The Trump presidency will, as many women are openly discussing on social media, be a very uncertain time for reproductive rights. The potential defunding of Planned Parenthood looms, as does the likelihood that the White House will take away the Affordable Care Act and make access to reproductive products and services either extremely expensive or impossible — and let's not even talk about the possibility that a conservative Supreme Court could overturn Roe v. Wade and leave the states to determine their own abortion preferences. It's a bit of a terrifying time. So what can you do if you know you need birth control that will last you through it, but you're not sure which long-term birth control option is for you?
If you're intent on not having children for at least the next few years, there are several options available to you. The IUD, or intra-uterine device, is the birth control option that's attracted the most media attention since the election results. Because the two options, the copper IUD and the hormonal IUD, last for 10 and five years respectively, they will effectively outlast the presidency (and are both very expensive to get without health insurance). NPR, discussing the rush to talk to gynecologists and Planned Parenthood centers around the country in the wake of the result, makes it clear that "the wheels of government take time to turn, so no one will lose their coverage on Day 1 of the Trump administration," but also validates the panic of women who fear that their access will be gradually cut away, and want to get things sorted as soon as possible.
If you don't want an IUD for your own reasons, though, there are other LARCs (long-acting reversible contraceptives) available to you. In honor of our new president-elect and #ThxBirthControl Day, here are some of your other longterm birth control options.
The Hormonal Contraceptive Implant
I have one of these and recommend them. In the U.S., this implant is marketed as Implanon: it's a progesterone-only plastic implant, around two inches long, that will be placed in your arm at your doctor's or gynecologist's office and will prevent pregnancy for up to three years. It's low-maintenance, low-impact, and carries a very high effectiveness rate.
The three-year length may be a problem, though, considering the four-year term length of American presidencies. You could push to have it inserted as late as you dare, but the issue with surgical interventions that need to be updated is that you can't stockpile them; this is something you have to use a professional for, and by the time it comes around to renewal you may need to switch to a different method or spend a lot of money getting a new one.
Diaphragms are an interesting alternative. They seem vaguely old-fashioned (Ms Magazine wondered, back in 2010, "where'd the diaphragm go?), but they last for a good long period and can be stockpiled effectively if you have a cooperative doctor. The trade-off is that they're fiddly and have only around a 91-95 percent effectiveness rate if used correctly every time, less if you've previously given birth. They need to be left in for a minimum of six hours after sex, and to have spermicide applied to keep them effective (which is available at pharmacies without prescription).
Diaphragms, which are made of silicone, are inserted into the vagina before sex to protect the cervix, and Planned Parenthood notes that with good care and maintenance it could last you up to two years. They need to be fitted and are available by prescription, so if this is your preferred method, you should talk to your healthcare provider about getting a prescription for several, in order to have back-ups over the next few years. You will need to be reassessed and resized at least once over the next four years, and be aware that you can't stockpile spermicide for a long period, as it does have expiration dates and will not work if you use it past them.
A Stockpile Of Sponges & Condoms
These aren't a longterm solution in and of themselves, but because they're both available from pharmacies and supermarkets without prescriptions, keeping a stockpile of them is easier than prescription methods. Condoms, both male and female, are highly successful one-use contraceptive methods that also protect against STDs, while the sponge, marketed in the U.S. as the Today Sponge, acts as both a cervical cover and a spermicidal contraceptive, and has a 91 percent effectiveness rating. The problem with the sponge is that it isn't recommended for use during your menstrual period, so you'll have to adopt other methods of contraception during that time. No, stockpiling four years' worth of either option doesn't seem very viable to me either, particularly since condoms with spermicide generally only last about two years; but they may be useful as a back-up plan.
It can be, realistically, very difficult for young women in particular to have either of the two procedures for sterilization offered in the U.S. (one involves using scar tissue to block the fallopian tubes, while the other ties or seals them). The difficulty doesn't lie in the procedures themselves, but in the willingness of doctors and medical professionals to provide them to women who haven't yet had children, or are just seen as too young to make the decision without possibly regretting it later.
Slate, reporting on this in 2012, found that doctors were generally unwilling to recommend the practice even to extremely confident and convinced young women because of "protection against future emotional pain" — reversing the procedures is very tricky, and medical professionals are often worried that a change of mind later in life would create serious and preventable problems. They're much more likely to recommend an IUD or hormonal implant for long-term reversible contraception, and will want to discuss, at length, why these aren't right for you. If you were already planning to have the procedure in the next four years, now is a good time to talk to your gynecologist or reproductive health center: the cost of both options is currently covered under the Affordable Care Act, and may well skyrocket afterwards (Planned Parenthood estimates the cost of tubal ligation, the colloquial "tying the tubes," as around $6,000).
These are scary times, but don't panic yourself into inaction: get the information, and plan.