When news broke that Supreme Court Justice Ruth Bader Ginsburg had died at age 87, Pooja Patel, a 27-year-old living in D.C., called her sister and cousin.
“I was like, okay, RBG died, it means the Supreme Court is going to be controlled by conservatives, that changes everything,” she said. By the end of the call, she’d convinced both to do what she had been begging them to since the 2016 election: get an IUD.
It’s an eerie refrain, once heard in the days and months after Donald Trump was elected in 2016, and now yet again being echoed by some women in private conversations and on social media.
An IUD, or an intrauterine device, is one example of a long-acting reversible contraceptive device, which, depending on the type, can last between three and 12 years. After the 2016 election, anxiety over Trump’s pledges to repeal the Affordable Care Act, which includes a mandate requiring health insurance plans to cover birth control, prompted some women to seek options that could outlast a presidential term.
And a 2019 study published in the Journal of the American Medical Association proved it: The study found that there was a significant upswing among insured women seeking long-acting reversible contraceptives in the first 30 days after Trump’s election. When compared with the rate of IUD insertions in 2015, researchers extrapolated that there were approximately 700 additional insertions per day after the 2016 election on top of the approximately 4,716 insertions per day that would have been otherwise predicted.
In an email, Planned Parenthood said it saw a surge in questions about birth control in the first week after the 2016 election, both online and at its health clinics, with a more than 900 percent increase in appointments for IUDs.
For some of the people who got IUDs because Trump was elected, those devices are also about to expire. Now, some say Ginsburg’s death has galvanized them to get their IUDs replaced. Others on social media expressed concern about another rush to get IUDs, citing negative side effects and the pain many experience during and after insertion.
Rebecca Mercier, an obstetrician-gynecologist who practices in Philadelphia, said it’s difficult to say whether Ginsburg’s death will result in a dramatic upswing of people seeking devices like IUDs. It’s one thing to see social media posts about IUDs and another one to make an appointment to get one, but she anticipates seeing people making these decisions in the two months leading up to the election.
She knows how politics can affect patient choices. In 2018, her practice published a research paper with the American College of Obstetricians and Gynecologists based on a survey of a small sample of patients who received an IUD or the Nexplanon arm implant in summer 2017. A majority of the women seeking the contraceptive device reported supporting the Affordable Care Act, and more than a third reported that the election impacted their decision.
Mercier said she supports any conversation, including on social media, that increases discussion on birth control options. She encourages people who are interested in an IUD to discuss it with their provider.
“It’s not in anyone’s interest to make panicked decisions to get IUDs, if that isn’t otherwise the right thing for them,” she said. But if social media spikes their interest and they head to their doctor to discuss that method, “I think that’s a great opportunity for them to access care and make the decision to choose the method that’s best for them,” she said.
She said doctors might ask a patient interested in an IUD about their reproductive goals, including whether they plan on having a baby and what birth control methods they’ve used. She also said patients should ask about potential side effects, how the method would impact fertility and future pregnancies, and how easy it would be to get an IUD removed if it’s not the right fit.
Bridget Bradley, a 26-year-old living in D.C., is among those who started seeking medical advice on IUDs right after Trump’s election. She got one inserted in February 2017.
“I was convinced that having Donald Trump as president would result in birth control either becoming too expensive or outright unavailable,” she said. She plans to replace her IUD soon because she is fearful of who might replace Ginsburg, particularly the fervently antiabortion conservative judge Amy Coney Barrett, who has already emerged as a front-runner on Trump’s shortlist.
“The idea that someone like Amy Coney Barrett could replace RBG and swing the balance … is once again sending the same cold fear and sweat down my neck,” Bradley said.
Maya Francis, a 35-year-old who lives in Virginia, says she doesn’t trust the government to act in the interest of women — especially not in the interest of women of color. She previously had an IUD removed because it wasn’t compatible with her. But since hearing of Ginsburg’s death, she is thinking more about the reproductive freedom an IUD gave her. She’s even considering stocking up on emergency contraception, which can be purchased over-the-counter in pharmacies.
“It’s really important for women to be able to choose,” she said. “The idea of being a Black woman and being inherently more at risk as it relates to having children, the idea of taking on the risk at the time when I do not want to, is pretty daunting.”
Some women worry that if the Supreme Court becomes more conservative, Roe v. Wade will be overturned and safe access to abortions will disappear. Earlier this month, Trump signaled that Sen. Tom Cotton (R-Ark.) was on his shortlist for potential Supreme Court nominees should he have the opportunity. Cotton immediately tweeted, “It’s time for Roe v. Wade to go.”
Hannah Evell, a 19-year-old living in Dallas, plans to get her Nexplanon replaced when it expires soon. Evell, who has endometriosis, uses birth control for period pain management, but she also is nervous about the future of Roe v. Wade.
“I live in Texas, it’s bad enough that the state is constantly closing down abortion clinics, and not just them, but clinics that offer birth control,” she said.
For others, the fears of how the open seat on the Supreme Court impacts their reproductive health isn’t just about access to care alone, but also access to care without discrimination. Nemo Kavaldjian, a 25-year-old who is non-binary, got an IUD in August from the same physician who helped them start hormone therapy. Kavaldjian knows how important it is to have protections from discrimination when in a doctor’s office.
“It is interesting thinking about the political wins Ginsburg was able to provide [assigned female at birth] people and women,” they said. They’ve heard horror stories of transgender people being denied care in gynecological settings because they had transitioned.
“Before I came out as non-binary, it was definitely a little more clear-cut: You’re just a woman, you get the things women get. [Now] going to the doctor has added a layer of stress. Will people be understanding of my situation?” they asked. With an open seat on the court, Kavaldjian worries about how discrimination cases may be handled, pointing to the Trump administration’s attempts to chip away at nondiscrimination protections for transgender people in health care.
Mercier, the OB/GYN, says the political climate is important, but it’s equally important to listen to yourself.
“For women who are thinking about making decisions about their reproductive health care, it’s very important to understand the larger world that we live in,” she said. “But, ultimately, no matter how worried we are about the political future, each person needs to bring the decision back to their own means and what’s the right thing for them to be doing at this point in time.”
While Patel is glad she successfully convinced her sister and cousin to seek IUDs — she calls herself an “IUD evangelist” — something still doesn’t feel quite right.
Just like how it shouldn’t have rested on the 87-year-old Ginsburg’s shoulders to safeguard reproductive care, she said, “it shouldn’t be on every woman to get an IUD.”