Sweeping restrictions on abortion across the U.S. have already had major ripple effects in reproductive health care. During president-elect Donald Trump’s next administration, restrictions on abortion are likely to ramp up, and birth control may be next. The double hit is causing some people to urgently consider long-acting reversible contraception such as intrauterine devices (IUDs), or permanent contraception such as sterilization.
“I’ve definitely noticed a change post-Dobbs,” says Rachel Flink-Bochacki, an ob-gyn who practices in New York State, referencing the 2022 Supreme Court decision in Dobbs v. Jackson Women’s Health Organization that eliminated the nationwide right to abortion. In particular, Flink-Bochacki noticed an increased level of interest in sterilization among her patients. “It was a common conversation among ob-gyns, where we were all sort of saying, ‘Does anyone feel like we’re getting way more consults for this?’”
The data suggest this perception had some truth to it, says Xiao Xu, a health economist at Columbia University Irving Medical Center. In a recent report in JAMA, she and her colleagues found a statistically significant increase in sterilization procedures nationwide in the immediate aftermath of the Dobbs decision, which overturned the 1973 Roe v. Wade ruling that legalized abortion. The study also found that states with abortion restrictions continued to show higher rates of sterilization six months later. Other research has shown increases in long-acting reversible contraception use and sterilization procedures since Dobbs. These measures can prevent pregnancy for years at a time or for the rest of someone’s life. They are also less prone to failure than a daily pill and other short-term and temporary contraception.
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The results of the 2024 election appear to have further amplified this interest: reports from Planned Parenthood, which provides family planning and other reproductive health services, suggest sharp increases in appointments for vasectomies, IUDs and birth control implants at centers nationwide. That’s not surprising. “If abortion is becoming more difficult to do, women may turn to contraception to prevent a need for abortion,” Xu says. “Any abortion-targeted policy can have an impact broader than abortion care itself.”
Long-Acting Contraception
Three methods of long-term birth control are currently available: an arm implant, several varieties of IUDs, and sterilization procedures. All are extremely effective, with fewer than one pregnancy per year for every 100 people using them. In a survey conducted between 2017 and 2019, when abortion remained legal nationwide, some 24 percent of women relied on either their own or a partner’s sterilization for birth control, while 10 percent relied on an IUD or arm implant. People interested in any of these approaches will first consult with their doctor before scheduling the IUD or implant insertion or surgery, all of which are usually outpatient procedures.
Sterilization involves procedures such as a vasectomy, which cuts or blocks the tubes that carry sperm out of the testes, or a bilateral salpingectomy, which removes the fallopian tubes that carry eggs to the uterus. Both procedures are conducted under anesthesia but are typically minimally invasive; they are also irreversible. Flink-Bochacki notes that the consultation process includes a doctor evaluating that someone has fully thought through the decision, although some practitioners may refuse to perform these procedures on people without children. In the wake of Dobbs, she notes, reproductive health advocates have created online lists of doctors who are willing to perform these procedures on people without children.
The arm implant and IUDs only work on people who can get pregnant, and they are long-lasting but not permanent. “They are phenomenal options, and they are reversible, so if you don’t like [them], you can obviously have [them] removed, and your fertility returns and there’s no long-term effects,” Flink-Bochacki says. (She notes that IUDs and implants are also the most popular form of contraception among ob-gyns themselves.)
The matchstick-sized arm implant is inserted and removed under local anesthetic; it is approved for up to three years of use before needing replacement, but Flink-Bochacki says data suggest it can last for five. It contains a type of hormone called progestin that stops ovulation and thickens cervical mucus, which reduces the likelihood of sperm reaching the uterus. Like the pill, which stops or reduces ovulation and prevents fertilization and implantation, the arm implant steadily releases progestin throughout the body, although at lower levels than the pill. For some people, the arm implant is associated with irregular bleeding patterns, Flink-Bochacki warns.
Two types of IUDs are available. Each is placed directly into the uterus, which can be quite painful—people worried about pain during insertion should ask about management options in advance, Flink-Bochacki notes. IUDs also require returning to the doctor to have the device removed.
One variety of IUD relies on progestin, but unlike the arm implant, the hormone doesn’t travel throughout the whole body. Such hormonal IUDs can last from three to eight years and can reduce period pain and bleeding. There are also copper IUDs, which don’t contain hormones and can be used for 12 years. The copper causes local inflammation and directly interferes with sperm’s mobility, preventing them from reaching the uterus. But these IUDs can worsen period pain and increase bleeding, Flink-Bochacki warns.
