For women, the next four years are looking darker by the week. With 100,000 pussy hats still in the laundry, President Donald Trump surrounded himself with a posse of pasty, patriarchal, mostly religious conservatives and made his first moves to gut sexual and reproductive health care for women.
No one knows what kind of family planning services will be available a year from now, or what it will cost, or who will have health insurance. But at least some of the options we have right now are going away, because many in the Mike Pence crowd won’t be satisfied until they have stigmatized and eliminated most modern contraceptives along with abortion. From their point of view, if that means killing cancer screenings and STI treatment and prenatal care for young and poor women, so be it.
Faced with these prospects, what should we do to take care of ourselves and our teenage daughters?
Today, thanks to Obamacare, expensive IUDs and contraceptive implants are free — which is unlikely to be the case once conservative Republicans make changes. Some women prefer pills or the shot or implants, or another form of birth control, and no one method works for everyone. Even so, to get through the next four years, an IUD may be the best option for many. Why? An IUD not only protects against pregnancy, but it can also save your life, especially if other health services like cancer screenings and prenatal care are being cut. And it lasts.
1. "My IUD will last longer than your presidency." So proclaimed a sign at the D.C. Women’s March, and it’s true. An IUD can be taken out at any point, with a fast return to normal rates of fertility. But if you aren’t ready for parenthood, or are busy loving the kids you have, a state-of-the-art IUD gives you anywhere from three to 12 years of protection, depending on which kind you choose. Hormonal IUDs, which release a mostly local microdose of progestin, are good for anywhere from three to seven years. Hormone-free copper IUDs have been approved for a decade, but actually continue to work much longer. Despite what you may have heard, both are genuine contraceptives, preventing egg and sperm from hooking up.
2. Get it and forget it. For those of us whose well-being is precarious, and for those who actually care about other people and our world, the next four years are going to be stressful and sometimes depressing. We are going to need all our mental energy for taking care of each other and fighting back. There may be a lot we can’t control, but we can at least eliminate the stress of broken condoms or trying to remember daily pills (or all-day morning sickness from forgetting and having to double up).
3. Lighter and fewer periods. Unless your last name is Kardashian or Trump or you were born with a similarly monogrammed silver spoon, some crappy things may be in store for you over the next four years, but one thing you don’t have to put up with is miserable monthlies. Some women like having periods, but most would just as soon not spend 6.25 years of their one precious life bleeding, which is what the typical 456 cycles add up to. We now have options. After an initial adjustment phase, hormonal IUDs cut period cramps and bleeding by on average 90 percent, and a lot of women have no period at all. Is it healthy? Yup. In fact, reducing menstruation has a number of health benefits.
4. A penny saved. Monthly periods are expensive. One journalist estimated that the average American woman will pay about $18,000 over her lifetime for menstrual supplies and birth control pills. That’s about $2,000 between now and the time we can get someone into the White House who won’t grab us all by the pussy. When you eventually do want to get pregnant, it will make absolutely no difference whether you bled all those years or not.
5. Climbing the ladder. Painful periods, also called dysmenorrhea, are the number-one health reason girls miss days of high school and the No. 1 reason young women miss days of work. In fact, a study in Italy estimated that 15 percent of the wage gap between men and women was due to “cyclical absenteeism,” literally caused by menstrual cycles. We women won’t be able to shatter the glass ceiling and fix the national wage gap this year like so many hoped just months ago, but the problem-period part of the gap is one you can take into your own hands.
6. And then there’s pregnancy. In real life, the least effective IUD or implant works 20 times better than the pill, or almost 40 times as well as condoms for preventing pregnancy. That’s a big deal when an unexpected pregnancy would be an especially big deal — like, say, when you’d have to immigrate to Canada to get paid family leave or affordable health insurance, and the rest of the safety net has been weakened to fund lifestyles of the rich and famous.
7. A womb when you’re ready. We don’t talk about this much, but pregnancy takes a lot out of a woman’s body, and not just when she’s pregnant or right after. Up to a third of women who have had a baby leak pee occasionally. Scar tissue may make sex painful. A prolapsed uterus can create a feeling of pressure. And that’s just the ordinary stuff. When a woman feels ready to have a child, she bears these risks willingly. But when our world is churning, the health costs of an unexpected pregnancy can feel particularly acute. Truly reliable birth control puts you in control. It means better health for you going in and better health for your baby coming out, and less likelihood of needing that safety net.
8. Making abortion obsolete trumps Pence. Look. We all know that the abortion fight isn’t about abortion. On the pro-choice side, it’s about being able to live the lives of our choosing and form the families of our choosing and bring children into the world with someone we love when we feel ready. It’s about stacking the odds in favor of our children flourishing. On the anti-choice side, some true believers are convinced that an embryo is a baby soul and killing it is murder. But just beneath the surface, it’s about trying to force women back into a gender script that was written in the Iron Age and punishing those who deviate. We know this because they have spent decades obstructing the kinds of sex ed and contraceptive access that drive down abortion but give women greater autonomy. This means that if contraceptive technologies (like IUDs, implants and whatever is in the pipeline) make abortion obsolete, we get what we want, and they don’t.
9. Live to fight another day. Hormonal birth control, including the IUD, has YUGE bonus health benefits. A hormonal IUD won’t help your acne like the pill does, but you do get less anemia, less pain, less endometriosis and — here’s a big deal — a 40-percent reduction in uterine and ovarian cancers. In some countries hormonal IUDs are being used to treat early stage cancers. Getting an IUD — if it’s right for you — is like putting on your oxygen mask first, because you can’t take care of anyone else if you don’t take care of yourself. So take care of yourself. And then, take care of the sisterhood by donating to Planned Parenthood, which is one of the easiest places to find a skilled, experienced practitioner who can insert an IUD same day, no charge (for now).
If you’re reading this, you probably won’t be among those hit first and hardest by the loss of reproductive health services. In one of their first executive actions, Trump and Pence targeted the poorest of poor women because they were the easiest to hit. They killed funding for International Planned Parenthood and any global health organization that so much as mentions abortion by re-instituting and expanding Ronald Reagan’s “Global Gag Rule.” Next in line? Probably poor American women who rely on Medicaid and Title 10 for birth control, and then working women who rely on Obamacare because paying out-of-pocket stretches a thin family budget to the breaking point.
But eventually they hope to get to all of us. Let’s be ready.