The 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 University Health Services to make an appointment for an IUD consultation.
“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. 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 Zeffers 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 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 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, and an IUD can cost 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 are seeking IUDs and implants 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 too.
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 now Trump 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.
“We don’t know what’s going to happen, but it is a little bit concerning,” Ernst said.
Despite that, however, Ernst 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 recommend 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 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.
“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, adding that she looked forward to no longer worrying about taking daily birth control pills on a strict schedule.
Because LARC methods of contraception have been increasingly promoted for adolescents by major medical organizations, Ernst added, UHS has, over the last few years, increased its LARC insertion training 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 at the University of Michigan 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 noted 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 has concerns 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 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 that, although she is upset by the sense of urgency she feels to protect herself following Trump’s election, she is most angered 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.
Zeffer 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.”