A close-up of a hand demonstrating the correct placement of an Intrauterine Contraceptive Device (IUD) in the Uterus during the national celebrations of World Contraception Day. (Photo by James Wakibia/SOPA Images/LightRocket via Getty Images)
Project 2025 — a 900-page policy agenda for the next Republican presidency authored and supported by Trump allies, former and current Trump staffers and Vice President-elect JD Vance — details a pathway for nationwide attacks on abortions, IVF and contraceptives. And now, some reproductive rights advocates and experts suggest this is a good time for Americans to start conversations with providers about their birth control plans.
“It’s just really important that we educate as many people as possible on how to protect themselves [for] the next four years — and perhaps the next decade,” said Dr. Sophia Yen, co-founder of Pandia Health, an organization specializing in reproductive care. If you’re at an age where you could have children, Yen’s message is: “Get your birth control under control. Maximize it — get the best possible one that you like and can tolerate.”
San Francisco gynecologist Dr. Katherine Gregory said her biggest message to people of reproductive age is to start having the conversation about birth control with their provider now, to explain their concerns — rather than quickly making a decision “because of fear.”
“I’m kind of always going to try to take the position of ‘What can you do to protect yourself and others?’ And there’s lots” you can do, she said.
Remember: California’s laws still currently favor reproductive rights
California positioned itself as a leader in reproductive care in the country immediately after the overturning of Roe v. Wade — and the state is now doing so again ahead of a second Trump term. However, California’s autonomy could be at risk with conservative control of all three branches of government, warned Gender Equity Policy Institute’s Nancy Cohen, who told KQED that “federal law will trump state protection.”
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“States like California and New York that have constitutional protections for abortion rights and reproductive health care in general … those become meaningless” in the light of any national restrictions, Cohen said.
Addressing this threat in a statement the day after the election, Gov. Gavin Newsom said that “lawyers from the Attorney General’s Office and my office have been preparing for a potential second Trump term for more than a year.” The state, Newsom wrote, was “marshaling the arguments and evidence needed to be ready to challenge in court unconstitutional and unlawful federal policies, and to mount robust and vigorous defenses of California’s laws, policies and programs.”
“We’re living in California, and we’re lucky that we feel a bit protected. But we can’t take that for granted,” Gregory said.
Amid all this uncertainty, and before California likely enters new legal territory as it gears up for a fight against the second Trump administration, how can individuals empower themselves around birth control and longer-term reproductive measures?
Knowing the best birth control for your body is always a good idea, regardless of the political climate. Keep reading to learn more about the current contraceptive options open to you and what experts suggest you do to prepare ahead of any possible change in laws governing reproductive freedom.
What will a birth control discussion with a provider look like?
Gregory said that people should start a conversation with their health care provider about the best birth control options for them. If you do not have insurance, Planned Parenthood can offer these services.
“There’s lots of things that we talk about with our patients to help them decide on what’s the best contraceptive,” she said. “I hate the thought that — out of fear — young women may not make the right decision for themselves,” Gregory said. For her, taking control of your own reproductive health is inseparable from “having these discussions with a provider.”
When talking to a provider, Gregory said patients can come prepared to discuss topics like:
What they want to see or expect from their contraceptives
How long they want their contraceptives to last
Their health history
Other questions could include whether the person wants to have children or not — and, if so, whether they have a timeline for starting a family.
Even voicing your concerns about upcoming policies under the new Trump administration could help a provider give advice on what birth control to suggest, Gregory said — mindful that “it’s impossible for any provider to predict what will happen.”
Advocating for yourself in a doctor’s office isn’t always simple. If you’re concerned about freezing up in front of medical professionals, NPR’s Life Kit has a guide with tactics to get what you need out of your appointment.
What are the different birth control options, and how long do they last?
The Centers for Disease Control and Prevention (CDC) has a thorough chart that ranks the effectiveness of birth control types — with the implant and intrauterine devices listed as the most effective among reversible methods. The California Surgeon General’s guide also has a list of methods, benefits and possible side effects.
