Brigham and Women’s Hospital researchers have documented a trend in women’s health that had previously been reported mostly anecdotally: President Trump’s election set off a birth control boom.
In the immediate aftermath of the Nov. 8, 2016, upset election, women rushed to secure long-acting, reversible contraception — the kind that could feasibly last through the duration of a Trump presidency. Compared to the same monthlong period in the previous year, demand for IUDs and other implants spiked 21.6 percent, according to the study, which was published in JAMA Internal Medicine online Monday.
Dr. Lydia E. W. Pace, director of the Women’s Health Policy and Advocacy Program at the Brigham, set out to quantify a trend that seemed to emerge in the days and weeks following the election.
Trump campaigned on repealing the Affordable Care Act, which made birth control coverage standard under private employers’ insurance plans, as well as in subsidized care. Since 2013, women have been able to get birth control without copayments.
After the election, with the imminent threat of repeal, reports began surfacing that women were rushing to doctors and clinics seeking IUDs and other implants known as long-acting reversible contraception. Such methods, which have steep up-front costs, provide birth control for years and are considered the most effective method on the market.
Most of the reports were isolated or anecdotal, said Pace, though she pointed to an analysis released in early 2017 by athenahealth, the Massachusetts-based developer of electronic health record systems, comparing data from October 2016 to January 2017 to data from the previous year. That analysis found a similar 21 percent increase in visits for management or insertion of an IUD around the election.
Planned Parenthood League of Massachusetts also reported seeing a spike in inquiries about birth control and appointments for IUDs and implants.
In the six days after the election, Planned Parenthood scheduled 265 IUD insertions, compared to just 52 in the six days leading up to the election, the office reported then.
But since IUD and implant insertion rates fluctuate throughout the year — and have risen over the past decade — the Brigham and Women’s researchers wanted to isolate the specific effects of the election.
Of the prior reports, Pace said, “None to my knowledge had used statistical methods to control for preexisting or seasonal trends, which was what we hoped to contribute.”
To pinpoint the scope of the changing demand relative to the election timing, the Brigham researchers examined a commercial insurance database and studied more than 3 million women of reproductive age, between 18 and 45. Then, they compared the rates of long-acting contraception insertions in the 30 business days before and after Nov. 8, 2015, with the same time span before and after Election Day, Nov. 8, 2016.
While the rate changed little before and after Nov. 8 in 2015, the 2016 rate changed from 13.4 per 100,000 women before the election to 16.3 per 100,000 women afterward — a 21.6 percent increase. That means an additional 2.1 insertions per 100,000 women per day after the election or, if extrapolated to the 33 million women of reproductive age who have employer-sponsored health insurance, an additional 700 insertions per day — or 21,000 in a month.
“I was and am quite impressed by those numbers,” said Pace. “That’s 21,000 additional IUDs or implants that we can associate with the election.”
And while her data can’t determine exactly why those decisions were made, she does conclude there was a link.
“Political events do or can influence women’s contraceptive decision-making,” Pace said. “It suggests to me that many women really valued that coverage that they do continue to have under the ACA, and I think that’s an important message for the public and for policy makers. There continue to be efforts to reduce women’s access to comprehensive contraception and reproductive health care more broadly..”
Though Congress did not repeal the ACA outright, lawmakers and the Trump administration have taken steps to disable some of its provisions, including the birth control mandate.
The administration has expanded the range of employers who can be exempted from providing contraceptive coverage beyond those with firm religious objections to include those with moral reservations.
The new rule was due to take effect last month but has been blocked by the courts while it is being legally challenged by various states, including Massachusetts.
Massachusetts also enacted a law requiring birth control coverage in anticipation of the Trump administration undoing the mandate.
Jacey Taft, 27, of Dorchester was among those who got an IUD “because of Trump’s rhetoric,” as she put it. She had taken birth control pills in the past. But in the aftermath of Trump’s election, she was one of the many who contacted gynecologists’ offices, hoping to secure a longer term solution.
“I was and still am scared of what may happen to health care and especially women’s health care, and figured a 5-year IUD could buy me time until (hopefully) the next president is elected,” Taft wrote in an e-mail. “The ob-gyn I visited also told me they were booked for months because of the fear of Trump, but thankfully someone else rescheduled their appointment, allowing me to get one.”
Under her insurance, Taft was able to get a free IUD that might otherwise have cost $1,000 to get implanted. She hasn’t had to return to the ob-gyn, and she is grateful that Massachusetts enacted its own law.
“This is really a lucky state to be living in at this moment,” Taft said. “I worry for women in other states where clinics are being shut down and access is really limited.”