When I was 16, I decided to get on birth control. My high school boyfriend and I were chomping at the bit to do the deed, and I wanted to act responsibly (high-five to my teenage self!). Back then, for me, that meant taking the Pill. And since I had less-than-zero intention of sharing my desire to become sexually active with my busy single mom, I hightailed it to a Planned Parenthood in a neighboring New Jersey town. There, a doctor discussed my options with me, conducted a pelvic exam—my first—and dispensed a prescription. It was a seamless, formative experience.
Fast-forward to today. While a slew of women (some of them peers I know and admire) have bravely, publicly acknowledged that they’ve had abortions, I have a different confession: I’ve never been pregnant. A big reason is that I’ve had easy access to affordable birth control.
Why am I revealing this non-news? Because while much of the reproductive-rights conversation is centered on abortion, the Trump administration is also waging war on your birth control—the very thing that prevents the need for an abortion.
Like me, 99 percent of women who have had sex have used birth control at some point. And currently, more than 62 million are getting it for free. (That’s largely thanks to the 2010 Affordable Care Act, or ACA—which requires health insurers to fully cover all FDA-approved forms of contraception—and to clinics such as Planned Parenthood that receive government funding for “family planning services.”) This has helped the teen and unintended pregnancy rates drop to historic lows.
But that could all change…and it has already begun. “We are seeing a deeply concerning attack on access to affordable, high-quality contraceptive care,” says Kinsey Hasstedt, senior policy manager at the Guttmacher Institute, a research and policy organization committed to advancing sexual and reproductive health and rights. Since last year, the government has made moves to:
Kill the ACA and gut Title X, a federal program that funds free or cheap contraception for some 4 million low-income women (a majority are under 30 years old and more than 60 percent are women of color). Title X helps prevent more than 800,000 unintended pregnancies a year, which would otherwise result in close to 300,000 abortions.
Eliminate federal funding for orgs such as Planned Parenthood. This would mean fewer clinics, longer drives, endless wait times, or no access at all for those who can’t get birth control through insurance. (For the record, abortions make up just 3 percent of PP’s services, and they are almost never paid for with federal tax dollars.)
Make it easier for employers and schools to refuse to cover birth control for any moral or religious reason, putting hundreds of thousands of people at risk for steep out-of-pocket costs. At the same time, the administration is appointing Supreme Court justices who could ensure these plans become law. If that happens, birth control could cost American women at least $1.4 billion more every year!
Over the past half century, contraception has been crucial to women’s advancement, which is why it needs to remain accessible and cost-free rather than a financial burden. (This isn’t even remotely controversial: 96 percent of American voters support contraception access.) Yet government officials are trying to halt or, worse, eradicate this progress.
“The message from the administration on birth control is, ‘You’re on your own,'” says Susan Inman, a chief counsel at the Center for Reproductive Rights. Adds Rachel Fey, director of public policy at Power to Decide, a campaign to prevent unplanned pregnancy: “This is real. Alarm bells need to ring. I’ve been doing this for 18 years, and this is the greatest number of threats I’ve seen in my career.”
If this is all sounding a little too Handmaid’s Tale, keep reading. Cosmo debriefed top experts for advice on how to stop the erosion of your birth-control access. I hope you’ll join me in letting politicians know that we see what’s happening and we’re not forfeiting our reproductive rights.
STEP 1: Assess Your Risk
Consider which statements apply to you. The more you identify with, the higher your chances of losing access to affordable birth control. None seem relevant? Great, you can still help others.
◻️ I don’t have health insurance.
◻️ I don’t qualify for Medicaid (aka the government program for people with low incomes).
◻️ I have health insurance through my religion-affiliated workplace or school (e.g., I work for a Catholic university or a church). Or it seems like my employer opposes birth control for “moral” reasons.
◻️ I get my BC from Planned Parenthood or another publicly funded clinic.
◻️ I live in a rural area or “red” state.
◻️ I don’t own a car or have access to one.
◻️ I pretty much live paycheck to paycheck.
As the federal government aims to restrict access, some states are rushing to expand it. A guide to bright spots and danger zones.
