Three days after November’s election results were in, Alia Kuykendall made an intensely personal decision. She rethought her plan to remove the intrauterine device, or IUD, that she had been using since 2014 to ward off pregnancy.
Like other California women, the 23-year-old Sacramento resident worried about consequences of Donald Trump’s election to the presidency on reproductive services and rights. During the campaign, Trump pledged that if elected, he would defund Planned Parenthood clinics, repeal the Affordable Care Act, which covers contraception, and ban abortion.
In that new political environment, Kuykendall wasn’t sure she could get a legal abortion if she became pregnant.
“I realized that even though California is really strong, we’re probably going into this period where we’re going to be hit hard on reproductive rights and it’s really imperative that I not get pregnant in the next four years,” Kuykendall said. “I don’t want children; I can’t afford children. And if I got pregnant and I wanted an abortion, what if that wasn’t available to me in the future under Trump’s administration?”
Reproductive health providers, advocates and some women in California have voiced similar concerns after the Nov. 8 vote. In a state that overwhelmingly voted against Trump, some worry that private or public insurance will no longer cover monthly birth control pills, or that the community clinics women rely on for basic reproductive health screenings will be forced to close their doors. Some women have even rushed out to get IUDs, which can be effective as birth control for up to a decade.
Staff members at the Planned Parenthood clinic on B Street in Sacramento said they have been receiving inquiries every day from women worried about their access to birth control. In the four days before the election, the Planned Parenthood call center for Northern California received 322 requests for IUD appointments. About a month after the election, they received 378 calls in a similar four-day period, the center said.
Shauna Heckert, executive director of the health services provider Women’s Health Specialists, said staff members at her network of clinics from Sacramento to Redding have reported about a 30 percent increase in IUD requests comparing last December with this one.
“There may be episodic birth control that’s better for them, but they say, ‘What are we going to do?’ ” Heckert said. “When we see family planning services are so tenuous, women really want to bank on something they can count on. If they don’t know what tomorrow brings, having a three or five-year method might be the perfect answer.”
The reality in California, however, is that privately insured women may be seeking IUDs prematurely, said Amy Moy, a spokeswoman for the nonprofit reproductive health group Essential Access Health.
While anticipating a repeal of federal health care laws under a Republican Congress in 2014, California legislators passed a separate provision that requires all health plans to provide birth control free of charge in the state.
“It’s great that the threat people anticipate from the federal level is sparking an interest in women getting the contraceptive care that they choose and that they need,” Moy said. “We want them to know that in California we’ve got them covered, and the ability to do so is not based on any federal statute. They don’t have to make a mad dash.”
California women are in a rare situation on health issues across the board – at least for the next several years, said Barbara O’Connor, emeritus director of the Institute for the Study of Politics and Media, and a former communications professor at California State University, Sacramento.
The president-elect has two options for limiting abortions – overturn the Supreme Court’s 1973 Roe v. Wade decision or push the Republican-led Congress to pass legislation curbing abortion rights, which would likely be challenged in court because of its conflict with standing law. Both processes are politically treacherous, O’Connor said, and would take at least three to four years to put in motion.
In the meantime California can continue providing abortions and other health services for women of all income levels, so long as the state government agrees to fund them, she said.
“Everyone has said, from the (state Senate president pro tem) to the speaker to the governor, that we’re going to resist. And the constitution allows that,” O’Connor said. “We have our laws in place, and if we choose to spend our money on free clinics for women, we can operate as normal. Ultimately, there’s going to be a collision, but who knows when and who knows how?”
Kayla Clemens, a 21-year-old Sacramento native attending school in Oregon, said she’s concerned that without federal funding, she and other women will end up paying more for reproductive health services. She got an IUD in July, shortly after Trump became the Republican nominee for president, to make sure she was set in advance.
“In the media and through a lot of my friends, I could tell it was definitely a smart idea to move forward with it, especially because it does last,” Clemens said. “I have a lot of friends who just need this stuff, and I’m very worried about it.”
Some health care providers are bracing for the Trump administration putting Medicaid funding on the chopping block, as some Republican legislators have proposed. If that happens, California’s low-income and uninsured women would likely be the most affected, health advocates said.
That’s because even with the state provision in place, a cut to Medicaid funding could weaken California’s family-planning safety net, Moy said. And while privately funded insurance plans will continue to cover birth control, women on Medi-Cal plans may experience changes in coverage or lose their insurance entirely.
A restructuring of Medicaid could also endanger California’s Family PACT program, which relies on federal funding to provide reproductive health services for 1.6 million uninsured California residents.
Low-income women could also lose access if the new administration cuts service providers off from the federal Title X fund, which provides grants to organizations serving low-income women. Earlier this month, the U.S. Department of Health and Human Services finalized a regulation banning states from denying funds to any health provider that’s safely and adequately providing Title X services, but the new administration could reverse the ruling.
Without insurance coverage, birth control pills cost $15 to $50 per month, and IUDs cost as much as $900. Women saved $483 million in out-of-pocket costs for contraceptives alone in 2013 because of federal health law guidelines, according to QuintilesIMS, a health data analytics group.
Cheri Greven, spokeswoman for Planned Parenthood Mar Monte, which oversees Sacramento-area clinics, said the threat of budget cuts is enough to get people in the door.
“It’s tangible,” she said. “If today (the pill) is not a monthly cost consideration that you’re budgeting for, you now need to start thinking about that – how is this going to affect you economically?”
Wynette Sills, a Sutter County resident and director of volunteer anti-abortion group Californians for Life, said she’d like to see federal funding reallocated to health centers that do not offer the procedure but can assist women with other needs, such as housing and employment.
Sills stands outside of Women’s Health Specialists on Ethan Way every Thursday and Friday morning to talk to women seeking abortions about what their other options might be, she said. She compared advocating anti-abortion beliefs in California to “being in a wind tunnel where your cheeks are in your ears because you’re going into such a headwind of opposition.”
“We’re promoting (abortion) as if it’s this huge gift to women,” Sills said. “It shows that we as a community have failed to come alongside her when she’s found herself in this situation. … On something as contentious as abortion, Americans should not be forced to use tax dollars.”
Nonprofit clinics and women’s health advocacy groups have already begun looking for ways around any federal moves to block funding or access to reproductive health care.
“We’ll look to other funding sources, to our community,” Heckert said. “It’s not going to be easy, and the threat is real. But we have a group of very committed people.”