“The higher up on the scale you go, the fewer times you have to think about dealing with it, but also the greater the efficacy,” Yen said. “So maybe switch up for a better one if you can.”
The most to least effective forms of birth control, according to the Centers for Disease Control and Prevention. (Courtesy of the Centers for Disease Control and Prevention)
In order of effectiveness, birth control options — many of which are prescription-based — include:
Implant
The implant — also known as nexplanon — is a tiny rod inserted in your upper arm. It is good for preventing pregnancies for up to five years.
Different hormonal IUDs last for different amounts of time. For example, Mirena and Liletta IUDs last up to eight years. Kyleena’s IUD lasts up to five years.
“In general, women are turning towards long-term contraception, such as the IUD,” Gregory said. “It’s convenient, it works extremely well … it removes that anxiety for a longer period of time.”
For some patients, the procedure of inserting an IUD can range from uncomfortable to painful. Yen said for many people, scheduling an IUD appointment near the last day of their period can help reduce that discomfort and pain “because the hole [of your cervix] will be already open.”
Yen also recommends taking 600mg of ibuprofen (with food) half an hour before the procedure. (Patients should not take ibuprofen if they have bleeding problems, kidney problems, or are allergic to the medication.) Lastly, Yen said patients can also ask the staff to numb their cervix, emphasizing that people facing pain “don’t have to ‘suck it up.’”
The depo-shot (Depo-Provera) is an injection every three months or four times a year. If a patient gets their first shot at any other time than the start of their period, they should use another birth control method, like a condom, for a week if they have sex.
There are two brands of rings: NuvaRing, which lasts up to five weeks, and Annovera, which lasts up to one year.
The birth control patch
A person can wear a birth control patch on their belly, back, or sometimes arm, which releases hormones that help prevent pregnancy. There are two brands: the Xulane patch and the Twirla patch. Similarly to the ring, a person would wear the patch for three weeks and then take it off for one week, then put on a new patch.
The pill
The pill is the birth control medicine you need to take around the same time every day. While there is now an “over-the-counter” option that is a “mini-pill,” meaning it is progestin-only, a “combined pill” with both estrogen and progestin is slightly more effective.
Yen said due to the Affordable Care Act, there is “no copay, no deductible for any FDA-approved birth control. If there’s a generic of it that they like or a brand of it that they’ve made a deal with the drug company, you have to go with that one, but it should be the same dose in the same formulation.”
Yen recommended getting birth control automated and delivered regularly through your pharmacy in case a person forgets to renew their supply. In California, a person can request up to a year’s supply, meaning, for example, physicians write for 13 birth control pill packs — or 17 packs, if one wants to skip their period.
What are the surgical, permanent options to prevent pregnancy?
For people who are done having children or are very sure they do not want children, there are one-time surgical procedures that aim to prevent pregnancy permanently:
Both practitioners stressed the importance of patients working with their providers to be very sure of whether these types of surgical procedures are right for them — both because of their permanent nature and also because of the risks of any kind of surgery.
“Surgery like this is very, very safe,” Gregory said. “But it’s surgery, and it can have complications.”
Gregory said during the first Trump administration, her practice saw an uptick of women in their 20s and early 30s requesting sterilization. “These were women who very clearly communicated that they have never wanted children,” Gregory said. “They’ve thought about it, and they’ve asked for tubal sterilization.”
But providers often still deny people a referral for this type of surgery, usually “because of their age,” Gregory said.
Some medical offices might dissuade or turn away a person from pursuing this option — or say that someone would need their partner’s permission, which is “not true,” Yen said. (“Feel free to report that provider to the medical board,” she said.) In the aftermath of Trump’s second win, crowdsourced lists began circulating online listing doctors nationwide who have performed tubal ligations regardless of a patient’s marital status or number of children.
