refuse treatment based on moral or religious beliefs. She points out that sterilization, which is already difficult to access, is particularly vulnerable to such opposition.
Overall, Taylor says it’s important to think beyond abortion when it comes to reproductive rights. “Bodily autonomy is relevant to all kinds of reproductive health experiences, and any threat to abortion is a threat to all reproductive health care, including contraception,” she says.
Still, Frink Bochacki hopes that the current and future political climate won’t have too much of an impact on people’s decisions about contraception. “I think it’s very legitimate for people to be concerned about these things,” she says. “We hope they can make conscientious and intentional decisions based on their goals and preferences, and not feel forced to do something they don’t want to do out of fear of the alternatives.”
