In the wake of the Supreme Court’s decision last month to overturn Roe v. Wade, the landmark case that established a constitutional right to abortion, many people are worried about how access to contraception in the future might change. In fact, some users of long-lasting birth control methods — especially intrauterine devices, one of the most effective ways to prevent pregnancy — are already worrying that by the time they need their device replaced, they could have limited access to it.
IUDs, small devices inserted into the uterus to prevent pregnancy, come in two types: copper and hormonal. A long-term, reversible birth control method, IUDs last between three and 12 years, depending on the brand, according to Planned Parenthood.
While overturning Roe v. Wade does not directly ban IUDs or affect birth control at all, legal experts have told TODAY it could empower states to restrict or ban access to some contraception, such as IUDs. In fact, at least 12 states already have laws that allow some health providers to refuse to provide contraception-related services for religious reasons, according to Guttmacher Institute, a research group that advocates for abortion rights: Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Illinois, Kansas, Maine, Mississippi, South Dakota and Tennessee.
Sarah Lake, a 25-year-old in Richmond, Virginia, shared on Twitter that she's scrambling to replace her IUD because she's worried IUDs will be banned by next year, when hers expires. In 2018, Lake got a low-hormone IUD due to her family history of blood clots, she told TODAY. “It’s what my doctor and I believe is safest for me, so (the overturning of Roe) was definitely concerning. … Once I heard the news, I called my doctor,” Lake said.
“I feel like I’m kind of a sitting duck. … I’m hoping that I can just get it replaced,” she added. She has a consultation with her doctor to discuss replacing her IUD early scheduled for August.
Anna Seiges, 38, a professor and mother of two in North Carolina, shared on Twitter that she replaced her IUD early after the Supreme Court decision on Roe. “Never in my life would I have thought Roe is going to get overturned, and so I was like, what else? Maybe IUDs could be on their way out,” Seiges, who got a new IUD in June two years before the old one expired, told TODAY.
Will IUDs be banned?
Social media posts like Seiges' and Lake's show that many people are worried they won't be able to access their preferred contraceptive method in the near future — and these fears aren't entirely misplaced, experts told TODAY.
“It’s not paranoia,” Jean Bae, visiting associate professor of public health policy and management at New York University's School of Global Public Health, told TODAY.
The constitutional right to contraception and former constitutional right to abortion come from a “broad framework of a right to privacy that the Supreme Court has recognized as an implied right of the Constitution,” Bae said. "I’m not sure the right to contraceptives as part of that whole framework is that stable, either."
The Supreme Court cases that established a constitutional right to contraception were the legal foundation for the constitutional right to abortion, Wendy Mariner, professor of health law, bioethics and human rights at Boston University School of Public Health, told TODAY. And while the Supreme Court's final opinion on Roe stated that the decision should not "cast doubt on precedents that do not concern abortion," Mariner is skeptical.
"If (the right to abortion) is not in the Constitution, according to a majority of the Supreme Court, then it seems to me they could easily decide that the right to contraception is not in the Constitution,” she said.
What's more, in Justice Clarence Thomas' concurring opinion that supported overturning Roe, he called on the Supreme Court to revisit a few past rulings, including those that established the right to contraception. And in their dissenting opinion, the justices who voted to uphold Roe expressed concern over the future of "the right to purchase and use contraception."
“Do I think there will be advocates pushing to prohibit contraception or at least some forms of it? Yes,” said Mariner.
While experts noted the rulings that established the right to contraception did not address the range of types of contraception and the different mechanisms they use to prevent pregnancy, the way an IUD works could "come into the definition of what (a state) legislature considers to be an abortion," Mariner said.
Why? IUDs prevent pregnancy differently from the birth control pill, for example, which inhibits the female body from releasing an egg so that there's no egg available for the sperm to fertilize. IUDs also primarily work by preventing fertilization, but they can in theory prevent a fertilized egg from implanting in the uterus, both Mariner and Dr. Daniel Grossman, director of Advancing New Standards in Reproductive Health (ANSIRH) at University of California, San Francisco, told TODAY.
The definition of pregnancy, according to the American College of Obstetricians and Gynecologists, the nation's leading group of OB-GYNs, is implantation of a fertilized egg in the uterus, "so pregnancy doesn’t begin until implantation has successfully occurred,” Grossman said. But if a law went into effect prohibiting terminating a pregnancy from the moment of “fertilization, or so-called conception ... they could limit contraceptive methods that have any effect to prevent implantation of a fertilized egg,” Grossman said, adding that conception isn't a medically recognized term.
The question then becomes whether a state legislature can choose "to define abortion in non-scientific ways and to define a pregnancy in non-scientific ways," Mariner said. "This is a serious issue, and it implicates not only IUDs but any kind of birth control."
Bae said she's not aware of any state laws that explicitly include IUDs under the umbrella of abortion-inducing drugs. But at least one state, Missouri, specifies that an "unborn child" starts at fertilization, and it penalizes "any person who knowingly performs or induces an abortion of an unborn child." And Louisiana legislators are pushing to remove implantation from the state's definition of personhood so it would start at fertilization, she said. The bill is still pending.
Some states, such as Kentucky, Idaho and Arkansas, specifically exempt contraception from their abortion bans, Bae pointed out. A few others mention fertilization in their abortion statutes, but it's unclear whether they would impact IUDs, she added.
"I want to caution that, because it is in such an early stage after Roe v. Wade was overturned, we will have to wait and see how the states would interpret and enforce their statutes, as in whether they consider a doctor inserting an IUD to be covered under the abortion statute or not," Bae said.
It's important to note that while an IUD can stop implantation, it's not the main way it prevents pregnancy, per Grossman: “With the copper IUD, the copper ions are potentially toxic to sperm, and with the hormonal IUD, it causes thickening of the cervical mucus to prevent the sperm from entering the uterus."
The IUD is not also not medically considered to cause abortion because it does not disrupt an ongoing pregnancy, based on the medical definition of pregnancy. "Anything that happens before implantation is, from a medical perspective, not considered an abortifacient,” Grossman said.
While the experts TODAY spoke with didn't rule out the possibility of states attempting to restrict certain forms of contraception in the future, they don't think it'll happen anytime soon, if it does happen.
“I am not aware right now of any prominent legal efforts to ban contraceptives, but in the long run — and I don’t know how long that period would be — it could happen,” Bae said. She also doesn't believe we're at the stage where people need to take immediate action to make sure they have continued access to contraception, she said.
Concerned about how much birth control will cost in the future? The decision to overturn Roe v. Wade does not affect insurance coverage of contraceptives, Bae said, and the Affordable Care Act requires insurance plans to cover contraceptives approved by the Food and Drug Administration, which Mariner said would be “difficult” to change since it’s a federal law.
Should you get your IUD replaced early?
“I would caution someone against making a rash decision right now, because it doesn’t seem like there’s a policy imminently about to go into effect that’s going to restrict contraception,” said Grossman. “I’m definitely worried about that in the coming years, but I would hope that people would have some warning before that actually went into place."
He added that if you have an IUD already, you should consult your doctor before making any quick decisions about getting new one.
“Talk to (your) provider about how long the IUD could actually remain in place because some of the recommendations have changed and there’s more data,” he said, adding that IUDs can be removed and replaced ahead of schedule for many reasons. The only concern is whether your insurance will cover it, so be sure to check your insurance policy beforehand, as well, he advised.
If you don’t have an IUD but want one, Grossman recommended making an appointment with your health provider to review all your birth control options and decide together what’s best for you.
NBC News social newsgathering reporter Rania Soetirto contributed reporting.