While some women are taking a voluntary birth control "cleanse", others face a battle for access. 

By Mara Santilli
Nov 09, 2020 @ 3:44 pm
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Credit: Getty Images/Erin Glover/InStyle.com

Quarantine has been unpredictable to say the least, but I've come to count on one constant: A pregnancy announcement every time I open my Instagram feed, whether from a friend or a celeb. (Kelly Rowland, Hilary Duff, Karlie Kloss, and Emily Ratajkowski are just a few who have recently shared they're expecting.) Clearly, the quarantine baby boom is proving just how many people have been taking a birth control hiatus in the time of COVID-19.

Not everyone has babies on the brain, though: Women are going off of birth control for many other reasons besides pregnancy right now. Some cite the nonexistent COVID-19 dating scene and desire to track their natural cycles, while others are in panic mode — research shows that one in three women is struggling to obtain birth control coverage due to layoffs and loss of health insurance that has made paying for contraception out-of-pocket impossible for some. And that’s not even touching the Trump administration’s war on birth control that has put access in jeopardy. 

Here, experts explain the state of birth control in 2020: why people are skipping their packs, choosing to get pregnant, or scrambling to get long-acting contraception in an effort to stay in control of their own bodies. 

The Birth Control “Cleanse”

For single women taking hormonal birth control primarily for contraceptive purposes (rather than to help with painful cramps, acne, or other PMS symptoms), the pandemic has led many to take a pause. After all, with casual sex (mostly) taken off the table, why worry about pregnancy protection? Doctors are noting this trend “particularly in women in their twenties through forties who are not trying to conceive but haven't been dating or sexually active as much due to social distancing and pandemic life,” says Lucky Sekhon, M.D., an OB-GYN, reproductive endocrinologist, and infertility specialist. 

Others have also seen the pandemic as the perfect opportunity to go on a “cleanse” from hormonal birth control options like the pill. “Many of my patients have said they went off birth control to 'give their body a break' and to make sure they can still get a period and have a regular cycle after being on long-term contraception for decades,” says Dr. Sekhon, although she adds that there isn’t actually a medical need for a birth control break. (Since methods like the IUD or birth control implant require a doctor’s appointment to remove, this “cleanse” seems to be happening more often with women who are on the pill or who use a birth control patch or ring, which women can take out themselves at home, Dr. Sekhon notes.)

If you’re giving your body some time off from birth control, allow additional time for your body’s cycle to get back to its natural rhythm. “Birth control pills are usually quickly reversible, but if a patient has been on long-term birth control for over ten years it can sometimes take up to six months to begin ovulating regularly again (if they ovulated regularly, at baseline),” explains Dr. Sekhon. 

The Quarantine Baby Boom

Some couples have seen quarantine as the perfect time to abandon birth control and expand their families, due to the increased flexibility of working from home and more time with their partners, suspects Banafsheh Bayati, M.D., FACOG, an OB-GYN and medical co-founder at Perelel. Even before the pandemic, there’s been an increase in patients choosing to track their own cycle and use natural contraceptive practices like the rhythm method (basically, just avoiding sex when you’re most fertile), she adds. 

At the same time, Dr. Bayati has noticed an uptick in unplanned pregnancies during the pandemic. While we don’t yet know how many, the UN predicted seven million unplanned pregnancies globally due to difficulty accessing birth control and rises in intimate partner violence during COVID-19. 

The jury is out on whether there will truly be a quarantine baby boom — after all, the stress of caring for other children and helping them with virtual schooling, while dealing with economic repercussions from the pandemic is still there for many parents, Dr. Bayati adds. 

Barriers to Access in Quarantine

For others, going off the pill during quarantine wasn’t intentional and a function of being unable to obtain their prescriptions. “In a study by the Guttmacher Institute, 33 percent of respondents said that due to the pandemic, they had trouble accessing birth control, or had to delay or cancel a visit to a provider for sexual and reproductive health services,” says Meera Shah, M.D., Chief Medical Officer at Planned Parenthood Hudson Peconic. “Unfortunately, this is disproportionately true for women with low incomes and Black, Hispanic, and queer women.” 

