Usage of highly effective, long-lasting birth control has jumped after Donald Trump’s victory in the November presidential election, as American women consider what a Republican effort to reverse the Affordable Care Act could mean for access to intrauterine devices (IUDs) and other contraception.

An IUD typically lasts three to 10 years, so it could potentially prevent pregnancy for a whole presidential term or even two.

Doctors saw a 19 percent increase in IUD-related visits in November and December compared to the prior year, according to data from AthenaHealth, a provider of billing software to healthcare providers.

“It certainly looks like some women are concerned that full coverage for contraceptive services will be more expensive for them, and so are getting IUDs without cost while they still can,” said Josh Gray, vice president of research at AthenaHealth.

IUDs are considered one of the most effective birth control methods available. But the high upfront cost (as much as $500-1,000 for someone who’s uninsured) has dissuaded many women from choosing them. Usage of IUDs increased after the Affordable Care Act went into wide effect in 2014.

Passed in 2010, the ACA mandated healthcare plans to provide some preventive services, including birth control, at no extra cost. And a study last year in the journal Contraception found that the ACA’s requirements had a notable impact on lowering the out-of-pocket expenses for women for birth control.

A separate study of 30,000 privately insured women in the Midwest found that the ACA mandate resulted in cheaper birth control and produced a significant increase in the use of contraceptives, including a large increase in women choosing long-acting birth control methods such as IUDs and implants.

The rise in access and decrease in cost in birth control in the U.S. has also coincided with a relatively sharp decline in the nation’s teen birth rate, which was the lowest on record in 2015.

It remains unclear how Trump administration and Republican-controlled Congress will approach changes to the Affordable Care Act. An early push for fast repeal has stalled as Republicans consider the possible political consequences of any action.

Still, reproductive health advocates say they’re worried about Trump’s pick to head the Health and Human Services Department, Republican Congressman Tom Price. In 2013, he voted in favor of the amendment to a budget resolution that would have allow insurers to opt out of covering birth control based on religious or moral objections.