Certain ones now require all FDA-approved forms of birth control be fully covered by state-regulated insurers. So even if the ACA dies, local women’s free BC may not. Meanwhile, other states have passed laws allowing patients to get 12 months of birth-control pills at once, sparing them frequent pickups (and reducing unintended pregnancy rates by up to 30 percent)
On the rise: reports of pharmacists declining to dispense birth control because of personal beliefs. In 13 states, they can flat out refuse to honor your prescription. In six, they can even hold on to or return an Rx instead of referring it to someone else, potentially forcing a woman to go back to her doctor for a new one.
As of January, 10 states and Washington, D.C., allow pharmacists to prescribe birth control, bypassing the need for an MD visit. Many facilities are still in the process of rolling out their programs. Visit BirthControlPharmacies.com to see what’s available near you.
Only a handful of states still haven’t expanded Medicaid coverage or used a family-planning program to at least offer free contraception to cash-strapped citizens who don’t qualify for Medicaid.
Planned Parenthood is being targeted by a new law denying Title X cash (used for free or low-cost birth control) to clinics that refer for or perform abortions. The PP in Lincoln, the capital, serves about 4,000 women who may now face higher costs (or longer wait times at the only other Title X clinic in town, which serves around 1,400).
Similar Laws Targeting Abortion Providers Have Gone into Effect in 12 Other States:
Arkansas, Arizona, Colorado, Iowa, Indiana, Michigan, Missouri, Mississippi, North Carolina, Ohio, Texas, Wisconsin
Step 2: Beware the True Costs
What you could end up paying for birth control if the Affordable Care Act is decimated and clinics such as Planned Parenthood are defunded:
* ALL POPULARITY FIGURES ARE BASED ON 2014 GUTTMACHER INSTITUTE DATA OF USERS IN THE PAST MONTH
Unlike the “abortion pill,” which ends a pregnancy, these meds prevent conception in the first place—yet some politicians (inaccurately) argue they are abortifacients, and the drugs are under attack in many states. The two types, levonorgestrel (e.g., Plan B One-Step) and ulipristal acetate (Ella), are now fully covered by insurance with a prescription. Otherwise, OTC pills can cost up to $67 out of pocket.
Truth: Even with superb insurance, getting your BC can be a pain. “Right now, to get the Pill, women have to find a health-care provider, get an appointment, get a prescription, then go to the pharmacy,” says Kelly Blanchard, president of Ibis Reproductive Health, a nonprofit research organization. But what if you could just wander into a drug- store and pluck it off a shelf? Ibis and its partner, HRA Pharma, are in the process of developing a progestin-only, truly OTC birth-control pill. If it scores FDA approval, it could prompt other companies to develop additional OTC options.
There’s just one catch: Politicians disagree about who would pay. Republicans want users to fork over the cost (which Ibis estimates will be $15 or lower per month) using health savings or flexible spending accounts, while Democrats say private insurers should pick up the tab. As with so much else contraception- related, until they decide, this total game changer remains a maybe.
Should You Get an IUD—ASAP?
After the 2016 election, Planned Parenthood famously reported a 900 percent spike in IUD interest, as women freaked out about Trump coming for their reproductive rights. They had cause for concern: The administration isn’t just trying to roll back access, it also wants to convince women they shouldn’t get some types of birth control. Many conservatives consider IUDs to be abortifacients (doctors disagree), and now the Department of Health and Human Services is paying—with your taxes—for “research leading to…discontinuing reversible contraceptive methods, such as…intrauterine devices.” Translation: The government wants to get women to take out their IUDs. (“What’s shocking is that this is completely counter to what the medical community is pushing toward,” says Mary Alice Carter, executive director of Equity Forward, a research organization focused on repro rights.)
Given this, it’s rational to ask whether you should rush to get one of the long-lasting devices now, says Mara Gandal-Powers, senior counsel for reproductive rights and health at the National Women’s Law Center (NWLC). “I completely understand this fear of not knowing if you’ll be able to get the birth control you need. People shouldn’t have to make health decisions based on politics.”
The fact is, the IUD may soon be the most cost-effective BC method, says Aisha Wagner, MD, a fellow with Physicians for Reproductive Health. Getting one is still free for most people (Trump’s rules were tied up in court as of press time), and you wouldn’t risk seeing a monthly co-pay in the future. Plus, most IUDs will outlast this administration. So go ahead, if you’re interested (and aware of the potential side effects). Once it’s up there, no one can make you take it out.
