People with uteruses and the organizations that support them are putting up a fight against unwanted health outcomes.
Two months after Nyla Thursday got another IUD—her fourth—she was still having cramps daily.
This wasn’t the first time that birth control had been a challenge for Thursday. The pill killed her sex drive and made her feel disconnected from her body. Her body rejected the copper IUD twice before—painful experiences with lots of cramping. The implant didn’t work out either.
When the U.S. Supreme Court struck down Roe v. Wade’s abortion rights protections in June 2022, with its landmark ruling in Dobbs v. Jackson Women’s Health Organization, Wisconsin defaulted to a pre-Civil War statute that bars doctors from performing abortions in any circumstance. (There is an exception for when the pregnant person’s life is at risk, but it is uselessly vague.) Since that day, Thursday, 32, has been preoccupied with the possibility of an unwanted pregnancy with her partner.
“It takes a toll on women in such a different way. It’s kind of unquestionable that my career would step back because of the physical demands of motherhood. A huge part of me wouldn’t want to have a kid past 35,” says Thursday, a grad student who finishes her program in May.
Madison-area folks and organizations that offer reproductive care are seeing contraception through a different lens post-Roe. Abortion pills are available online and the procedure can be accessed in neighboring states. But the lack of bodily autonomy is hitting home and people are trying to prevent, and preparing for, worst-case scenarios.
Shortly after Dobbs was decided, the City of Madison and Public Health of Madison and Dane County (PHMDC) stepped in to expand community access to contraception. They launched more services and staff in the fall, with an estimated price tag of $1.4 million annually to be shared by the two groups, according to PHMDC.
But first, PHMDC needs to inform the public that free and private reproductive healthcare is available and confidential.
The agency’s goal is “getting more folks with vaginas in the clinic and educating them on birth control,” says Gabby Aranda-Pino, the sexual reproductive health supervisor at the PHMDC clinic at 2705 E. Washington Ave.
“Our nurses are knowledgeable, and it’s very stigma-free and judgment-free,” says Aranda-Pino.
At the moment, most of PHMDC’s patients are men who have sex with men and are seeking STI tests. Uninsured and underinsured people also visit the clinic. But a chunk of the funding from the City will be used to train staff to offer Long-Acting Reversible Contraception, or LARCs, like IUDs and contraceptive implants.
To help get the word out, PHMDC’s outreach arm has been tabling at events, meeting with local drag queens and LGBTQ+ business owners, and giving packets with safer contraceptives and information to Briarpatch Youth Services.
“Especially with the Dobbs decision, we don’t want anybody afraid to come to us for a free pregnancy test or for birth control, or emergency contraception, out of fear of retaliation,” says Aranda-Pino. Even though it’s a government-funded clinic, care is private and off the record, no matter the age of the patient.
Planned Parenthood suspended abortion services at its two Madison clinics, as well as locations in Milwaukee and Sheboygan, after Dobbs was decided. But the organization started performing vasectomies at a Milwaukee clinic in January. Lisa Boyce, then-spokesperson for Planned Parenthood Advocates of Wisconsin, says Wisconsin’s Planned Parenthood clinics aren’t currently considering adding tubal ligation to their services, because it’s a more complicated procedure.
There’s an undercurrent of worry that conservatives will move to further constrict reproductive rights.
In a joint survey that Madison Minutes and Tone Madison conducted in summer 2022, dozens of respondents expressed concern that contraception access could be limited in the future. PHMDC’s clinic on East Wash is training its staff on alternative pregnancy prevention measures in case access to contraception is denied.
“That way, in the absence of hormonal birth control, with the combination of rhythm or calendar methods and barrier methods, such as condoms, or spermicide, we would at least be able to give people the information that they would need to be able to make choices for themselves,” says Stephanie West, supervisor of PHMDC’s sexual and reproductive health program.
Planned Parenthood of Wisconsin has an eye on that possibility too.
“We know that opponents of reproductive care often also oppose birth control pills, emergency contraception,” says Boyce. “So yes, it is something that we are absolutely anticipating.”
Walgreens announced that its stores would stop carrying medical abortion pills in states where Republican officials have threatened to take legal action. The pills are still available from other pharmacies, Planned Parenthood, and online retailers.
Despite access to information and resources, the chance and uncertainty around reproductive health are leaving people with uteruses in Madison feeling unsafe and disempowered.
“Knowing that there is not access to abortion in this state, which is a piece of the reproductive health care puzzle, makes me feel less safe about being pregnant on my terms. No one should have to go through the journey of pregnancy and parenthood without an active choice,” Thursday said in an email.
April Chaney, 34, has an IUD and is strongly considering a tubal ligation.
“While the IUD and birth control have kept [my partner and I] child free for 13 years, I’m not willing to risk an accidental pregnancy now that I no longer have access to abortion,” Chaney said in a response to the Madison Minutes/Tone Madison survey.
Even getting ligation surgery is a challenge in the face of antiquated capitalist gender expectations. Doctors often refuse to perform the surgery without permission from the seeker’s male counterpart or before they reach a certain age deemed beyond prime childbearing years.
“I should be able to go to any doctor or gynecologist, and if they can’t do the procedure, they should be able to just say, ‘Yes, this is the thing you want, here’s the doctor for you to go see,’ rather than having to wonder if the doctor I speak to is going to give me a hard time because I don’t have children yet,” Chaney says.
Chaney keeps a list of local doctors who perform tubal ligations close for when she’s ready to take the next step. Though many doctors don’t advertise that they perform ligations, social media has helped get the word out. After Dobbs was decided, users sourced a list on Reddit of doctors around the country who perform ligations. Nearly 20 Madison doctors made the list, which includes reviews.
Traveling to a neighboring state like Minnesota or Illinois for abortion requires resources that many don’t have. Chaney’s employer, however, offers financial assistance for people who travel out of state for medical care.
Rural-urban access and Catholic hospitals
Tubal ligation—and even contraception itself—isn’t allowed by directives that govern Catholic hospitals. Many Catholic hospitals don’t make it clear whether or not they provide contraception services. This is especially important in Wisconsin, which has some of the highest percentages of Catholic hospitals in the country.
According to a study from UW-Madison’s Collaborative for Reproductive Equity (CORE), American women are more likely to be served by Catholic hospitals—and rural women in Wisconsin are three times more likely than urban women to expect that a Catholic hospital will offer the full range of contraceptive methods. The November 2021 study was published in the journal Contraception.
“This is a huge inequity that affects people in rural parts of our state that are solely served by Catholic health care systems where they can’t just go down the street to a Planned Parenthood,” says Jenny Higgins, an author on the study and a professor of Obstetrics and Gynecology at UW-Madison.
The article recommended more investment in rural health care as a next step to broadening contraception access, since Catholic hospitals are unlikely to offer the full spectrum of care.
“Contraceptive care is just an incredibly important preventive health care service that should be available to folks, just like COVID testing and STI testing,” Higgins says. “More county health care clinics or more family medicine providers being trained in contraceptive care, more Planned Parenthoods—those would all be things that help deliver better care, but it should just be such a basic part of everyday health care, especially now more than ever.”