When Cristina Polenica (SESP ‘16) graduated from Northwestern last spring, she thought she’d be looking for a job, not a new form of birth control. But when Donald Trump won the presidential election in November, she immediately decided to stock up on long-acting contraceptives. Trump wouldn’t take office for a few more months, but for Polenica, the future of women’s healthcare already felt uncertain. “I have no idea what’s going to happen after Trump [becomes president],” Polenica remembers thinking. “He’s been saying all of this really scary shit, and I might as well go and do this now, while I still can.”

In December, a little over a month before Trump took office, Polenica had an intrauterine device (IUD) inserted, a more permanent birth control method that can last several years. “I saw my chance, and I took it,” she says.

She’s not alone. As members of the Northwestern community look to the future, many worry about what reproductive rights and care they may lose if state or national laws are overturned. With the Supreme Court’s balance in flux, the possible repeal of the Affordable Care Act (ACA) and Planned Parenthood under threat, those affected (basically anyone with a uterus) are taking action to protect themselves and their bodies over the next four years. However, restrictions on reproductive care won’t affect all women equally: Low-income women, particularly low-income women of color, stand to lose the most if lawmakers slash funds and cut off care.

For many Northwestern students, college is the first time they’re wholly responsible for their own health care. Making informed choices about sex and contraception can be difficult, especially in a new environment. Medill sophomore Claire Fahey* says that while she was already familiar with local reproductive resources, transitioning care might be tricky for residents beyond the Windy City. “I was really lucky, because I had an OB-GYN before and I’m from Chicago,” she says. “I didn’t have to go find a new one, which I know is a big problem for a lot of students.”

For those interested in counseling and advice for contraceptive options in Evanston, the Women’s Health staff at Northwestern University Health Services (NUHS) is available for consultations with a nurse practitioner, general physician or an OB-GYN. But there’s a catch: University policy says all degree-seeking students must have health insurance, either through the Student Health Insurance Plan (NU-SHIP), or private coverage that meets certain requirements. Beyond Northwestern, current federal health care law through the ACA also requires all Americans to be insured, but allows parents with their own health insurance to cover children through the age of 26. The ACA also mandates private insurers must cover birth control for policyholders at little to no cost.

Post-election, many women have chosen to have IUDs inserted in response to legislative changes that will take away affordable access to short-term birth control methods like the pill. Planned Parenthood has reported a 900 percent increase in demand for IUDs since Election Day. Fahey says she’s already thinking ahead to a time after college without the ACA when she might have to fend for herself. She’s been looking into getting an IUD now, while she has coverage, as a more long-term solution that could last through the next presidential election.

After deciding on a birth control method, next steps include obtaining and filling a prescription. To do so, interested students can visit NUHS, an outside doctor or the nearest Planned Parenthood, located less than five miles away in Rogers Park. Local drugstores chains like CVS and Walgreens can also fill prescriptions there.

Ashley Boval, a SESP senior, says she went to Planned Parenthood for a few years to get her prescription. She’s one of many women who have relied on the organization since it was established more than a hundred years ago. According to a 2013 Planned Parenthood fact sheet, 34 percent of the organization’s services are contraceptive-related, and the group estimates it helps patients avoid roughly 515,000 unintended pregnancies every year.

If a Northwestern student did experience an unintended pregnancy, they would be able to terminate it in Illinois. Although Roe v. Wade made abortion legal across the country, many states have passed legislation restricting when and where women can end their pregnancies. Known to be more pro-choice than other Midwestern states, Illinois has become a hub for women crossing state lines to practice their constitutional reproductive rights.

“Women are already traveling hundreds of miles to get abortions, so if you lessen the access, it’s only going to be limited to rich women who can afford to make hundreds and hundreds mile travel, miss work, buy plane tickets,” says Abby Student, director of operations for the Midwest Access Coalition (MAC), a Chicago-based organization that seeks to provide accommodations to women who need to travel to Illinois to get safe and legal abortions. “[Illinois] is going to become a haven for women seeking reproductive care, specifically abortion.”

The Republican control of the presidency and both houses of Congress, at least for the next two years, could mean drastic changes to access to reproductive care. Congressional Republicans have promised to not just repeal the ACA but replace it with an alternative system. However, they have not yet provided details on what that system would look like. Planned Parenthood could also face cuts to its funding.