STEP 3: Hack Any (Birth Control) Crisis
When getting a script is tough, apps and sites like Nurx, The Pill Club, Pandia Health, Planned Parenthood Direct, and Prjkt Ruby can prescribe and send the Pill, the patch, or the NuvaRing to you (with free shipping). In most cases, you just complete an online questionnaire, text or video-chat with an MD, or transfer an existing Rx. Many apps accept insurance and offer automatic refills. The downsides: They don’t do IUDs or other long-lasting methods and aren’t available in every state. For more info, check out Bedsider.org, an online birth-control support network run by Power to Decide.
If you get slapped with out-of-pocket costs for birth control, it pays to pick up the phone. “Look at mail or e-mails from your insurance company for info on who to call,” says NWLC’s Mara Gandal-Powers, “and be sure to have documentation of your benefits ready.” For now, most insurers are required to fully cover BC, but errors and fine print can still result in random charges. For extra help advocating for yourself, call the NWLC’s CoverHer hotline at 866-745-5487 or e-mail CoverHer@NWLC.org.
In the event that a pharmacist refuses to fill your prescription, “It’s important to ask, ‘Is there someone else who can give me this medication?'” says Gandal-Powers. In some states, pharmacists must refer you to a colleague or transfer your script to another pharmacy. You can also file a complaint with the pharmacy’s national headquarters; many big chains have policies that protect customers. If the pharmacy is acting illegally (look up your state laws at NWLC.org), you can also file a complaint with your state’s pharmacy board.
Don’t have insurance or don’t want to use your parents’ to get birth control? Go to Bedsider.org to look up government-funded providers near you that prescribe free or low-cost contraception. “We try to be a clearinghouse for all your options,” says Power to Decide’s Rachel Fey.
If you’re over 18 and on your parents’ plan, call or write your insurance company and request to have any documents related to your health care sent directly to you. In many states, the company is not obligated to do this, but it’s worth the ask.
Should your employer deny you contraception coverage through your work insurance, talk to your doctor to see if the Pill could address any other conditions you have. Then ask your insurer: “I need this medication for acne. Is that covered?”
After Lili Gomez, 22, of Texas, asked for an IUD, her doctor’s reaction was shocking. “She said, ‘You have to commit to 10 years on the IUD, so ask your partner if he’d want kids in that time span,'” recalls Lili. (An IUD can actually be taken out any time.)
Provider bias like this is common, says Aisha Wagner, MD. Patients may be given incorrect info or coerced into (or out of) certain types of birth control. If you feel your doctor is judging you or spouting BS, it may be time to switch to a new one.
If your company cuts BC coverage, “gather colleagues and meet with HR,” says Suzanne de Janasz, PhD, a visiting professor of management and conflict resolution at George Mason University. She suggests the A-C-E approach, popularized by persuasion expert Kathleen Kelley Reardon, PhD. “A is for appropriateness,” de Janasz explains. “Similar companies offer free coverage, so yours should too. C is for consistency with the company’s focus on employee well-being. And E is for effectiveness. Canceling coverage will be pricey when more employees get pregnant.”
How to Fight for Your Rights!
Planned Parenthood’s Trump Tracker (TrackingTrump.org) has the latest news on the administration’s attacks on birth control. Go to Guttmacher.org or KFF.org for info on what states are doing to strengthen or restrict access.
“When the government proposes a rule, they must allow public comments online [at Regulations.gov],” says Susan Inman, of the Center for Reproductive Rights. “Anyone can post. We need to create lots of noise around why these policies are harmful.”
“Call your senator or congressperson and let them know how you feel,” says Rachel Fey. Even if your elected officials agree with you, “remind them to prioritize birth-control access.” Find contact info at USA.gov/Elected-Officials.
“The best way to make politicians listen is to vote,” says Dawn Laguens, executive vice president and chief brand officer of Planned Parenthood. To find candidates’ records on birth control, go to VoteSmart.org.
This article originally appeared in the November 2018 issue of Cosmopolitan, on newsstands now, or click here to subscribe to the digital edition.
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