Abortion restrictions across the US have already had a major impact on reproductive health. during The next administration of President-elect Donald Trumpabortion restrictions are likely to increase, and birth control may be next. The double whammy causes some people to consider long-acting reversible contraception (such as intrauterine devices (IUDs)) or permanent contraception (such as sterilization).
“I’ve definitely noticed a changeDobbs,” says Rachel Flink-Bochacki, an ob-gyn practicing in New York state. 2022 Supreme Court decision Dobbs v. Jackson Women’s Health Organization which eliminated the right to abortion nationwide. In particular, Flink-Bochacki noticed an increased level of interest in sterilization among her patients. “It was a basic gynecological conversation where we were all saying, ‘Does anyone feel like we’re getting more inquiries for this?'”
The data suggest there was some truth to that perception, says Xiao Xu, a health economist at Columbia University Irving Medical Center. in a recent report JAMAhe and his colleagues observed a statistically significant increase in sterilization procedures nationwide. Dobbs the decision, The one that overturned 1973 Roe v. Wade the ruling that legalized abortion. The study also found that states with abortion restrictions continued to show higher sterilization rates six months later. Other studies have shown an increase in the reversible use of long-acting contraceptives since sterilization procedures Dobbs. These measures can prevent pregnancy for years at a time or for someone’s lifetime. They are less likely to fail than the daily pill and short-term, temporary contraceptives.
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The 2024 election results seem to have fueled that interest even more: Reports from Planned Parenthood, which provides family planning and other reproductive health services, suggest a significant increase in appointments for vasectomy, IUDs and birth control implants at centers nationwide. That is not surprising. “If abortion becomes increasingly difficult, women may turn to contraception to avoid the need for abortion,” Xue says. “Any policy targeting abortion can have a broader impact than abortion care itself.”
Long-acting contraceptives
There are currently three methods of long-term birth control available: an arm implant, several varieties of IUDs, and sterilization procedures. All are very effective, with less than one pregnancy per 100 people who use them per year. In a survey conducted between 2017 and 2019, when abortion remained legal nationwide, 24% of women relied on their own or their partner’s sterilization for birth control, and 10% relied on an IUD or arm implant. People interested in one of these approaches will consult with their doctor before scheduling an IUD or implant insertion or surgery, all of which are usually outpatient procedures.
Sterilization includes procedures such as vasectomy, which cuts or blocks the tubes that carry sperm from the testicles, or bilateral salpingectomy, which removes the fallopian tubes that carry eggs to the uterus. Both procedures are performed under anesthesia, but are usually minimally invasive; they are also irreversible. Flink-Bochacki notes that during the consultation process, a doctor assesses that someone has fully thought through the decision, although some practitioners may refuse to perform such procedures on people without children. In light of that Dobbsnoted, reproductive health advocates have created online lists of doctors willing to perform these procedures on childless people.
Arm implants and IUDs only work in people who can get pregnant, and are long-lasting, but not permanent. “They’re huge options, and they’re reversible, so if you don’t like (them), you can obviously take (them) off, and your fertility will come back and there’s no long-term effect,” says Flink-Bochacki. (He notes that IUDs and implants are also the most popular form of contraception among ob-gyns.)
The matchstick-sized arm implant is inserted and removed under local anesthetic; it’s approved for use for three years before needing to be replaced, but Flink-Bochacki says data suggests it could last five. It contains a type of hormone called progestin, which stops ovulation and thickens cervical mucus, which makes it less likely that sperm will reach the uterus. Like the pill, which stops or reduces ovulation and prevents fertilization and implantation, the arm implant continuously releases progestin throughout the body, although at lower levels than the pill. For some people, the arm implant is associated with irregular bleeding patterns, notes Flink-Bochacki.
There are two types of IUDs available. Each one goes directly into the uterus, which can be quite painful; People concerned about pain during insertion should ask. management options in advance, Flink-Bochacki warns. IUDs also require a return visit to the doctor to have the device removed.
One variety of IUD is progestin-based, but unlike the arm implant, the hormone does not travel throughout the body. Hormonal IUDs like these can last three to eight years and reduce period pain and bleeding. There are also copper IUDs, which are hormone-free and can be used for 12 years. Copper causes local inflammation and directly interferes with sperm motility, preventing them from reaching the uterus. But these IUDs can increased period pain and increased bleedingwarns Flink-Bochacki.