Government money, which makes up around 43 percent of Planned Parenthood revenue, comes in two main forms: Medicaid reimbursements and family planning funds through Title X. The Hyde Amendment, passed in 1976, has prevented Medicaid money from going to abortion services (with a few exceptions), but lawmakers can shrink the budget for the organization’s other services by amending the legislation that controls Medicaid and Title X to prohibit funds from going to Planned Parenthood. States also have a say on funds, and since Planned Parenthood funding isn’t a line item in any budget, many have already come up with a variety of creative ways to prevent money from reaching the organization. Now that an increasing number of governor’s mansions and state legislatures have turned red, more states could deny funding for Planned Parenthood and similar organizations.

Two Republican leaders in particular, Senate Majority Leader Mitch McConnell of Kentucky and Vice President Mike Pence, have been vocal about targeting the organization. As governor, Pence worked hard to defund Planned Parenthood in his home state, while McConnell has recently made a point of including it in his goals for the party moving forward.

And it’s important to note that these federally funded programs serve the most vulnerable women. According to the Guttmacher Institute, a sexual health research organization, more and more low-income women – especially those who are Black and Latina – have come to rely on publicly-funded reproductive care clinics over the past decade. Black and Latinx people are overrepresented among those who use Planned Parenthood services, making up 15 and 23 percent of patients, despite comprising only 13 and 17 percent of the general population.

Whatever a Republican health care overhaul might entail, it’s unlikely to include much, if anything, in the way of protections for contraception or abortion services coverage. Without such rules, businesses wouldn’t have to provide it, even if they didn’t have a religious motivation. This in turn could have a trickle down effect on students covered by the insurance of parents employed by such a business.

Graphic by Andie Linker

Some worry that in a rush to fulfill campaign promises, Republicans in Washington would go even further and repeal the ACA without a proper replacement, leaving millions of Americans uninsured and cutting off its other protections.

“So many women who don’t have the resources to have insurance received insurance under the ACA – my mom is one of them,” Boval says. “[She] technically runs her own company, and she was able to get insurance for the first time under the ACA, so while she’s older and no longer needs birth control, that would be terrifying to me as a young woman. No longer being able to afford insurance, because it’s not made affordable to you by the government.”

Elaine Nekritz, a Democrat in the Illinois House of Representatives, says recent legislation should keep contraceptive care affordable in Illinois. Nekritz sponsored Illinois’s Comprehensive Contraceptive Coverage Act, which became state law in June 2016. The law expands on the provisions defined in the ACA and closes loopholes that prevented some women from getting coverage. “Especially given the results of the November federal election [and the] people that completely want to repeal the ACA, having that be the law in Illinois really does help to protect women,” Nekritz says.

But protections will likely vary from state to state if national healthcare laws change, and Boval says that could possibly impact major life choices moving forward. “I feel like a lot of people on this campus are fortunate enough to have parents that use insurance we can continue to be on, or have job prospects in the future that will provide us with affordable insurance,” she says. “Whether or not that insurance will cover birth control will entirely depend on where people work, and I think that it sucks that as a woman, that we might have to be cognizant of that, choosing where we work based on what benefits are afforded to us or what our insurance covers.”

Graphic by Andie Linker

After joining a Facebook support group created by a Northwestern student in response to the presidential election, Polenica says she began to explore her contraceptive options more fully. When conversation turned to IUDs, she realized it was the best option to keep her protected for the next several years. “The changing birth control thing was something I was thinking about before the idea that Trump was actually president, but that kind of like spurred me to go do that,” Polenica says. “Instead of completely shutting down with the fear that I felt, it kicked me into action.”

Fahey also says Trump’s unexpected win made looking into long-term contraception feel more urgent. Although she’d been considering an IUD before Election Day, the possibility of impending changes pushed her to act more quickly. Like Polenica, Fahey reached out to others in the Northwestern community for advice about IUDs and more. “I had a new sense of urgency toward that aspect of my life, just because I could see the ways in which his election could have a real impact on my day-to-day life in that manner,” Fahey says. “Trump had a huge impact on how many people I’ve talked to about this and definitely made me realize I really want to do this and take agency over something.”

