Shari Rudavsky

shari.rudavsky@indystar.com

Afraid that contraceptive coverage rules could change under a Trump presidency, women are increasingly asking health care providers about contraceptive options that could last longer than four years.

While it’s difficult to quantify how widespread the interest has been, many local health care providers say that since the election they have had calls from women wanting to know about birth control options such as intrauterine devices and hormonal implants.

Under the Affordable Care Act, many insurers offer coverage for a wide range of contraceptive options, from birth control pills and diaphragms to long-acting, reversible contraception that can last up to 12 years.

During the campaign, President-elect Donald Trump vowed to repeal Obamacare, raising concerns among some woman that they will have to pay out of pocket for contraception. In addition, Vice President-elect Mike Pence, who is also Indiana's governor, has a long record of trying to end government funding of Planned Parenthood, which is a provider of women's health care.

“We have seen an upswing in people making appointments to have those conversations,” said Ali Slocum, a spokeswoman for Planned Parenthood of Indiana and Kentucky. “Our messaging hasn’t changed. But we are recommending that people be as proactive as possible because we don’t know what this presidency will bring.”

Ann Marie Elliott, 26, had been thinking about getting an IUD but had relied on other forms of birth control.

Then, last week she made an appointment with her obstetrician-gynecologist.

Knowing that she was not ready for an unplanned pregnancy, she plans to ask her doctor for an IUD.

“It really was just imperative to me to ensure that I could at least keep myself protected from any unwanted pregnancies for the next handful of years,” the Downtown resident said. “So proactively I made the decision to go ahead and get it.”

Dr. Nicole Scott, an obstetrician-gynecologist at Indiana University Health and Eskenazi Health clinics, say she and her colleagues have been fielding more requests for consults about contraceptive options since Nov. 8.

A colleague from Utah, who recently delivered a lecture in Indianapolis, recounted that he had 67 requests for IUDs in three days, Scott said.

At the Planned Parenthood clinics where Rebecca Evans works in the Indianapolis area, she’s hearing more women expressing interest in long-acting, reversible contraception and asking about their cost. There’s been an increased interest in these options over the last several months, she said.

Some patients ask questions and don’t make a decision on the spot. Then there are those such as the woman she saw the other day who told her she didn’t want children in the next five years, so would she please put a device in now?

“A lot of times we tend to place things on the back burner. Now this is pushing that to the forefront,” Evans said.

Planned Parenthood offers programs to provide these options for free or at a reduced price for patients who don't have insurance or whose insurance doesn't cover them.

Not every provider is seeing a marked increase in requests for long-acting reversible contraception.

Dr. Kristina Box, an obstetrician-gynecologist with Community Health Network, and her colleagues have heard from a “handful of people” who have asked about having their long-active reversible contraception replaced sooner than would be warranted.

Insurers often place limits on how frequently patients can access their medical services, such as having an IUD replaced.

“The question is just whether it will be covered again. If they just had it put in two years ago, their insurance may not cover it,” Box said.

IUDs come in two forms, copper and hormonal. Most IUDs, which are small, T-shaped devices, emit the hormone progestin. These devices thicken the cervical mucus, trapping sperm and preventing it from reaching the egg. They may also prevent ovulation, meaning that the sperm has no egg to fertilize. These types of IUDs can last from three to six years, depending on the brand. IUDs with copper, which can last for up to 12 years, block the sperm from reaching the egg.

Birth control implants are another form of long-lasting contraceptive. These matchstick-sized rods are inserted in the arm and release progestin. They can provide effective contraceptive coverage for up to four years.

Before 2013, when the health reform went into effect, patients might have to pay in the thousands of dollars to have a long-acting reversible contraception placed, even with insurance. Since insurance started covering contraceptive devices, more women have been opting for them, Scott said.

And that’s a good thing, Scott said, as it drives down the number of unplanned pregnancies. More planned pregnancies lead to a decrease in infant mortality, stronger family units and fewer NICU stays, as well as fewer abortions, Scott said.

So now she’s urging her patients more than ever to give serious consideration to long-acting contraceptive options.

“I definitely encourage that decision sooner rather than later,” she said.

As their name connotes, these options do not have to be forever. The removal process is a pretty simple one for women who have them and decide it’s time to start a family, Evans said.

Still, deciding whether to have one placed can be a difficult decision for women, she added.

“The thing we see is the uncertainty is making people nervous, and I think people just don’t know and obviously we can’t give any answers,” she said. “We don’t know yet how this is going to change.”

Call IndyStar reporter Shari Rudavsky at (317) 444-6354. Follow her on Twitter: @srudavsky.

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