Access to birth control is the other major issue that will affect women. In 2015, 67% of American women were getting free birth control, with no copays, thanks to the ACA. Trump has said he would reverse this (Kozlowska, 2016).
Trump can take away birth control without copay and without involving Congress, but if he does, it is likely to take time to go into effect. Most experts feel that while this is an issue, it is not one that is likely to change in the very near future. So there is no reason to rush out and get an IUD—unless you were planning on it, anyway.
Legislative and religious limitations and restrictions on reproductive healthcare already put women at risk. In an article by Eisenberg (2016), reproductive rights have been denied to women for some time. Eisenberg cites several examples, including hospital policies that result in the inability to terminate a pregnancy that is nonviable if a fetal heart rate is present; healthcare institutions that limit the offering of prenatal screening because of costs; religiously-affiliated hospitals and faith-based insurance plans that limit contraceptive options to the women they serve; healthcare facilities that refuse emergency contraception to victims of sexual assault; and hospitals with restrictive policies not offering residents training in performing abortions. These authors further suggest that OBs should be taking a more active role in protecting patient’s rights. Keeping silent is not an option.
Further, most of these losses of reproductive rights will affect the women who are most vulnerable, further contributing to the health disparities in our country. The perfect example is adolescent pregnancy, which has long-term health and socioeconomic consequences.
A recent study by Lindberg (2016) shows the current reduction in the adolescent pregnancy rate can be attributed to improvements in the use of contraception. Further, the study also showed that contraception use did not promote sexual activity. Cutting off access to free or low-cost contraception and abortion will threaten those hard won gains.
With nearly 50% of pregnancies in the US unplanned and 40% of unplanned pregnancies ending in termination, now is the time to renew our efforts to educate and support our patients. We don’t want to discourage the use of contraception by returning to high copays or the absence of health insurance. Women’s healthcare providers need to be more proactive about protecting access to reproductive healthcare.
Sometimes we become too complacent. For instance, people could easily have signed up for healthcare prior to the election and talked to their doctors about getting an IUD much earlier than this. But we can use this shift in philosophy as a wake-up call. We are not guaranteed healthcare unless we work to put people into office who share our beliefs. My advice is to stay informed about the upcoming changes and to act as advocates for your patients.
It’s going to be a bumpy ride.
Abelson R. Donald Trump Says He May Keep Parts of Obama Health Care Act. NYT. November 11, 2016.
Eisenberg DL, Leslie VC. Threats to Reproductive Health Care: Time for Obstetrician-Gynecologists to Get Involved. Am J Obstet Gynecol. 2016 Nov 3. DOI: 10.1016/j.ajog.2016.10.037. [Epub ahead of print].
Kozlowska H. How a Trump Presidency Will Threaten Women’s Reproductive Rights. Retrieved on November 11, 2016. Available at:: http://qz.com/834521/trump-birth-control-reproductive-rights/.
Langley M, Baker G. Donald Trump, in Exclusive Interview, Tells WSJ He Is Willing to Keep Parts of Obama Health Law. President-elect hints at Possible Compromise After Vows to Repeal the Affordable Care Act. Available at: http://www.wsj.com/articles/donald-trump-willing-to-keep-parts-of-health-law-1478895339.
Lindberg L, Santelli J, Desai S. Understanding the Decline in Adolescent Fertility in the United States, 2007-2012. J Adolesc Health. 2016;59(5):577-583. DOI: 10.1016/j.jadohealth.2016.06.024.
Health Care. Trump/Pence website. Updated 2016. Available at: https://www.donaldjtrump.com/policies/health-care. Accessed November 14, 2016.