I distinctly remember the feeling of waking up after the morning after the 2016 election — confused, disappointed, angry and panicked. In my high school that day, one of the most common topics of conversation amongst my group of peers was what long-lasting contraceptive we should get that we could rely on to last us through the Trump presidency in the inevitable case that our reproductive rights were put at risk. Unfortunately, there were very few options to choose from that would give us this assurance. Given the unpredictable side effects that often come with all contraceptive options, many people, especially young people like me, want ones that are reversible — decreasing accessibility even more. This leaves pretty slim pickings: only birth control Implants and Intrauterine Devices (IUDs).
As I ventured to find the right birth control for myself, I ran up against this lack of options immediately. As someone who experiences mental illness, I was advised by my doctor against an Implant, as mood swings are a common side effect – worsened for people with depression. I was then left to choose between an intra-uterine device (IUD) or to give up on a Long-Acting Reversible Contraceptive (LARC). I decided to get an IUD, and I am grateful every day that I did so, but not everyone has this choice. Insertions, whether it’s an IUD or an Implant can be extremely painful and the hormones cause many birth control users unpredictable side effects. Furthermore, while these methods may be technically “reversible”, implantation can be uncomfortable to do so and requires a medical professional, which can be a major hurdle for some women.
Across the board and since far before the Trump presidency, women who need access to contraceptives are pressed for truly good options. 2020 marks 60 years since the first oral contraceptive was approved by the FDA, yet contraceptive users still experience dissatisfaction with their options. A 2012 Guttmacher study found that the three features of birth control deemed “extremely important by the largest proportion of women were: effectiveness; lack of side effects; and affordability.” For 91 percent of women, no one contraceptive has all the features they think are extremely important.
The fact is that 69 percent of women who use the pill, injection, vaginal rings, or existing patch options for birth control give up on them in the first three years. Women in the U.S. have a median of trying three different forms of birth control, usually as in an effort to find the least bad option. Almost half of users say they chose their contraceptive form because they didn’t like the other options available.
So why is it, that after 60 years contraceptive users are still faced with unpopular and limited options? This is certainly a complicated question, with unsatisfying answers. Unsurprisingly, one of the biggest reasons for the slow pace of progress on contraceptive care is because of the politicization of the issue across every stage, most notably in the FDA approval process. I’m proud that NOW has been on the frontlines of these fights time and time again: challenging the FDA and HHS on the more than 50-year fight for over-the-counter access to Emergency Contraception (EC) regardless of age, which was first approved for rape survivors in the 1960s, but not as an over-the-counter option without age restrictions until 2013. NOW has taken other efforts to advocate for more choice in contraceptives.
Yet, not all hope is gone. This Valentine’s Day brought exciting news for contraceptive users when, after nearly a decade of review, the FDA approved a new form of birth control set to hit the market later this year. Twirla, is a low-dose transdermal patch applied once a week for three weeks, followed by a week of no application. This exciting new option expands possibilities for contraceptive users and can be a safer option than a traditional oral contraceptive. Yet it’s still self-controlled — allowing for assurance and autonomy. Testing on more than 2,000 women pointed to Twirla’s limited side effects and positive results for menstrual control. Testers reported a 1.5-day reduction in unscheduled bleeding and spotting and reported scheduled periods shortened to an average of 3.7 days.
Twirla may not be the perfect contraceptive option for everyone, but it will better meet the needs of today’s very busy young women, I believe. Seeing the FDA approve another option for contraceptive users is a huge reason to celebrate in these times when it feels like all reproductive news is bad news. As I continue to follow this story, it is with cautious optimism, thinking of all the patients who have one more opportunity to find the right reproductive health care option they need — yet knowing there is so much progress still to be made so that no young women feel the outcome of an election will risk their basic right to reproductive freedom.
By Maia Brockbank, NOW Public Policy Intern