When news of Ruth Bader Ginsburg’s passing broke on Friday night, a familiar ripple of panic spread throughout social media. With Donald Trump free to appoint a third Supreme Court justice, giving the court more leverage to overturn Roe v. Wade, some urged women to start stockpiling emergency contraception or make an appointment to get an IUD.
Since Trump’s election, this call to action has become almost routine. In the month following the election, some 21,000 women in the United States had an IUD inserted. Providers said they were receiving several calls a day from frantic patients inquiring about IUDs, and Planned Parenthood alone saw a 900 percent uptick in IUD appointments within the first week of Trump’s win. Birth control anxiety loomed large even before the actual election results: Days before voters went to the polls in 2016, Daily Beast contributor Erin Gloria Ryan wrote a story headlined “Get an IUD Before It’s Too Late,” warning women about the impending end to Obamacare and suggesting that individual action was political recourse.
Two years later, when Justice Anthony Kennedy announced he was stepping down from the court and Justice Brett Kavanaugh was confirmed as his replacement, there was another push for women to consider getting the device, which can prevent pregnancy for up to 12 years. “After Trump, I remember patients being very specific about the threat to the Affordable Care Act,” Amy Hagstrom Miller, the president of Whole Woman’s Health, said, referring to the ACA’s contraceptive mandate, which requires insurance plans to cover the full cost of birth control. “With Kavanaugh, it was more about people feeling that all of their rights were going out the window.”
Ginsburg’s death has again spurred this hazy sort of dread, whose boundaries are indefinite. Many imagine a future full of worst-case scenarios: Roe falls, the ACA crumbles, and we enter the extended universe of The Handmaid’s Tale, one where women have no bodily autonomy and it’s impossible to access any form of contraception at all. But while it seems clear that the future is grim, it’s not yet clear just how grim or how soon additional restrictions on reproductive rights will go into effect.
“Get an IUD” might seem like sage universal advice for those able to get pregnant, but it primarily serves to stoke alarm, convincing people that they need to make a hasty decision about birth control. It’s also primarily a pitch to women with a considerable amount of privilege, who have the ability to make decisions about their reproductive health without being constrained by their socioeconomic circumstances. This group of women will likely always be able to access the care they need. Getting an IUD can be a solution for one woman, personally—and a potentially very good one—but it’s far from a solution for decades of dwindling access to reproductive health services.
“Outside of what’s happening in the current political climate, an IUD is a great option for contraception, but it’s not the best method for everyone and there are a lot of other great options too,” said Meera Shah, a New York-based physician and fellow with Physicians for Reproductive Health. “I want people to be able to make informed choices.”
Shah and other physicians had already been seeing an uptick in people’s interest in IUDs even before the political upheaval of the Trump presidency. Whereas in the early ’90s just 1.5 percent of women used an IUD or implant, by 2013 that percentage grew to 7.2. In the ’70s and ’80s, IUDs became safer and more effective—now it’s estimated that the device is more than 99 percent effective. And, as they became more and more effective, physicians began recommending it as an option to their patients. Many young people, certain that they didn’t want to be pregnant for the foreseeable future, began to see it as an attractive option for long-term protection. Plus, the ACA’s contraceptive mandate made what’s typically a costly device free with health insurance.
These features of the modern-day IUD have made it a go-to option for many people looking for a form of contraception that can outlast a president (even a two-term one) hostile to reproductive rights. But they haven’t been embraced by everyone. Given the history of various contraceptive methods being forced on marginalized communities—including extremely recently—entreaties to get an IUD may not have the same resonance with low-income people and people of color, to whom providers are more likely to recommend long-acting reversible contraception, often from a place of unconscious (or conscious) bias.
“As a clinic that mostly serves people of color, Black people, and Black women, we have not seen the same kind of panicked reach toward long-term contraception like IUDs, because that’s not the preferred method for our communities,” said Wula Dawson, the director of development and communications of Atlanta’s Feminist Women’s Health Center.
Still, perhaps the biggest assumption baked into people’s urgings to make an emergency IUD appointment is that this is something people have access to at this very moment. These entreaties forget that even with Ginsburg on the court, birth control and abortion were already inaccessible to large swaths of the country, especially pricier methods of birth control like IUDs.
Since the Title X rule cut off funding to health clinics that provide abortion services, birth control has become significantly more expensive for those clinics’ patients. The rule has also shuttered some community clinics, which has made it more difficult for people who are uninsured or on Medicaid to obtain birth control.
Twenty-one states allow certain employers and insurers to opt-out of the ACA’s contraceptive mandate, meaning that even residents in those states who have insurance may have to pay out-of-pocket for contraceptives depending on how a particular employer feels about reproductive freedom. The mandate, of course, relies on people having insurance to begin with.
“The procedures we offer are the same, the contraceptive methods are the same, but what people have access to in Virginia, Minnesota, and Maryland versus Indiana and Texas are night and day,” Hagstrom Miller said.
She said somewhere between 85 to 90 percent of the patients who visit Whole Woman’s Health clinics in Minnesota and Maryland have insurance through Medicaid or private insurance, whereas “barely 10 percent” of the patients she serves in Texas are insured. If patients need to get the IUD removed, due to negative side effects (which include mood changes, cramping, and irregular bleeding) or a desire to change methods, they will also have to front the full cost of a second clinic visit.
“The idea of ‘options’ of contraceptive methods—I put ‘options’ in air quotes—is absurd to talk about,” Hagstrom Miller continued. “So it’s a bit of a privileged narrative, about going out to get an IUD. The people who are going to be hit the hardest already have less access and less coverage.”
“I don’t think people understand—there’s only one Planned Parenthood in Mississippi,” said Laurie Bertram Roberts, the executive director of the Mississippi Freedom Fund, the state’s abortion fund. “If you’re low-income and you need an IUD you either have to go to a community clinic or to the health department. You might wait months to get an IUD from the time you start the process to the time you actually see an OB/GYN.”
A wide-reaching systemic problem requires a solution on the same scale. Roberts said abortion funds like the ones she runs (she’s also the incoming executive of director of Alabama’s Yellowhammer Fund) are a good place to channel panic and uncertainty.
Everyone should pursue the form of birth control they feel is best for them, she said, but if they’re thinking about other people’s access to abortion and contraception, donating to a local fund is the best way to help. Stockpiling emergency contraceptives like Plan B or urging others to get an IUD are implicit appeals to self-preservation, which turns away from the collective action that protecting and expanding access to reproductive health care demands.
When I asked Roberts about stockpiling Plan B, she called it “cute.” She said abortion funds can purchase emergency contraception at a much lower price point, and distribute it more widely. Aside from offering financial support for abortion services, many of the funds provide emergency contraception for free, and can help with the logistics of getting people to and from clinics.
“People who want to strategize around how to solve this problem are coming from a good place,” said Lindsay Rodriguez, the senior communications manager at the National Network of Abortion Funds. “But there’s no need to recreate the wheel: Abortion funds have been around for decades, and it’s important to lift up their experience and expertise.”