Emily Cooper, 23, is a graduate student at UMass Amherst who has taken oral contraceptives since she was 15 years old.
In 2013, when a condom failed during a snowstorm, University Health Services (UHS) and the university bus system were both closed due to the weather. Even though Cooper was also on the pill, she and her partner walked nearly two miles in the snow to get Plan B One-Step emergency contraception at CVS. Cooper said that emergency contraceptive pills were easily accessed and inexpensive ($10) when she purchased them through UHS, but at CVS it cost her around $75.
“I started bawling my eyes out and everything on campus was closed,” Cooper said. “When I took (Plan B) I did feel relieved. I was really scared.”
There are many hidden burdens for people who can get pregnant. The physical challenges associated with menstruation and contraception are often taxing on their own; the added societal and political burdens, including shame and stigma and the cost of reproductive health care, often cause even more undue strain and stress.
On top of that, the Trump Administration recently rolled back a federal mandate requiring employers to provide insurance that covers birth control. Lawmakers and nonprofits in Massachusetts are resisting this national trend by trying to keep contraceptives accessible.
According to the Centers for Disease Control and Prevention (CDC), over 99 percent of 15 to 44-year-old women who have ever had sex have used some form of birth control at some point in their life. So when the government or employers make birth control and safe and legal abortions less accessible, it is terrifying to women in their 20s, according to Dr. Joan Berzoff, professor emerita at the Smith College School for Social Work.
“It’s financial, it’s occupational, it’s relational. Whether it’s school or a job, it’s terrifying to think one has to give all that up,” Berzoff said.
There are ways for male-bodied sexual partners to help prevent pregnancies, but they are often either less common or less effective. Only about 5 percent of 15 to 44-year-old sexually active women depend on a male vasectomy to prevent pregnancy, and about 9 percent depend on male condoms, but women who rely on their partner’s use of a condom have double the chances of becoming pregnant compared to women on the pill, according to the CDC.
Berzoff also said that most of the men she works with are vigilant about birth control.
“They are not leaving things to chance,” Berzoff said.
When Isabella Chiaravallotti, 23, of Sunderland got unintentionally pregnant last year, deciding what to do next was a complicated process.
“It was an eye opening and transformative experience for me,” Chiaravallotti said.
Chiaravallotti ended up having what she described as a fairly late-term abortion at 17 weeks. In October she published a book, called Milk for No One about her personal experiences with pregnancy and abortion.
“We often use a clinical lense for this very personal and emotional thing,” Chiaravallotti said. “Motherhood is something that I’ve always wanted and considered, but it’s hard to imagine what that would be like until it happens. I felt entirely out of my depth.”
Even though everyone’s experience with contraception and abortion is different, it’s clear that there are many ways that preventing unwanted pregnancies is a burden on people who can get pregnant, from cost, to physical symptoms, to stress and anxiety.
“Everybody with the right plumbing has some sort of pregnancy anxiety, unless that plumbing can no longer make you pregnant,” said reproductive rights expert Loretta Ross, who is a visiting Assistant Professor of Women’s Studies at Hampshire College. “But that’s also the anxiety of being a woman. Our first anxieties are around getting our period.”
For Ross, those anxieties are tied to the way that our society values women and motherhood.
“We don’t value women’s bodies in a patriarchal society the way they should be,” Ross said. “We don’t privilege motherhood in a way that provides the necessary social supports.”
That also extends to victims of rape, Ross said.
Chiaravallotti said that while she was pregnant, she felt disrespected as woman in her society and found it hard to find the support she would need to see the pregnancy through, like finding affordable healthcare.
“If a woman has good educational and good job opportunities, protection from pregnancy discrimination at work, affordable childcare, a supportive partner, that woman may turn an unplanned pregnancy into a wanted pregnancy, but if a woman lacks any of those things … then even a planned pregnancy may become an unwanted pregnancy,” Ross said.
“A lot of it is to do with power,” Chiaravallotti said. “Women could have a lot of power in the community that we don’t talk about. It’s about respect for remarkable biology, and respect for the body of someone who has a uterus.”
Using Contraceptives Today
In 2010, former President Obama signed the Patient Protection and Affordable Care Act (ACA) into law, including a provision that requires all employers and educational institutions (except for churches and houses of worship) to provide insurance that includes female contraceptive coverage. However, when the craft chain store Hobby Lobby petitioned against the ACA’s contraceptive mandate on religious grounds, the Supreme Court supported them and struck down the mandate in 2014, setting a precedent for privately owned businesses to reject the mandate. In October of this year, the Trump Administration officially rolled back the mandate and expanded employers ability to deny birth control coverage due to “religious beliefs” or “moral convictions.”