In addition to the logistics and side effects of each birth control method, Flink-Bochacki also notes that people may need to use it longer than they may think. Until someone has gone a full year without a period, they may still be able to get pregnant. Flink-Bochacki recommends that if a person’s birth control method eliminates periods, as some do, they should continue to use it until age 55.
Reproductive Freedom at Risk
Policy experts worry that these contraception options may be at greater risk in the coming years, even though birth control and abortion have widespread support in the U.S. According to April data from the Pew Research Center, 63 percent of American adults believe abortion should be legal in all or most cases; in a separate survey, 79 percent of registered voters said that widespread access to birth control is good for society. In the pre-Dobbs contraception survey, 65 percent of U.S. women between 15 and 49 years old reported currently using some form of birth control.
Despite this popularity, during Trump’s 2024 presidential campaign, he praised his Supreme Court appointees for overturning Roe v. Wade. And the conservative policy agenda Project 2025, which several of Trump’s cabinet nominees have ties to, lays out a path for using an existing law called the Comstock Act to enforce a nationwide abortion ban without additional legislation. Particularly at risk is medication abortion, which accounted for 63 percent of all abortions in the U.S. in 2023. Access to this treatment has already come before the Supreme Court, which preserved its availability but left open the possibility of future legal challenges, and it is likely to be subject to additional cases.
The second Trump administration’s potential new efforts to restrict access to contraception may be more subtle than the antiabortion campaign, but it could have a major influence on people’s birth control access, says Liz McCaman Taylor, an attorney and senior federal policy counsel at the Center for Reproductive Rights, a global nonprofit organization that focuses on reproductive rights policy.
Theoretically, extreme right-wing politicians could directly challenge court rulings that protect contraception access, but Taylor thinks that approach is unlikely. “Birth control is even more popular and ubiquitous than abortion is, so the mainstream strategy is not to make it illegal writ large or pull the drugs’ approvals in the same way,” she says. “Instead I think that we’ll see death by a thousand cuts in the same way that was used to take down Roe eventually.”
These more subtle techniques include a strategy to warp the definition of abortion—a tactic already used in right-wing rhetoric, says Brigitte Amiri, an attorney and a deputy director of the American Civil Liberties Union’s Reproductive Freedom Project. “One of the attacks, very specifically, that you see in Project 2025 is the attempt to conflate certain forms of birth control with abortion,” she says. Medically, someone is pregnant only once a cluster of cells called a blastocyst has implanted in the lining of the uterus. But right-wing extremists often talk about pregnancy beginning with fertilization, falsely arguing in turn that emergency contraception, or “the morning-after pill,” and IUDs are abortion measures because they can prevent implantation.
Amiri and Taylor both expect opponents of contraception to begin by eroding the Affordable Care Act (ACA). The policy includes the Women’s Preventive Services Guidelines, which lays out a range of care—including contraception—that must be covered by insurance at low or no cost. Trump may attempt to remove at least emergency contraception and IUDs, but potentially birth control more broadly, from this list. Such a measure wouldn’t forbid birth control but would make contraception more expensive—before the ACA, it could represent more than a third of a person’s out-of-pocket health care spending. (People living in states with more protective health care laws may be somewhat insulated from ACA changes because the federal government provides only the minimum health benefits; state governments can require additional coverage.)
Title X, a government program that has historically provided birth control and other health care, will also be a likely target. During Trump’s first term, his administration banned clinics receiving Title X funding from referring people to abortion care, which caused some clinics to leave the Title X network, nearly halving the number of people that could receive the network’s birth control services. President Joe Biden reversed this policy, but Amiri expects Trump to reinstate it.
Taylor also expects that health care professionals who oppose abortion and contraception may find it easier to refuse care based on their moral or religious beliefs. Sterilization, which can already be difficult to access, is particularly vulnerable to these objections, she notes.
Overall, Taylor says it’s important to think beyond abortion when it comes to reproductive rights. “Bodily autonomy is connected to all kinds of our reproductive health experiences, and if there is a threat to abortion, it is a threat to all reproductive care, including birth control,” she says.
Still, Flink-Bochacki hopes that the current and future political climate won’t factor too strongly into people’s decisions about contraception. “I think it’s very reasonable that people are concerned about these things,” she says. “I hope that they’re able to make conscientious, intentional decisions based on their goals and their preferences and are not feeling like they’re forced into things that they don’t want to do because they’re afraid of the alternative.”