This story was originally published in 2019 during Donald Trump’s presidency. Given Texas’s extreme new law banning abortions after six weeks that went into effect this week, we are republishing the story as its message feels particularly resonate.
Nearly half a century after the Supreme Court ruling that enshrined a woman’s right to choose into federal law, the future of Roe v. Wade is uncertain. If Roe is overturned or restricted, yes, we will need to raise holy hell. But beyond fighting policy, there are steps every woman should take now to protect their rights, according to ob-gyn Kate White, M.D., and nurse practitioner Molly Finneseth.
“Hope for the best but prepare for the worst.” Some may say that’s a pessimist’s credo, and that those of us who worry about how the current political climate will impact reproductive rights are just liberal Chicken Littles. But who would have thought we’d be having the kinds of conversations that we’ve had in the past two years about access to basic women’s health care?
As health care providers who see more than 250 women as patients each month—that’s 3,000 a year—we are very concerned about what the new composition of the Supreme Court might mean for our patients. The right to an abortion is already restricted or imperiled in many states, and the future of accessible contraception is also increasingly uncertain. (Justice Brett Kavanaugh hinted that he believes oral contraceptives are abortion-inducing drugs during his Supreme Court confirmation hearings.) That means, depending on what cases come before the Court, we may be one judicial decision away from abortion becoming illegal across the country.
We have been taking care of women and girls for a combined 46 years and have seen women at every stage of their reproductive life; we know how, often, women don’t think about abortion until they need one. We’ve already started talking with our patients about things to think about to protect their health and their choices in the next few years. Since we can’t be in all y’all’s exam rooms, we want to share that same advice with you.
1. Think long and hard about pregnancy.
Public health professionals talk a lot about planned and unplanned pregnancies, but many women don’t think about pregnancy as something you plan (it’s not like a Caribbean vacation or a birthday party for your boyfriend). Many women we care for honestly don’t think about pregnancy until they have a scare—or until they’re actually pregnant. But if it becomes really hard or super expensive to access an abortion, women may not have the luxury of not knowing what they want until “later.” You’ll have to know and be able to act fast.
2. Think equally hard about your birth control.
If you know that you don’t want to have a baby in the next few years, it may be time for a talk with your partner. Are you both actively avoiding pregnancy? Are you using your birth control consistently (like, all the time) and correctly (no condom slippage or starting pill packs too late)? If not, an IUD or an implant may be a better choice for you. The insertion procedures have a bad rap for being scary, but we’ve talked many a woman through them, and everyone gets through them okay. Most say it’s nothing worse than a Pap smear or a period with cramps. For many, that’s well worth years of peace of mind.
And if you don’t currently have a partner, make sure that you’re prepared for the casual encounter that gets intimate before you thought it would. That’s another advantage of the implants and the IUDs: You get to have sex like a man…without thinking about becoming pregnant.
3. Think about what birth control will cost you.
When we talk to patients about contraception, we always ask what is most important to them about their method. We often hear questions like, “Can I stop and restart when I want?”; “What will it do to my periods?”; and “What are the side effects?” But these days we also talk about short-term versus long-term investment. If you want the pill, patch, or ring, how do the monthly copays add up compared with a longer-term investment in the IUD or implant? Here’s why: The availability of abortion isn’t the only thing that may change—insurance coverage for contraception may as well. Your $4 copay may soon become a $50 coinsurance cost, depending on how the new Congress and the new Court approach things like the Affordable Care Act. That could mean shelling out a whopping $600 per year for your birth control. This is where long- versus short-term planning can become super handy. While IUDs cost more upfront, they can come out to as little as $136 per year when you divide the cost over their many-year life span.
4. Track your periods.
Using an app on your phone to track your periods has many advantages—you can be prepared when your next period is due, and you can see whether your physical symptoms like cramps are related to your periods. But another advantage is that you’ll know as soon as you’re late for a period or miss one altogether. This alerts you to take a home pregnancy test right away. With some states already eyeing limiting abortion before a fetal heartbeat is detected, like Iowa, knowing early on whether you’re pregnant will give you more options if you need to seek abortion care.
5. When you’re pregnant, seek prenatal care early.
Women who are healthy don’t always go to their ob-gyn or their midwife early—we get it, those first prenatal visits can feel like a waste of time. But getting care early means finding out a lot of things about your health that you might not have known, like being anemic or being a carrier of certain genetic diseases. Early obstetric care also allows you to choose prenatal testing (blood tests and ultrasounds) that might reveal that something’s wrong. Even if you wouldn’t choose to have an abortion under any circumstances, information about a problem facing your baby can help you prepare, such as planning to deliver in a hospital with specialized neonatal care.
6. Set up a rainy-day fund and check your passport.
Abortions can be incredibly expensive. While it’s hard to pin down an average (insurance coverage and variations in state-by-state costs contribute to a wide range), Planned Parenthood estimates the procedure can run up to $950. That doesn’t include the cost of transportation or housing if you need to travel to get an abortion. And unless you live on the right or left coast, or a comfortable car ride to Chicago, access to abortion care will likely require travel. Insurance won’t pay for an out-of-state abortion, and gas, food, and lodging costs are going to be just as real as the cost of the procedure.