In addition to the logistics and side effects of each birth control method, Flink-Bochacki also notes that people have to use it more often than they think. If someone goes a full year without a period, they may be able to get pregnant. Flink-Bochacki recommends that if a person’s birth control method skips periods, as some do, they should continue using it until age 55.
Reproductive Freedom at Risk
Policy experts worry that these contraceptive options could become more dangerous in the coming years, even though there is widespread support for birth control and abortion in the U.S. According to April data from the Pew Research Center, 63% of American adults believe abortion should be legal. all or most cases; in a separate poll, 79% of registered voters said expanding access to birth control is good for society. in the previousDobbs contraceptive survey, 65 percent of US women ages 15 to 49 reported using some form of birth control.
Despite this popularity, during Trump’s 2024 presidential campaign, he praised his Supreme Court nominees for overruling them. Roe v. Wade. And the conservative political agenda 2025 projectIt paves the way for the use of an existing law that several of Trump’s cabinet nominees have ties to. Comstock Act to enforce a nationwide abortion ban without additional legislation. Medication abortion is particularly at risk, accounting for 63% of all abortions in the US in 2023. Go to the Supreme Courtit preserved its utility but left open the possibility of future legal appeals, which are likely to be subject to additional cases.
New efforts by the second Trump administration to restrict access to contraception may be more subtle than the anti-abortion campaign, but it could have a big impact on people’s access to birth control, says Liz McCaman Taylor, the Center’s senior attorney and federal policy adviser. Reproductive Rights, a global non-profit organization focused on reproductive rights policy.
In theory, far-right politicians could directly challenge court rulings protecting access to contraception, but Taylor says that approach is unlikely. “Birth control is even more popular and ubiquitous than abortion, so the main strategy is not to increase illegal prescription or remove drug approval in the same way,” he says. “However, I believe we will see death with a thousand cuts in the same way it was used to bring it down Orcaza finally.”
Among these more subtle techniques is a strategy to distort the definition of abortion—a tactic already used in right-wing rhetoric, says Brigitte Amiri, an attorney and deputy director of the American Civil Liberties Union’s Reproductive Freedom Project. “One of the attacks, very specific, is the attempt you see in the 2025 project combine some forms of birth control with abortion“, he says. Medically, someone is only pregnant when a cluster of cells called a blastocyst has implanted in the lining of the uterus. But right-wing extremists often talk about pregnancy beginning with fertilization, arguing falsely emergency contraception, or the “double pill”, and IUDs are abortion measures because they can prevent implantation.
Amiri and Taylor hope to start wearing down opponents of contraception Affordable Care Act (ACA). The policy includes the Women’s Preventive Services Guidelines, which establish a range of care—including contraception—that an insurer must cover at low or no cost. Trump may at least try to remove emergency contraception and IUDs, but possibly birth control more broadly, from this list. This measure would not ban birth control, but it would make contraceptives more expensive; Before the ACA, it could represent more than a third of a person’s out-of-pocket health care spending. (People living in states with more protective laws may be somewhat insulated from the ACA changes because the federal government provides only minimal health care benefits; state governments may require additional coverage.)
Title X, a government program that has historically provided birth control and other health care, will also be a likely target. During Trump’s first term, his administration banned clinics receiving Title X funding from referring people for abortion care, which caused some clinics to drop out of the Title X network, nearly halving the number of people eligible for in-network birth control services. President Joe Biden reversed that policy, but Amiri hopes Trump will reinstate it.
Taylor also hopes that health care professionals who oppose abortion and contraception will find it easier to deny care based on their moral or religious beliefs. Sterilization, which can already be difficult to achieve, is particularly vulnerable to these objections, he noted.
Overall, Taylor says it’s important to think beyond abortion when it comes to reproductive rights. “Bodily autonomy is tied to our reproductive health experiences, and if there’s a threat to abortion, it’s a threat to all reproductive care, including birth control,” she says.
However, Flink-Bochacki hopes that the current and future political climate will not factor too much into decisions about contraception. “I think it’s very reasonable for people to be concerned about these things,” he says. “I hope they are able to make conscious and deliberate decisions based on their goals and preferences and not feel like they are being forced into things they don’t want because they are afraid of the alternative.”