Some of these providers may deny a patient on the basis that they may regret the decision, but Gregory said the denial “can’t be that arbitrary.” Physicians should instead refer to the existing scientific research, she said.
Gregory said if a young woman in her late 20s comes into her office and “really wants a tubal sterilization,” she would have a “frank discussion” with her to make sure the patient has considered all her options and to “understand how she’s come to this decision.”
“She’s an adult, and she can make these decisions about her own body,” Gregory said. “I think that there will be probably another uptick in young women requesting tubal sterilization, and that is their right.”
Plan B, emergency contraceptive, on the shelf in a drug store in Annapolis, Maryland, on July 6, 2022. ((Photo by JIM WATSON/AFP via Getty Images))
What are my emergency contraception options?
Emergency contraception can prevent 95% of pregnancies within five days of unprotected sex, including if a condom breaks or missing the window of forgiveness with birth control pills.
You can find a clinic that offers these services using Planned Parenthood’s search tool. (More on this below.) Planned Parenthood also has a quiz for people to see which method of emergency contraception is best for them.
A person can get Plan B at a drugstore or pharmacy over the counter or have it prescribed. Plan B has a shelf life of four years if a person wants to stockpile in case of emergency. (Be sure to check the date on the side of the box to confirm this.)
Yen noted that a person’s body mass index will factor into whether or not the over-the-counter emergency contraception is effective. For example, if a person’s BMI is greater than 26 — a medication like Plan B may not work as well. If it is greater than 30, Yen said, it “doesn’t work at all.” Yen said ella — a prescription emergency contraception (also known as a “morning-after pill”) — is effective with BMIs up to 35. A person can also ask for prescriptions for future use — ella has a shelf life of three years.
Does my insurance cover birth control?
The California Surgeon General has a comprehensive list of out-of-pocket costs for each method of birth control. For example, the patch can range from free to $150, and the implant can cost up to $1,300 out-of-pocket.
According to the Surgeon General’s website, plans do not have to cover abortion medication or vasectomies. (However, there are ways for Californians — and people traveling to California — to get the procedure for free, depending on their income background.)
Private health insurance
Thanks to the Affordable Care Act, contraceptives are a covered benefit with private health insurance. If someone gets contraceptives within their network, “plans must cover these services without charging a copayment or coinsurance … even if you haven’t met your deductible,” according to the state. (However, an employer with religious objections can still request health insurance plans that do not cover contraceptive methods.)
Like private insurance plans, insurance plans under Covered California can provide pills, patches and rings for up to 12 months.
What are my birth control options if I am under 18?
In California, minors have the right to birth control access. Providers and doctors are not allowed to inform a minor’s parents about their health choices without their consent, and minors do not need to have a parent present to access these services from a provider. The American Civil Liberties Union Northern California has a comprehensive Q&A about the rights of minors and their access to birth control.
According to the ACLU NorCal, students are allowed to have doctor appointments during school hours — and schools are not allowed to inform parents.
Where can I find birth control or emergency contraceptive providers?
When it comes to getting your birth control changed or renewed, Yen predicts, “There may be a horde of people running right now to go get it done.” With this in mind, you might consider scheduling a visit to your provider’s office sooner rather than later.
You can also use the following services to ask about birth control options:
The legal battle over the abortion pill mifepristone rages on despite the Supreme Court’s rejection earlier this year of a lawsuit seeking to roll back its federal approval.
Plan C — a campaign dedicated to abortion pill expansion in the United States — said providers can provide the medication to their patients in case of future need, as abortion pills can last up to two years when stored in a cool place. The pills usually cost around $25 to $150, depending on the provider and any discounts it may or may not offer.
If money is a problem, Yen said a group of people could split the cost among them to have a stockpile of pills in case of emergencies.
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“It may be an investment … for every group of friends,” Yen said. “If anyone needs it, then you kind of pass it around, and then you buy another one when [an emergency] happens.”
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