With new administration, new concerns about birth-control access

Nov. 21--Madolyn Chavez, a sophomore at Keene State College, has been using the pill as a contraceptive for two years. An intrauterine device -- or IUD -- is a birth-control method she'd never considered, mostly because she isn't comfortable with the idea.

An IUD is a T-shaped piece of copper or plastic that's placed in a woman's uterus to prevent pregnancy. It's a long-acting, reversible birth control that can last up to 12 years.

But now Chavez, like many other women, is changing her mind. With a new president-elect and the potential for a new agenda in Washington, she worries the pill could become too expensive.

An IUD might be the best option.

"I don't know if I'd be able to afford it ... I like the pill, but I guess I'd have to weigh my options," Chavez said.

As President-elect Donald J. Trump continues forming his administration, uncertainty around future policy changes is driving concerns about access to contraceptives.

Since Election Day Nov. 8, online magazine and newspaper articles have warned of two potential actions by Trump and the Republican-controlled Congress that could affect contraceptives. Rolling back some or all the Affordable Care Act, President Obama's signature health care legislation, could eliminate a mandate for insurance plans to cover FDA-approved contraceptives. Meanwhile, cutting federal funding for Planned Parenthood, a health care organization opposed by some Republican lawmakers for its role in providing abortions, would create further barriers to more affordable options for birth control.

A more distant concern also looms: Trump's stated intention to nominate Supreme Court judges that would oppose Roe v. Wade, the 1973 decision that found that abortions are a Constitutional right under the 14th Amendment. Reversing that decision could allow states to abolish abortions.

In the face of uncertainty, some women are taking matters into their own hands. Their solution: request long-term reversible options like IUDs, before the new administration comes into office.

Since Trump's election, national reports abound of women seeking long-term contraceptives.

Some health care providers say they've heard the concerns in New Hampshire. Victoria Bonney, communications manager of Planned Parenthood New Hampshire Action Fund, said in a prepared statement that the organization had received "an uptick in questions" on the availability of contraceptives and other health care provisions since the election.

Tara Potter, a woman who works at the Planned Parenthood in Keene, said she couldn't comment on whether more patients have come into the office to get IUDs. However, she said that since the election, people have shown increased interest in keeping the office on Middle Street open.

The office has received an average of five more phone calls a week asking to either volunteer at the clinic or offering donations, she said.

An anonymous envelope was left in the Keene Planned Parenthood mailbox two weeks ago, with money in it; Potter didn't say how much.

"It goes to show people really do care about Planned Parenthood," she said.

Kathleen G. Dougherty, a Keene State senior, got an IUD a year ago, after being on the pill for five years.

The IUD made her periods heavier, caused cramps and was uncomfortable, Dougherty said, but it was better than the pill, which made her migraines worse.

"I had to drop the hormones," Dougherty said, talking about how her copper IUD is hormone-free.

She explained that the IUD was a better choice for her, but she fears many women will rush into the decision to get one without considering if it's the best option for them.

"I'm one to chirp IUDs," said Dougherty, of her support of the birth control option.

"But it isn't for every woman, and it's scary that so many women are turning to it just because it's the longest lasting."

Libby, a Keene State freshman, who declined to give her last name, said she isn't comfortable with an IUD, but would consider getting one if she couldn't afford her birth control.

If women's insurance plans didn't cover FDA-approved contraceptives, the average cost of a pack of birth control pills would be $50 a month from a clinic, on a sliding fee scale. An IUD could cost up to $1,000, which is why women are considering getting one while they're still affordable using insurance, according to a report in USA Today.

Some local gynecologists are hearing the concerns firsthand. Gina Pattinson, director of marketing at Brattleboro Memorial Hospital, said OB/GYN physicians at the hospital have heard "from patients who are generally concerned about women's rights as they relate to reproductive freedom and choice following this election.

"Younger women are especially worried about the possibility of repeal of the contraceptive legislation of the Affordable Care Act," Pattinson said.

Other physicians said they hadn't heard direct worries, but understand them. Sarah Bay, certified nurse-midwife and owner of Hearts and Hands Women's Care LLC in Peterborough, hasn't noticed more questions after the election -- but, she said, it's too early to tell, as appointments to install IUDs often involve weeks of waiting times.

Bay said she hopes Trump will show flexibility on the contraceptive provisions of the Affordable Care Act once he "looks at the numbers."

"Taking away birth control adds unplanned pregnancies and children without parents," she said. "The more access we have to birth control the more women are having planned family structures, the better it works out."

Lindsay Cushing and Autumn Vergo, two women's health nurse-practitioners at Cheshire Medical Center/Dartmouth-Hitchcock Keene, agreed. They said they haven't had patients bringing up the election in recent weeks, and wouldn't comment on the outcome, but they emphasized the importance of access to contraceptives for women, and choice.

"The long-acting reversible methods of contraception are very effective, very safe. They're a very good value," said Vergo, who is also a midwife. "So, from a practitioner's standpoint, we do encourage their use for women for whom that's an appropriate choice.

"Personally, I've heard, from having conversations with patients in the room, some concern about (access)," Cushing said. "But teenagers might not be aware of those changes, so (they) may not be as cognizant of needing or wanting to be worried, or having that worry."

Cushing added that for those concerned, "there should be nothing stopping them from coming in soon to get (a long-term option)."

The concerns come in a state where contraceptive services are relatively easy to obtain.

Planned Parenthood is one of 13 family-planning agencies operating clinics across New Hampshire, 12 of which receive federal funding, according to its Department of Health and Human Services. Federal funds are provided through Title X programs, introduced by the Nixon administration under the Public Health Service Act.

The clinics appear effective: In 2010, New Hampshire had the lowest rate of unplanned pregnancies in the country, at 32 per 1,000 women aged 15 to 44, according to a study from the Guttmacher Institute.

New Hampshire also has the lowest teen pregnancy rate in the country, the study showed.

Results like those have made mandated contraceptive coverage popular among many Americans, and have spurred national organizations to defend it.

Janel George, director of reproductive rights and health for the National Women's Law Center in Washington, D.C., said that it's difficult to predict which provisions of the Affordable Care Act might stay and which might be taken away. But she stressed that the mandated contraceptive coverage provision in the act, which took effect in 2012, had delivered positive effects for health care costs and coverage for women.

"Prior to this enactment, a lot women found access to birth control to be cost-prohibitive," George said, citing costs for oral contraceptives in the hundreds of dollars monthly. "We saw a lot of women not able to have a continuity in terms of accessing or continuing their birth control."

The new law has ushered in a positive phase for that kind of care, George said, but any attempts to roll it back could have calamitous effects. Removing insurance mandates and cutting funding for Title X agencies could deprive women of basic services beyond just contraceptives, including counseling, she said.

"It's important to recognize that birth control is healthcare, and that's key," George said.

For her part, Dougherty agrees.

"This is women's health," Dougherty said. "And it's important."

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