That was exactly what Caitlin Marquis, 29, of Northampton was afraid of when Trump was elected.
Marquis has been on some form of birth control since she was in high school. She has also used emergency contraceptive pills several times out of fear that her contraception might fail.
“(Birth control) is one of those subtle emotional labor things for women. We have to shoulder that anxiety,” Marquis said. “When I was on oral contraceptives I was always afraid that I wasn’t taking it perfectly. (In high school) I was young enough that it was terrifying.”
Marquis said that when President Trump was elected last fall she experienced another kind of fear: fear that she would lose access to affordable birth control altogether.
“When Trump got elected, I went to get an IUD (Intrauterine Device). Everything felt scary,” Marquis said.
According to the Guttmacher Institute, about 70 percent of women who are in their childbearing years (15 to 44) in the United States and are at risk of unintended pregnancy, meaning that they are sexually active and could become pregnant if they failed to use contraceptives correctly. That’s at least 43 million Americans who need to use contraceptives consistently in order to prevent pregnancies that they don’t want or that would be mistimed.
In an effort to protect access to contraceptives in Massachusetts, the state Legislature passed and Governor Charlie Baker signed An Act Relative to Advancing Contraception Coverage and Economic Security in our State (ACCESS) into law last month. Similar to the provision in the ACA, the law mandates that all insurance providers in Massachusetts cover the cost of FDA approved contraceptives with no copay. The law came into effect in November, but insurers will have up to six months to bring the changes into effect. It also expands coverage by guaranteeing coverage of a 12-month supply of birth control all at once, coverage of prescription-free emergency contraceptives, and coverage of more kinds of birth control.
As the federal government begins to curtail access to affordable contraception, Massachusetts Senate President Stanley Rosenberg (D-Amherst) said that a statewide law like ACCESS is important.
“The concern is that publicly funded programs will no longer be able to support expenditures in this area,” Rosenberg said. “We wanted to create blanket coverage for women through their insurance, private or public.”
Since this interview, Rosenberg has stepped aside to allow an investigation into his husband Bryon Hefner’s alleged sexual misconduct and claims of influence in the state Senate.
Disparities in contraceptive use
About 1.4 million women will continue to have access to no-pay birth control in Massachusetts because of ACCESS. Despite this, black women and women below the poverty line still use contraception less than their wealthier and white peers, according to the Guttmacher Institute. To meet this need, clinics like Tapestry offer affordable, high-quality, and confidential sexual and reproductive health care and education.
“For black women, there’s a lot of research showing that there’s a gap between the number of women who don’t want to get pregnant (who are sexually active), and the number of women using contraception,” Ross said.
According to the Guttmacher Institute, only 83 percent of black women who are at risk of unintended pregnancy use contraception, compared to 91 percent of their Hispanic and white peers, and 90 percent of their Asian peers. As someone who studies the reproductive rights of black women in America, Ross questions whether or not this gap is due to access or other factors.
A report published in 2010 in the U.S. National Institutes of Health’s National Library of Medicine found that there are disparities in contraceptive use across different races and socioeconomic groups. It reports that, “12 percent of women earning less than 150 percent of the Federal Poverty Level (FPL) were not using contraception, compared to 9 percent of those earning more than 300 percent of the FPL.” The research identified three major factors that contribute to these disparities, including contraceptive safety concerns (that may arise from a lack of sexual education), lack of access to family planning services, and unequal treatment by health care providers based on race and ethnicity.
Tapestry has offices in Springfield, Holyoke, Northampton, North Adams, Greenfield, and Pittsfield that provide sexual and reproductive healthcare on a sliding scale. Tapestry reports that teens pregnancy rates dropped 54 percent in Berkshire County between 2009 and 2014, in part due to their outreach and birth control access while partnered with Berkshire United Way.
Bre Durant, 30, of Easthampton is a mother and student who has used different forms of contraceptives both before and after the birth of her son. As someone who grew up in the Pioneer Valley, Durant was familiar with the services offered by Tapestry. Durant said that the cost of birth control and the confidentiality and ease of Tapestry’s services were all factors in her decision to go there.
“I did not have insurance when I started going,” Durant said. “I was a teenager and that’s where people I knew went.”
“Regardless of what you’re able to pay, you can come to Tapestry and we’re going to meet your need,” said Cheryl Zoll, CEO of Tapestry. “The importance of the ACA and now the ACCESS bill is that it preserves choice in its truest sense, because decisions can be made based on what a woman needs and not what she can afford.”