But switching birth control methods isn’t risk-free, especially if the decision is rushed. While Polenica says she loves her IUD, each person responds differently to each type of contraceptive, and some types aren’t for everyone.

Photos by Alex Furuya, graphic by Maxine Whitely

Communication sophomore Gracie Brakeman thought getting an IUD was her best option. Although she was on the pill, Brakeman says it was difficult to stick to the strict timetable with her erratic sleep schedule, a challenge other women echoed. The concept of an IUD was attractive, she says, because it doesn’t require daily maintenance. “Why would you take something everyday if you could just get something once?” she says. “It seemed like a lot more reliable.”

To explore her options, Brakeman reached out to Northwestern Health Services for a referral to a local doctor. They provided her with a list of gynecologists practicing in Evanston and she booked an appointment to have the IUD inserted. But the procedure doesn’t always go well, and the various brands, sizes and designs of IUDs don’t all work for everyone. Brakeman’s IUD caused excruciating pain and the doctor removed it almost immediately.

While being on her parents’ insurance allowed Brakeman to get an IUD at an affordable price, for those without premium insurance, the failed procedure would have been much more costly. According to market research from Amino Inc., the out-of-pocket median cost for a Mirena IUD, one of the common brands of IUD, including both the device and the procedure, is $1,109.

When women aren’t able to afford reliable contraception, the risk of unplanned pregnancy rises, which creates a need for stronger reproductive choice policies. But pro-choice legislation may be vulnerable to the Trump administration efforts. Though the process to overturn Roe v. Wade could be a long one, Trump already has one conservative justice lined up, and could appoint several more over his four years. In a November interview, Trump said women may have to travel to other states to have abortion procedures if that happens.

Student, the MAC director of operations, says these statements are concerning, and if laws change, Student says MAC’s services will need to grow. “The amount of women needing to travel to Illinois [is going to go up],” she says. “I see the clinic that I work at, our volume of patients being seen going up and our surgery hours being longer and women having to wait longer, so I really just see it being terrible for women.”

While Illinois Governor Bruce Rauner has supported pro-choice causes during his time in office, Nekritz says this collaboration isn’t necessarily enough to continue to protect reproductive access moving forward. Rauner is up for reelection in 2018, and in such a polarized political environment future Republican candidates may not be willing to back substantive legislation that support women’s health. Although she was able to push the Comprehensive Contraceptive Coverage Act through before the presidential election in November, Nekritz says even in a blue state like Illinois voting margins are often thin, and representatives tend to vote along party lines. “It’s really really hard for us to pass affirmative, good pro-women’s health legislation,” she says. “It would be a big battle in Illinois whether or not we could fend off bad legislation, and whether we could pass affirmatively good legislation to protect healthcare.”

As Trump makes his way through his first 100 days in office, students and Chicago reproductive advocates are evaluating their place in the resistance. For some, that means working to destigmatize abortion and contraceptive use. “We need to make sure that we’re having conversations so that people in Washington are understanding that this is the direct effect of your actions,” Boval says.

According to Nekritz, these conversations, although difficult, are crucial if progress is to be made. “I think what’s happening in the choice advocacy arena is, women are looking at that and saying ‘Why are we losing this battle, and why is it a partisan issue and what can we do to change that?” she says. “I think that we’re just going to have to start talking about it more.”

When looking at the mobilization against the Trump presidency, Brakeman, who attended a protest shortly after the election, says the intersectionality of the movement is inspiring. “A huge amount of the people at the protest had [signs] like, ‘My body, my choice,’ a lot of people with Black Lives Matter signs,” she says. “It was kind of terrible, because the reason that all these people had to come together is the face of injustice.”

Boval says while protesting is a good first step, it’s important for Northwestern students to continue advocacy work once the streets empty out. “We need to focus on fighting for what matters. That means, as a college student, donating to Planned Parenthood, volunteering at abortion clinics, making sure that women walking to get abortions aren’t harassed and speaking up and volunteering at centers for rape victims,” she says. “Kind of just stepping up in different areas that I don’t think we always think about stepping up [in].”

*Editor’s note: Claire Fahey has previously contributed to North by Northwestern.