Dear Broad Strokes,
I’m worried that, with the Republican government, I won’t be able to get affordable birth control. Everyone keeps talking about getting an IUD before reproductive rights are restricted. Should I get an IUD right away? If I did, what would that process be like?
It’s true that the new legislature’s efforts to repeal the Affordable Care Act have some serious repercussions for women’s reproductive rights. IUDs are one of the most effective forms of birth control available, and you don’t have to worry about birth control for several years at a time. But getting an IUD is also a big commitment – it lasts anywhere between three and twelve years. So don’t rush into this decision! Take the time to consider all of your options, what you’re looking for from birth control, and how your personal situation may or may not change in the next few years.
What will change?
Two provisions of the Affordable Care Act directly touch on your access to birth control. Currently, the Affordable Care Act mandates that private health insurance companies give women access to many forms of birth control, often for free or for a low co-pay. Additionally, if your parents have health care, the ACA allows you to stay on their health care plan until you’re 26. For many college students, this meant that we could expect long-term stability with whichever birth control method we preferred, and that if for any reason we needed to change our method, we’d be able to. We’ve grown up in a time where it’s a lot easier to find and afford the birth control method that works for your body and stick with it.
The ACA’s “contraception mandate,” or its requirement that insurance plans provide free and low-cost birth contro,l will most likely disappear when the ACA is repealed. Some (blue) states are enacting these protections to compensate, so keep an eye on your state legislature. The provision allowing young people to stay on their parents’ health care until the age of 26 has already been threatened during the Senate’s “vote-a-rama,” suggesting that once the law is fully repealed you will only be able to stay on your guardians’ health insurance until the age of 19. It’s possible that a replacement plan will restore these features, but since we don’t know what that replacement plan will look like, it’s extremely uncertain. I’m no political forecaster, but my guess is that we have between three months and one year before these features disappear from our lives.
Questions to Consider
When deciding whether to get an IUD, ask yourself the following questions.
Do you like your current form of birth control?
If you are happy with your current form of birth control, your first line of attack should be to figure out whether there’s any way you can stay on it. Different forms of birth control have different side effects, from irregular periods to acne to stomachaches to depression. So if you’ve found something that works for your body and your lifestyle, that’s pretty awesome. If it’s at all possible for you to stick with it, I would do that.
What health insurance plan are you on now?
If you’re on Yale’s health insurance plan, an IUD is free (as are many other forms of birth control). That’s unlikely to change, no matter what Congress does. So if you’re a first-year, you have a lot of time to make that decision. If it’s financially feasible to switch onto Yale’s health insurance, that might be a temporary solution if your previous coverage stops covering your birth control, whether or not you decide to switch to an IUD.
If your health insurance is private (if, for example, you receive your coverage through your parent’s or guardian’s employer), it’s difficult to know what will happen. One way to guess might be to research what that insurance company offered in the way of birth control before the ACA was passed: did it cover birth control, but with a co-pay? How expensive was it to get an IUD? You might be able to ask your parent/guardian about past coverage with their specific employer. But, again, it’s really difficult to make predictions.
If your health insurance is provided because of the Affordable Care Act, it’s probably in your best interest to get an IUD as soon as possible. Because a replacement plan hasn’t really been fleshed out yet, there’s a real chance that hormonal birth control could become astronomically expensive for you (without insurance, one month’s supply of birth control can be $150).
Finally, do you have a sense of your plans for after graduation? If you know you’re going to have stable employment, work for a volunteer program like AmeriCorps, or pursue graduate school, you’ll have health insurance, and you may even be able to research the different coverage options that different opportunities would provide. Especially if you’re a senior, factor in your options for health insurance coverage next year when deciding whether to get an IUD now.
What is an IUD? What’s it like getting one?
There are three types of IUDs:
- Copper IUD (ParaGard): this IUD functions as a barrier method, rather than a hormonal method. It can serve as emergency contraception if inserted up to five days after unprotected sex. It is effective for twelve years after insertion.
- Hormonal IUD (Mirena): a larger IUD that is effective for six years. Expect lighter periods.
- Hormonal IUD (Skyla, Liletta): effective for three years. Like the Mirena, but slightly smaller, which can make the insertion process less painful for some people.
If you decide you want to get an IUD, my best advice would be to book an appointment as soon as possible (even at Yale Health!), several weeks or even months prior to when you would like to have your IUD inserted. You’ll remain awake for the procedure, although a doctor may use a painkiller or local anesthetic. The procedure is very short, only a few minutes. You’ll place your feet in stirrups and the doctor will open up your vagina with a speculum and clean your cervix. Then, the doctor will use a tool to make the IUD become thinner and flatter, insert the IUD, and remove the tool so that the IUD expands. It can feel like a longer pap smear. Try to relax! As with sexual intercourse, if you get nervous, you’ll tense up your vagina muscles, which will make the process more painful than it needs to be. So take deep breaths, and don’t go in with the attitude that it’s going to be super painful – chances are, if you’re calm and relaxed, it’ll be just fine!
You should plan to have 2-3 weeks to take it easy after your insertion. Although for most people recovery takes far less time, you can’t know in advance how your body will react, so avoid strenuous activity for a few weeks. Some people experience very little pain after the day of insertion; others experience some pain for 2-3 weeks but then side effects end; others may have non-severe cramping for 3-6 months, after which side effects normally subside. If you’re experiencing severe pain – especially if it’s more than three weeks after your surgery – go see your doctor! There’s a chance that the IUD has been improperly placed (although this is rare, it does happen). If, after a while, your IUD has come to the end of its lifespan, or you just want to go off the IUD, you’ll have to go to your doctor or gynecologist and have it removed. You’ll be fertile again immediately after the removal.
If you do decide to go for an IUD, the main change you can expect is in your periods. Unlike the pill or the ring, which makes your periods highly regular, on the Mirena or Skyla IUDs, your periods may be more irregular. About 20% of women on hormonal IUDs stop having their periods altogether. An IUD has a smaller dose of hormones than other hormonal methods, so if you depend on your birth control for something else (like acne control), that might be a negative; however, side effects are likely to be somewhat less severe. Rarer side effects include the potential risk of ovarian cysts, which are usually temporary and harmless but can occasionally be painful and require surgical removal. On the copper IUD, your periods may become slightly heavier, longer, and crampier. You may also experience bleeding between periods for two or three months while your body gets used to the IUD. Uncommon but serious side effects are pelvic inflammatory disease or perforation: if you experience severe pain or sudden fevers after your insertion, see your doctor immediately!
In short, now is a scary time for reproductive justice, but when making a long-term decision about birth control, try not to panic. Research your options. If you decide that an IUD is your best option, congratulations! You won’t have to worry about birth control for a long time, and that will be nice. If you feel like it’s not right for you and you’ve found an alternative, take confidence in knowing that you’ve researched all your options and made a fully informed decision.
*graphic by SGH