Contraception trends over time
Linda Daniels, 65, of South Hadley first used birth control in college in Connecticut when it first became available through Planned Parenthood.
When asked about how access to contraception made her feel, Daniels replied simply: “Safe, happy, free.”
Daniels said that when she first went on the pill as a freshman in college, it felt very, “underground.”
“The information about where to go and how to get it came mouth to mouth,” Daniels said.
The history of birth control in America has deep ties to Massachusetts. In the 1950’s, founder of Planned Parenthood Margaret Sanger connected her wealthy friend and fellow feminist Katharine Dexter McCormick to research that was happening on an early version of an oral contraceptive at the Worcester Foundation for Experimental Biology. The pill was approved as an oral contraceptive by the Food and Drug Administration in 1960. Later in 1967, a Boston University professor named William Baird was arrested for handing out condoms and contraceptive foam at a lecture, eventually leading the the 1972 Supreme Court case Eisenstadt v. Baird that legalized birth control for all American citizens, regardless of marital status.
Ross said that it was the court case that preceded the Baird case, Griswold v. Connecticut in 1965, that started to change women’s attitudes about contraceptives by legalizing birth control use for married couples.
“Instead of seeing it as something shameful, women saw it as something that was liberating,” Ross said.
For Ross, the religious right and the Republican Party’s anti-abortion movement since the late 1970s is an attempt to reattach shame to women who are trying to “control their fertility.”
Now, 57 years after the pill was first approved by the FDA as an oral contraceptive, other forms of contraception are also popular. Johanna Kaiser, media relations manager for Planned Parenthood League of Massachusetts (PPLM), said that nationally, Planned Parenthood health centers have seen a 91 percent increase in IUD appointments since 2009. She also said anecdotally that PPLM health centers have noticed a spike in IUDs and implants since the 2016 presidential election.
“Many women choose IUDs because they are long acting, reversible, do not require a daily pill, and are highly effective,” Kaiser said. “Before the ACA, high, up-front costs often forced women to settle for another birth control method that didn’t meet their needs.”
The Pioneer Valley is home to many higher education institutions that have their own health care services on campus. Health officials at UMass Amherst also noted a trend of college aged female-bodied students choosing to use an IUD or an implant.
Emergency contraception (EC) pills are also more common today. According to the CDC, between 2006 and 2010 about 11 percent (or 5.8 million) sexually active women between 15 and 44 years old had ever used emergency contraception, up from 4.2 percent in 2002. EC pills were first made available over-the-counter to people 18 years old and older in 2006. Now, anyone can get progestin-only emergency contraceptives off the shelf in America, regardless of age. Emergency contraception pills are not abortion pills. When taken correctly, a pill like Plan B One-Step can prevent the release of an egg from the ovaries, prevent fertilization of the egg by the sperm, or prevent the egg from attaching to the uterus.
Several years ago, Durant was able to access a free emergency contraception pill at Tapestry after being sexually assaulted. Durant explained that the emergency contraceptive helped to ease anxiety about getting pregnant, and that Tapestry felt like a safe space to go where she wouldn’t be in public and would be dealing with mostly women.
“My emotional state was really messed up,” Durant said. “I felt shame. I don’t think I would have been able to walk into a CVS.”
Before emergency contraceptives were available, women had limited options to prevent unwanted pregnancies after birth control failure or unprotected sex. One 62-year-old woman who wished to remain anonymous due to the personal nature of abortion, said that she did not use the pill when it came out because of side effects. When she experienced birth control failure her options without emergency contraception pills were limited. She said that when she thought she might be pregnant she had a procedure called menstrual extraction, where the uterus is emptied through vacuum aspiration. She described the procedure as painful, and said that it was ultimately ineffective at preventing the unwanted pregnancy, resulting in her pursuing a dilation and curettage (D&C) where tissue is removed from the uterus. D&Cs are the most common type of in-clinic abortion for women during the first trimester.
Cooper, the woman who walked through the snow with her partner for emergency contraception, is currently finishing her graduate degree at UMass. The pill was initially prescribed to her by a gynecologist because of irregular periods, but now she takes them to avoid pregnancy. Cooper said that she was recently home sick because of a side effect of her oral contraceptive. She said that if she accidently takes her daily pills too close together she gets nauseous, and that doctors have told her that it is a normal side effect.
“I wish I didn’t have to take them,” Cooper said, describing additional side effects. “It’s a reminder that I’m putting this really powerful thing in my body.”
Meg Bantle can be reached at firstname.lastname@example.org.