With the Supreme Court overturning Roe v. Wade and Indiana’s new abortion bill (SB 1) put into effect on Sept. 15, there’s been an increase of attention on reproductive health and contraceptives.
Molly Graybeal, women’s health nurse practitioner at Open Door Family Planning, has noticed this increase of interest since the end of June.
As a clinic that follows Title X – a regulation that requires accessible, affordable and equitable reproductive and sexual healthcare – Open Door is required to show all of the options to patients who are pregnant and unsure of their plans, including information on abortion.
“We have a list, like a handout, of the closest locations where [the patients] can get resources on abortion information [and] schedule [an] appointment,” Graybeal said. “We had like three clinics in the Indiana-area that were on that list. And so now, we still will be giving out the information because that's part of our Title X requirement, but that list has completely changed, and all the clinics that we have that we feel are the closest to the Muncie-area are in Illinois.”
Open Door is a “contraceptive clinic,” meaning they don’t perform abortions and focus on prevention.
“I find that lately … in their explanation of why they want to talk about birth control, they'll say ‘Well, because [of] how things are now in Indiana, I really want to make sure that I don't get pregnant when I'm not ready,’” Graybeal said.
Due to these concerns, patients are looking into longer-acting birth control methods, such as intrauterine devices (IUDs) and implants, like Nexplanon, that go in the arm, Graybeal said. Patients are also thinking about the effectiveness of the different methods, due to their concerns of birth control being taken away.
Graybeal had patients call in and ask for their annual birth control pills early or to have their devices switched out early to prolong their use.
Despite concerns of birth control being taken away, Graybeal isn’t in “panic mode.”
“If anything, there's more reason to put funding into preventing unwanted pregnancies,” Graybeal said, “and that would be helping to provide contraceptive services to everyone.”
Another combattent Graybeal deals with is unequal levels of sex education. She finds herself often dispelling myths on sexually transmitted diseases (STDs) and the thought that “someone with the uterus is the only one that's responsible for contraception.”
On Ball State University’s campus, Health Promotion and Advocacy (HPA) focuses on “inclusive health and wellness education,” said HPA Director Re’Nesha Weston via email.
“HPA provides safer-sex resources, instructions on how to use said resources and information about consent,” Weston said. “We also provide presentations, events, individual and group consultations based on many sexual health topics (including but not limited to: communication, reproductive health, STI’s [sexually transmitted infections], STI testing, contraception and other resources on campus in the community).”
Like Open Door, Ball State University’s Health Center, through the Women’s Center, also provides contraceptives, according to its website. When it comes to contraceptive use, Graybeal recommends starting with condoms because they’re over-the-counter and other methods require a prescription.
The Women’s Center discusses the effectiveness of male and female condoms. HPA, on the second floor of the Health Center, offers a variety of different condoms. When it comes to the “higher tier,” or what Graybeal said meant more effective birth control, she said to “go schedule an appointment, go see a provider who can talk to you about contraceptive options and find what works for you.”
The “higher tier” of birth control starts at sterilization, which is a form of permanent birth control. Neither Open Door or the Women’s Center perform this kind of birth control. Sterilization gets rid of the ability for the pregnant person to be pregnant.
Going down the list, there are IUDs— 99 percent effective—and an implant that goes in the arm. The two methods are “long-acting, reversible contraceptives,” Graybeal said. They are “meant to stay in for a long period of time,” she said, and the lowest is three years while the highest is 10 years, depending on the type.
The Women’s Center can refer a patient to an OB-GYN if they seek to use either of these birth control options. The Open Door clinic does offer these contraceptives, and they perform the procedure.
Once an IUD or an implant is removed, the fertility of the patient returns. Both of these contraceptives are able to be removed early.
The next tier of contraceptives is birth control pills, patch and the vaginal ring. According to Planned Parenthood, the patch has estrogen and progestin and stops ovulation, which means the egg isn’t there for the sperm to fertilize. The vaginal ring releases hormones and also stops ovulation and fertilization.
Pills are used daily, the patch is used once a week and the ring, such as the NuvaRing, is used once a month, Graybeal said.
The Women’s Center and Open Door offer all of these options. According to the CDC, the “typical use failure rate” for all of these is 7 percent.
“All those methods tend to work the same. They have estrogen and progestin, and the idea is that you get three weeks of hormones and then one week that's hormone free,” Graybeal said. “So you get menstrual regulation with that and sometimes lighter periods.”
After those methods is the “Depo-shot,” or the injection, which lasts for three months. A patient will get four shots a year, and it has a six percent failure rate, according to the Women's Center.
In the last tier are condoms, spermicides and diaphragms, which all have around a 70 percent effective rate. Diaphragms have to be fitted to the patient's vagina by a professional, and spermicides need to be used with it as well, Graybeal said.
The Women’s Center is no longer able to provide a diaphragm. Additionally, HPA and the Health Center do not provide emergency contraceptives, such as Plan B One-Step, Weston said. Open Door provides emergency contraceptives, but appointments are necessary.
Title X, which Open Door uses, helps patients to obtain these methods with little to no cost. It also allows them, including minors, to keep their reproductive health private from anyone but their doctor.