The last thing Jana wanted was to go back on hormonal birth control. But after Roe v Wade was overturned, prompting abortion bans in her state and ones around her, she felt she didn’t have a choice.
Jana, who asked to go by a pseudonym because she doesn’t want her politically conservative family to know her story, started using birth control at 13. For nearly a decade, she tried different kinds of hormonal contraception to find the one that least exacerbated anxiety and depression. Her weight fluctuated, making her eating disorder even worse. After nearly a decade, her therapist suggested she get off birth control altogether. It worked. She felt in touch with her adult body for the first time in her life, and her mental health was finally in a good place. She started using apps to track her menstrual cycle, to tell her when she was ovulating and should avoid sex or use a condom.
Then, on 24 June 2022, the supreme court struck down the nationwide right to abortion. Jana, now a 24-year-old aspiring lawyer, saw warnings across her social media feeds that period tracker apps were sharing her data, and could be used as evidence if the user was suspected of having an illegal abortion. Jana deleted the apps.
A few months later, around the end of November 2022, Jana was pregnant. She managed to get an abortion, but only after over a month of canceled appointments, stressful calls with clinics and insurance, and having to lie to her anti-abortion mother in order to obtain the $500 she needed for the procedure.
Jana quickly realized she would have to go back on birth control. If she got pregnant again, she felt, there was a high chance she wouldn’t be able to book another abortion appointment. She felt lucky she was able to get that first one, and lightning doesn’t strike twice. She opted for Nexplanon, a small arm implant that releases birth control hormones into your body and lasts about five years.
“All of the things that I knew would happen if I got back on birth control happened: depression, anxiety and eating, especially,” Jana said in mid-June.
“The mental health stuff sucks, but I will never go through that process again,” she added, referring to the “horrible” stress of trying to access the abortion.
Jana is not alone in feeling backed into a corner by the supreme court’s Dobbs v Jackson Women’s Health decision. Within a month of the decision, in July 2022, a TIME survey found that 21% of respondents reported changing their method of birth control after Roe was overturned. CNN reported a 300% increase in demand for emergency contraception from the online pharmaceutical company Nurx in a matter of weeks.
I’m a part of these statistics. Even before the leak happened, when I knew Dobbs was going before the court, I opted to get a low-hormone IUD inserted, despite having had negative experiences with an IUD in the past. I live in New York, where abortion remains legal and comparatively easy to access, but it suddenly felt selfish for me to even risk taking an appointment from someone who might need it more than me, when I had access to insurance that covered long term birth control. However, requests for IUDs through my OB-GYN were so backed up that I had to call them every week or so for nearly four months before I was able to have one inserted.
While it was difficult for me to access this care in a timely manner, it’s much harder for millions of people across the country. Whether that’s because they’re one of the 27.6 million uninsured Americans, or one of the 1.2 million women living in a county without a health center offering a full range of contraceptive methods, or in a state without medicaid expansion, or unable to get respectful or thorough health care due to systemic medical racism and LGBTQ+ prejudice.
This trend of politics influencing people to seek longer, more effective kinds of contraception is not new. A study published in JAMA Internal Medicine in 2019 found that, in the weeks after Donald Trump was elected president in 2016, there was a nearly 22% increase in insertions of IUDs and arm implants. Many of the devices inserted in November 2016 will have passed their five-year FDA recommended expiration date by now.
Dr Rachel Neal, an OB-GYN working out of Atlanta, Georgia, said she has seen a trend toward LARCs nationally over the past six years, in part due to Trump’s presidency, as well as medicaid expansion and more insurance plans covering long term contraceptives. But in the past year Dr Neal has also seen an increased skepticism about any methods – including many birth control pills and IUDS – that pause or stop menstruation altogether. Before Roe was overturned, Dr Neal said that patients often saw not getting their periods as a positive side effect because they didn’t have to deal with cramps or spend money on tampons.
“Now they’re uneasy towards methods that cause them to have no periods because they want to … prove to themselves that they’re not pregnant,” Dr Neal said. People are much more aware of the possibility of getting pregnant while on different kinds of birth control (no form of birth control is 100% effective). If it fails, they want to know as soon as possible so they can get an abortion within Georgia’s legal limit.