Not only does the risk of unintended pregnancies rise when women don’t have access to effective birth control option, but “the risk of shorter interpregnancy intervals (period of time between delivery of one pregnancy and becoming pregnant with another) rises and the risk of pregnancy-related complications increases,” explains Temeka Zore, M.D., a board-certified ob-gyn, reproductive endocrinologist, and fertility specialist at Spring Fertility. Black women already have a maternal mortality rate that’s 3 to 4 times higher than white women, Dr. Zore adds, so it’s crucial for the option of contraception to be there. 

In the beginning of the pandemic, many doctor appointments were canceled and patients ran out of refills while sheltering in place. While that has since improved with the advent of virtual ob-gyn appointments, there’s also the fact that the entire supply chain of pharmaceuticals was delayed when many manufacturing facilities were shut down. Women using methods with more frequent dosage, like the pill, patch and injections, have been having the most difficulty continuing to get their prescriptions as regularly during quarantine, says Jessica Shepherd, M.D., an ob-gyn and Ceek Women's Health Ambassador. 

With the challenges of getting birth control, there’s been a shift in demand for longer-acting forms of contraception. “We’ve seen a 65 percent increase in requests for Annovera, a long-term form of birth control ring that works up to one year,” says Amy Roskin, M.D., J.D., medical director and head of clinical operations at The Pill Club. The Pill Club also noted an increase in orders in some states for a one-year supply of birth control as opposed to monthly deliveries.

When it comes to losing contraceptive coverage, the economic impact of the pandemic looms large. The Pill Club has seen a rise in self-pay patients during COVID-19, due to loss of health insurance from the spike in layoffs, says Dr. Roskin. For uninsured patients forced to pay out of pocket for birth control (which can cost up to $50 for a one month supply), some of these women have had to simply forgo using contraception they need altogether, Dr. Roskin says. 

If you’re having difficulty accessing birth control during the pandemic due to lost health insurance or a similar circumstance, many ob-gyns recommend a hormonal or copper IUD as a low-maintenance option. 

The Political War on Birth Control

And then there's the ongoing political battle for birth control access. Over the summer, the Supreme Court of the United States reached a decision on Trump v. Pennsylvania, allowing that employers can deny employees health insurance coverage of birth control on the grounds of employers’ personal, religious, and other objections to birth control. The Department of Health and Human Services estimates that the results of this case alone could strip up to 127,000 people of contraception.  

Then, after Justice Ruth Bader Ginsburg passed away, she was swiftly replaced by Justice Amy Coney Barrett, who has been hostile to reproductive rights. Later this month, there will be a vote to dismantle the Affordable Care Act, which has provided about 63 million women birth control coverage without a copay, according to Planned Parenthood. If the law is repealed, those millions of people will have no choice but to stop their birth control methods if they’re not able to cover the out-of-pocket costs or switch to a longer-term method of contraception like an IUD. 

“Politics should not be a factor people must consider when deciding to start using birth control, choosing a method, or switching methods,” says Dr. Shah. “This is true for people who depend on birth control to prevent unintended pregnancy or manage health conditions, and for those who otherwise would not have access to health care without the Affordable Care Act,” she adds. 

Luckily, many women are able to rest a little easier following the results of the 2020 election. While the Trump Administration has made moves to overturn the Affordable Care Act, President-elect Joe Biden has indicated plans to uphold the Affordable Care Act and free contraception under it during his presidency, as well as provide other birth control accommodations for people whose religious employers deny them contraceptive coverage. 

And then there's Vice President-elect Kamala Harris, who has been "a steadfast champion for reproductive rights and healthcare throughout her career," says Alexis McGill Johnson, president of Planned Parenthood Action Fund. "By choosing to run with her, Vice President Biden made it clear that he is deeply committed to not only protecting reproductive rights, but also advancing and expanding them. In the end, the people will be heard in this election, and the people want a government that protects and advances their health and rights,” Johnson adds.

With affordable birth control access on the line, it’s worth acknowledging that people use birth control for much more than just unplanned pregnancy. “Studies have shown that being on continuous birth control is effective for treating millions of people with endometriosis, menstrual migraines, or PMS,” Dr. Roskin says. Regardless of the reason for taking birth control, it’s part of health care — and needs to be available and accessible for all people to be able to make their own call whether they want to stay on it or not.