President-elect Donald Trump’s promise to dismantle the Affordable Care Act has women across the country seeking out long term birth control before they may lose access to free contraception. In rural West Texas, over 300 miles from the closest Planned Parenthood, some women are opting for a specific device.
Chloe Gallagher is a tour guide at an art foundation in Marfa. One November evening, she was scrolling through her Twitter feed when a hashtag caught her eye. Vice President Elect Mike Pence had just attended a performance of Hamilton, the hit Broadway musical. And Twitter users were re-imagining titles to other Broadway classics ad tagging their posts with #NameAPenceMusical. One of them was "Annie get your IUD."
“And I laughed out loud," she says, "I was just cracking up. And then I had this moment where the laughter sort of faded out, and I thought about it and I went, I really need to go do that.”
Like other women across the country and in rural west Texas, Gallagher has an appointment to change her birth control plan this month. She’s getting an IUD.
The IUD, or intrauterine device, is a small t-shaped contraceptive that’s inserted into awoman’s uterus to prevent pregnancy. Depending on which kind a woman chooses, it can be effective for 3 to 12 years. Under the Affordable Care Act, most marketplace insurance plans are mandated to fully cover IUDs. Since the election, Planned Parenthood is reporting a 900% national increase in demand for the device.
“I have heard that it can hurt a little," Gallagher says, "But I can't imagine that it would hurt anymore than finding out that I had a pregnancy that I didn't want and had to deal with it"
And for me, the insertion did hurt. I got an IUD in early January, after considering the side effects. IUDs can cause irregular periods, cramping, mood swings, and weight changes. Mostly, I was nervous about getting it put in. My procedure with Dr. Katie Ray was simple, and the actual insertion only took 3 minutes.
Ray practices family medicine and obstetrics at 3 West Texas health clinics that receive federal funding to treat low-income patients: one in Alpine, one in Marfa, and one on the US-Mexico border in Presidio. (Full disclosure: Dr. Ray is a board member of Marfa Public Radio/West Texas Public Radio.)
In 2014, Ray secured a grant to get a 2-year supply of free IUDs for local under and uninsured women. She went from having virtually zero interest, to putting in about 40 devices a year. Other area clinics I spoke with did not see an increase, but Ray says, in the months following the election, more than 10 women inquired about IUDs.
“I guess I've never seen a response to a political result before in the medical field so abruptly," she says, "You know you kind of see a trickle down effect when policies change, but I've never seen when people react out of fear and change their healthcare plan.”
That 10-year IUD Chloe Gallagher is getting will be one of the IUDs covered by Dr. Ray’s grant - Chloe doesn’t have health insurance. But Genevieve Gallaway, another Marfa resident who decided to change up her birth control following the election, does. Her marketplace health insurance covers the cost.
“I'm a small business owner, an entrepreneur living in the middle of nowhere, and I don't have a business that's bringing in an income that would impress anybody,” says Gallaway.
She’s getting the hormone-free, 10-year copper IUD. Out-of-pocket expense for this procedure can reach nearly $1,000, which Gallaway said she could never pay up front.
Dr. Ray says she’s happy to see women like Gallagher and Gallaway thinking ahead about their birth control plans. But she told me patients who came in to ask about IUDs after the election all had something in common. She described them as "kind of higher-education level, middle income, liberally minded women who have a lot of apprehensions about the recent election result.”
Dr. Ray is concerned about low-income women in the area, women who aren’t necessarily getting IUDs right now. She’s unsure what affordable birth control options will be available in the coming years.
Ray’s clinics have less than a one-year supply of free IUDs left on the shelves. With the future of the Affordable Care Act in flux, she’s not counting on anymore grants.
-- Sally Beauvais