TMC PULSE

t m c » p u l s e | m a r c h 2 0 1 7 12 12 A few weeks after Inauguration Day, Megan Toomey paid a visit to the doctor. She left the office that afternoon with a newly inserted IUD and peace of mind. Toomey is part of a growing group of women following the 2016 election who are opting to have IUDs placed due to uncertainty about the future of the Affordable Care Act (ACA) and the comprehen- sive contraceptive coverage it provides. Since former President Barack Obama enacted the ACA, women have enjoyed free or greatly reduced access to a variety of contraceptives, thanks to a provision mandating coverage of "all Food and Drug Administration approved contraceptive methods … for all women with reproductive capacity." During a vote just days before the Jan. 20 inauguration, however, the Senate took a major step toward repealing the ACA while simultaneously opting not to approve an amend- ment to continue requiring contraceptive coverage even if other parts of the bill are repealed. For many women, this further cemented their fear that access to birth control could soon be limited. Some took to social media to voice concerns and urge women to take stock of their reproductive futures. For others, it was the final push needed to make an appointment to have an IUD inserted. "I chose the IUD, and Mirena specifically, because it lasts for five years," said Toomey, a Houston mother of a 1-year-old. "It gives me comfort to know that by the time I need to make another decision about birth con- trol, our political climate will hopefully be different." Toomey added that she had never had an IUD placed before because she was concerned about the pain of insertion, but decided the financial benefits of the IUD now outweighed the possible negative aspects. The process did not require a copay. Had it not been covered, "paying the $700 for the IUD and $300 for insertion would not have been man- ageable," she said. Analysts for electronic health record company athenahealth studied 1 million patient visits to the 85,000 providers in their network and discovered that between October and December 2016, visits to obtain IUDs rose 19 percent over the same time period the previous year. The researchers say this is the first time in five years that IUD requests increased in both November and December. In the Houston region, Planned Parenthood Gulf Coast has seen an even greater spike in IUD requests in recent months. From Nov. 1, 2016, through Jan. 31, 2017, providers at Planned Parenthood Gulf Coast inserted 656 IUDs. In the same time period the previous year, the organization placed 381 IUDs. This amounts to a 72 percent increase. Laura Thomas, nurse practitioner and Planned Parenthood Gulf Coast senior director of clinical services, said she has noticed a change in the attitudes of the women she treats. Typical reasons she hears for choosing IUDs include not wanting to take a pill every day, wanting to avoid hormonal birth control and not wanting to have a period every month. Lately, she's noticing something new. "I've been hearing different things from patients than I've ever heard before," said Thomas, who has worked for the organization since 2009. "Even just yesterday, when I asked a patient, 'Why did you choose this method?' She said, 'Because I'm worried I'm not going to have coverage.'" For women uncertain about future access to contraceptives or even health insurance, IUDs are appealing because they are designed to prevent IUD Rush Uncertainty about the future of the Affordable Care Act has women seeking longer-term birth control B y S h e a C o n n e l l y The Skyla IUD, left, and the Mirena IUD, right. Credit: Andy Tullis/The Bulletin via AP I chose the IUD, and Mirena specifically, because it lasts for five years. It gives me comfort to know that by the time I need to make another decision about birth control, our political climate will hopefully be different. — MEGAN TOOMEY Houston patient

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