From the late-night Senate vote to repeal the Affordable Care Act to attorney general nominee Jeff Sessions’ demonstrated inability to disavow anti-abortion domestic terrorist groups, the incoming administration is looking like some fresh fucking hell if you possess a uterus. In the months following the election, I heard from women stockpiling Plan B, scheduling emergency IUD insertions, getting real about long-discussed vasectomies for their partners, and devising strategies to maintain their sanity and bodily autonomy in a country soon to be led by creepy old men who want them to have neither. You might feel alone right now if you’re going through this too, so remember: You’re a foot soldier in an army, fighting back against tyranny with birth control preparedness. And I’m here to help.
One of the greatest things about the Affordable Care Act was the birth control coverage mandate, which required insurance plans to cover birth control as the preventive care it is. This is why you’ve probably heard a lot recently about IUDs (intrauterine devices, for those of us who didn’t go to a women’s college). Not only are IUDs one of the most effective, longest-lasting forms of birth control currently on the market, they’re also incredibly expensive without insurance—$500 to $900. For women who live in strongly pro-choice states like Oregon, larger concerns about access to abortion under the travesty that is the Trump administration may not be as immediately applicable. But the encroaching high cost of birth control? That is. The birth control benefit may already be on its way out by the time you read this, so if you’re thinking about getting an IUD, now’s the time.
If you’re going the IUD route, your birth control preparedness starts with a decision: Hormones or nah? Hormonal IUDs (Mirena, Skyla, Liletta, Kyleena) contain a synthetic hormone that stops ovulation and thickens your cervical mucus. Copper IUDs (ParaGard) harness the power of copper to make your uterus an environment that’s toxic to sperm (a friend once aptly compared her ParaGard to a sentry warding off intruders; I have never forgotten this beautiful comparison). I know a slew of happy Mirena users who are especially enthused about the device’s serious side-benefit of making their periods lighter over time. Meanwhile, the ParaGard, while not adorably marketed like its vaguely floral-sounding sistren, has been around since the ’80s and lasts up to 12 years, so it’s tried and true: the sensible used Volvo of IUDs. It can also double as emergency contraception if it’s inserted within five days of unprotected sex. There are other hormone-free IUDs in use abroad—like the frameless, futuristic Gynefix—but they’re not yet available here, because (in case this wasn’t yet clear) America is way behind many other countries when it comes to birth control.
If you’re planning on getting an IUD, I’m guessing your next question is about insertion. And for good reason: Getting the ParaGard rates among the most painful experiences of my life, possibly ahead of running a half-marathon? (YMMV.) While many women I’ve spoken to are here with me in the “THE FUCK?! THAT FELT TERRIBLE” camp, a handful report only minor cramping followed by a pleasant bike ride home (LOL I CAN’T EVEN IMAGINE THIS). And if you’ve already given birth? I suspect we childless young women bent over our heating pads look like a bunch of crybabies.
Oh yeah, and your birth control preparedness plan? It doesn’t HAVE to include an IUD. I want to be clear about this: When it comes to birth control, you’re putting foreign objects and substances in your body to ward off babies, and only you have to deal with the side effects, which run a delightfully strange gamut from clear skin to unwittingly living under an emotional stormcloud for five years. As with all deeply personal medical decisions, you should never, ever feel pressured to undergo a medical procedure that doesn’t feel right for you, or welcome side-effects into your life that don’t seem worth it. So if you’re not feeling the IUD, don’t get one. I’m not a doctor!
It’s also important to remember that despite the quasi-religious fervor surrounding IUDs, there are plenty of options out there that have their own devoted followings: the pill, the patch, the ring, and the frequently ignored diaphragm (a new model just came out that doesn’t require fitting and comes in a delightful purple—so if you think the diaphragm is a thing of the ’80s or Carrie Bradshaw, you are incorrect). Whether you like your pill packs or cling to the trusty, unattractive ParaGard, your birth control has a simple job: It should prevent pregnancy or treat any of the conditions that birth control is prescribed for off-label (despite the GOP’s obsession with sex, there are lot). AND IT SHOULD BE RIGHT FOR YOU.
But whatever your preference may be, get it in order now. Do it because it will make Mike Pence cry. Do it because it will make you feel more secure in an insecure world. Do it because your capacity to get pregnant shouldn’t control your life. But most of all, do it for yourself. Because when it comes right down to it, that’s who you’re doing this for. That’s kind of the thing about reproductive rights: It’s not up to anyone but you.