When Celia Martin flew to her parents’ home in New Jersey on March 11, she didn’t know she’d be stuck there for weeks — or months. The 20-year-old, who attends IE University in Madrid and lives in Spain year-round, had brought along only about a month-and-a-half’s supply of her hormonal birth control, Dretinelle. The pill is available only in Spain and Sweden.

Martin’s been on Dretinelle since she was 15. She got terrible period cramps back then, she says, and thought she might have endometriosis, a painful condition in which uterine tissue grows outside the uterus. But her body adjusted well to the medication, regulating her periods and minimizing the cramping. Her doctors in the intervening years have discouraged her from switching to a different form: After all, finding a birth control that works well can be a difficult, sometimes years-long, process.

In Spain, getting Dretinelle had been a breeze, Martin says. She’d pay 8 euros a month and pick it up at the pharmacy. Now, in America, she’s faced with a quandary: Although she has insurance in America under her parents’ plan, she doesn’t want to risk trying a new pill. And for the price she’d have to pay for a consultation with a gynecologist, she says, she doesn’t think it’d be worth it.

“Being used to such an easy system in Spain, it’s difficult to come here and struggle so much, especially even with the insurance I have,” Martin says.

“I can’t even begin to imagine what it’s like for people with no insurance.”

There are myriad ways reproductive health care is being impacted by the pandemic: A handful of states are essentially halting abortion, women are giving birth in conditions they hadn’t imagined. And the same goes for the millions of women currently using some form of hormonal birth control.

The struggle is particularly acute for women who rely on in-person forms of birth control, such as the quarterly Depo-Provera shot, and may not be able to go to their usual clinics to receive them. Others have lost their jobs and health insurance, ratcheting up the price of contraceptives. Some simply can’t get appointments with their OB/GYNs as health-care systems are stretched thin.

The issue is even more dire in other parts of the world. On Monday, the United Nations Population Fund released a report on the impact of the coronavirus pandemic on family planning. The problem is exacerbated for women living in low- and middle-income countries, which face clinic closures and limited staff and risk not receiving contraceptives due to supply chain disruptions. If lockdowns continue for six months, the report found, an additional 7 million unintended pregnancies are expected to occur worldwide — mostly for women in these low- and middle-income countries.

Unintended pregnancy is a worry for women in the United States, too. Contia Worlds, a 21-year-old attending cosmetology school in Bainbridge, Ga., hasn’t been able to start again on the Depo-Provera shot, which is administered every 12 weeks. She’d been off birth control for a year to give her body a break from hormones, but was hoping to start back on the shot to help regulate her periods as well as prevent pregnancy — she’s the mother of a 3-year-old. But when she went to her local health clinic, the attending clinician said they weren’t offering the shot to new patients during the pandemic. She offered Worlds condoms instead.

“A lot of people right now might not be wanting to have babies,” says Lisa Maldonado, co-founder and executive director of the Reproductive Health Access Project, a nonprofit organization seeking to expand access to abortion and contraceptives. “So it’s really, really important that everyone have what they need safely, quickly, so they can keep living their normal, healthy lives.”

To get a birth control prescription in the first place, women often need to make an appointment with their OB/GYN to discuss options and talk through their medical history. Forgoing these in-person appointments may be the first obstacle in accessing contraceptives, according to Maldonado.

In recent years, advocates have been pushing to make birth control available over-the-counter, like it was for Martin in Spain. There are currently 12 states, plus the District of Columbia, where pharmacists are allowed to prescribe it, making it more easily accessible; in some cases, women can pick it up at the grocery store.

As Vice reports, apps like Nurx, which allow patients to have virtual consultations and get birth control pills mailed to them, have seen a surge during the pandemic. But users may still run into high costs, depending on their insurance.

More than 30 million Americans have lost their jobs because of the pandemic, and for many, that means losing health insurance, too. Women can receive free or considerably subsidized birth control under Title X, which provides federal funding to family planning services. Maldonado suggests checking out the nearest clinics that receive Title X funding and calling to see if you qualify. These clinics do require in-person visits to access the contraceptives, though, which may pose a barrier.

Some women are also launching mutual aid campaigns — similar to virtual tip jars for laid off gig workers — specifically for contraceptives. When New York City went on lockdown in mid-March, JaLoni Owens, a 21-year-old CUNY Law School student, saw a need emerge in the contraceptive space: women talking about how Plan B wasn’t on the shelves, or how it was harder for them to get birth control prescriptions after being laid off.

Owens had some experience organizing mutual aid on the campus level, pooling resources to make sure students had the textbooks they needed. So she launched a covid-19 reproductive health fund that redistributed donations and also allowed people based in the same region to do no-contact deliveries of what others needed — Plan B or menstrual pads, for example.

“In this time when everyone’s figuring out what tomorrow’s going to look like and how to budget for the future, I feel like no one should be in a position where now they have to plan for a child that they don’t have the means to support,” she says.

For now, women facing the realities of interrupted birth control routines don’t see many options except to “wait it out.” Deven Kasbohm, a 25-year-old living in Green Bay, Wis., has been getting the Depo shot for about a year to help regulate her hormones. Her doctor’s office isn’t allowing anyone to come in unless it’s something “very serious,” she says, and getting the shot apparently doesn’t qualify.

It’s now been about four months since she got her last shot — a month past when she should’ve received one. And the symptoms have been “absolutely killing” her. She’s been getting bad cramps, but hasn’t actually gotten her period yet.

“It’s just been kind of a big mess since this pandemic started,” she says.

Kasbohm may try calling the office next month, depending on what the restrictions in Wisconsin are like. She says there’s “nothing much else I can do, unfortunately.”

Martin, the student living in Spain, is supposed to go back to the country at the beginning of June. But she’s not sure she’ll be able to fly out then, given continued travel restrictions and the country’s strict lockdown. She ran out of her last packet of pills about a week ago. Although she’s heard horror stories from friends about getting “terribly depressed” or getting migraines after switching birth control, she hasn’t yet experienced any symptoms — no terrible cramps or mood swings.

For now, she’s grateful at least for that.

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