“Trust in our healthcare system is decreasing,” Dr Neal said. “And I do think people are unfortunately making decisions out of fear of an unintended pregnancy.”
Kelly Cleland, executive director of the American Society for Emergency Contraception, has seen people taking their reproductive healthcare into their own hands. Cleland’s organization provides people, often on college campuses, with free or affordable emergency contraception like Plan B and Ella (prescription emergency contraception which has a higher success rate and has a higher suggested weight limit than Plan B). Cleland said ASEC saw a four-fold increase in interest in the past year.
“It’s not just people saying, ‘I need to get this for myself,’ but, ‘I want to make sure that other people have this too,’” Cleland told me. “So very much people taking care of each other, mutual aid, let’s make sure that the whole community is OK.”
The mutual aid and community care framework around personal contraceptive decisions is one I’ve seen among people in my community, as well as among several of the people I spoke to for this article.
Another change that can be tracked over this past year are among people who do not engage in sex that could get them pregnant are taking extra contraceptive precautions caused by fear of lack of access to abortion.
One University of Pennsylvania college student I talked to named Hannah (who asked that only her first name be used out of fear of being tracked online) identifies as queer and said that she doesn’t have sex with people that could get her pregnant. However, she got an IUD from the campus clinic because of fear of being sexually assaulted and impregnated against her will while on campus. Hannah, 19, said several of her friends who also don’t have sex with people who could get them pregnant feel the same way, and took the same action. Hannah and her friends see sexual assault on campus as inevitable, she told me.
“We see it as part of college life now, it’s not if it’s going to happen, it’s more when,” she said. Roe being overturned made her feel more afraid to go out and go to parties, because it could result in an unwanted pregnancy she might be forced to carry to term due to not being able to access abortion.
“I feel a little bit safer now because I have a backup plan,” she added. “But I’m still nervous.”
Another new element of the post-Roe landscape is an uptick in people seeking more permanent methods. After the leaked Dobbs draft, Google searches for vasectomy went up 121%, and tubal ligation – generally known as “having your tubes tied” – went up 70% across the country, a study of Google metrics found.
Dr Neal, who in addition to her work as an OB-GYN is a fellow with the advocacy group Physicians for Reproductive Health, said she has definitely had more patients inquire about sterilization than in prior years. And for many of her patients, she said, she is not the first doctor they asked about sterilization, many of her patients have come to her after other doctors declined to perform the procedure.
“These are people that are very certain they never want to have a pregnancy that are having trouble from the sort of patriarchal doctors who are telling them that they need to have a pregnancy or need to wait until a certain age to get a sterilization procedure,” Dr Neal said.
This was true for three of the people I spoke to for this article, including Jana. Jana has always been certain she never wants kids, and said that she started asking doctors about sterilization when she was 15 years old. Since then, she has asked three different doctors in two different states. None have acquiesced.
Maggie, a 25-year-old living in Ohio, said that after self-managing her abortion in November, she asked her primary care provider for a recommendation of an OB-GYN who would perform tubal ligation. Maggie said the OB-GYN laughed in her face, suggested she was a “crazy cat lady” who “hated children”, and told her he was giving her a referral for a psychiatric evaluation instead.
After some online research, Maggie found a list of doctors who would perform sterilization on the subreddit r/childfree. So many people had called them from that list that they were completely booked up, she said.
“It really makes me sad to hear,” Dr Neal said about people being denied sterilization. “One of the four main ethical principles by which we are supposed to practice is patient autonomy.”
Eventually Maggie found an appointment in Michigan, at a prestigious hospital that did not seem to think she needed psychiatric help. If a preoperative pelvic exam goes well, Maggie will be undergoing the surgery in September. She said she feels relieved.
Despite the dire state of reproductive healthcare in the US, there has been one recent positive piece of news for birth control. In May, a panel of advisers to the Food and Drug Administration (FDA) voted unanimously to approve the first over-the-counter birth control pill: an estrogen-free drug called Opill. The FDA isn’t required to follow the recommendation of the panel, but it typically does.
Barriers to birth control access will continue to exist, and conservative legislators are already planning to go after contraception access the way they did abortion. But an over-the-counter pill would help in a landscape that is increasingly making it more and more difficult for people to control their own reproductive health.
