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What to Consider About Contraception and Pregnancy After Roe v. Wade Is Overturned

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A typical patient chair in cream with a paper covering of pink roses and blue butterflies.
In many states, the options for safe abortion access will become virtually non-existent if the Supreme Court overturns Roe V. Wade, the landmark Supreme Court decision that has protected abortion rights since 1973. (Catherine McQueen/Getty Images)

Access to a safe abortion already varies depending on what state you live in. Now that the Supreme Court has overturned Roe V. Wade, the landmark Supreme Court decision that's protected abortion rights since 1973, the options will become even more limited – or virtually non-existent – in many states.

There are potential implications for reproductive health well beyond abortion – including types of birth control, fertility treatments and treatments during pregnancy. Many people may have to rethink – or think more intentionally about – decisions they've long taken for granted.

Here's what you need to know about birth control, emergency contraception and terminating a pregnancy.

Consider "layering" contraceptive methods

Different types of birth control have different rates of failure – meaning, contraception does not 100% guarantee that you won't get pregnant if you're having sex. Your choice of birth control might depend on the associated side effects, whether your healthcare provider or local pharmacy keeps it in stock, if you have insurance, what your insurance covers and a method's efficacy.

Once you decide what type of birth control works for you, consider whether you need to take extra precautions if you don't want to get pregnant.

Dr. Katharine White, an associate professor at Boston University's school of medicine and author of the book Your Sexual Health recommends "layering" certain methods: if condoms are your primary method of birth control, consider also using the withdrawal method and/or tracking your ovulation so that you know when you're most fertile.

"I call this the BLT approach because it involves stacking methods on top of each other," like a bacon-lettuce-tomato sandwich. "Together, these can be very highly effective," says Dr. White.

Any birth control, Dr. White says, will be "much more effective than crossing your fingers hoping that you don't get pregnant."

You can keep emergency contraception on hand in case you need it

If your primary birth control fails or if you have unprotected sex and want to prevent pregnancy, you may find yourself at the pharmacy for emergency contraception.

Plan B and other emergency contraceptive pills are not the same as an abortion pill – emergency contraception prevents someone from getting pregnant in the first place.

Plan B is one of the most popular brands, but you can find a number of over-the-counter emergency contraceptives with levonorgestrel. You can also ask your provider to prescribe you Ella, an emergency contraceptive pill with ulipristal acetate.

Emergency contraception can prevent more than 95% of pregnancies when taken within three to five days of unprotected sex. But the sooner you take it, the more effective it is. Many sexually active people keep some on hand in their medicine cabinet as a precautionary measure.

Check the expiration date – it's typically several years out, but the pill becomes less effective after it expires. Because of the long shelf-life, you can stock up responsibly in case supplies get short.

If you find yourself using emergency contraceptives frequently, consider a different primary method of birth control.

"If someone finds that they're needing to take it often ... [like] more than once in a month or in one menstrual cycle, it may not be as effective because the way it works is to delay ovulation," says Dr. Raegan McDonald-Mosley, a practicing OBGYN and the CEO of Power to Decide, a sexual health and planning nonprofit group.

If you have an unplanned pregnancy, online resources can help find the right option for you

If a home pregnancy test shows that you're pregnant, trust it – it's rare to get a false-positive. If you're faced with an unwanted pregnancy, most states require you to act quickly.

If you live in a state that has severely restricted or eliminated access to abortion, you can find your nearest clinic through Power To Decide's abortion finder. Going to a clinic that provides abortions does not necessarily mean you will have an abortion, Dr. McDonald-Mosley says. You can make an appointment to confirm a pregnancy and discuss your options with a professional, including information about childcare services.

For a lot of people, traveling out of state to an abortion clinic is prohibitively expensive. The Women's Reproductive Rights Assistance Project (WRRAP) or the I Need a Database can show you clinics in your area and link you to local organizations that can help with funding.

If you can't travel to a clinic or prefer to manage your own abortion, you can get care online through aidaccess.org. The site provides online consultations for abortions and medication from overseas.

"Those pills are the exact same medication as we provide in our clinic," says Robin Marty, the operations director at the West Alabama Women's Center. Like with any medication, there can be health risks with getting medication online – and Marty cautions that depending on where you live, there may be legal repercussions involved in seeking abortion pills or inducing an abortion at home.

Be sure to look up your state's laws about managing your own abortion before you make your decision. There are numerous resources online that explain each state's laws regarding abortion restrictions there.

Seek professional medical care from a local clinic, your doctor or a local urgent care if you experience prolonged bleeding or other complications after taking medication to manage an abortion.

Complications from a medical abortion look very much like a miscarriage, says Dr. McDonald-Mosley. "So someone can potentially present to an emergency room or to their provider and say, 'I'm having cramping and bleeding and I had a positive pregnancy test,' and receive the care that they need without having to reveal that they have taken abortion medications."

If you're planning to get pregnant, talk to your provider early about your options, in case of complications

Sometimes, even planned pregnancies end in abortion due to complications that can pose a risk to the pregnant person, or a fetal anomaly that will result in the baby's death.

The legal implications are even less clear in these circumstances now that Roe v. Wade is overturned.

That's why Dr. White says that people who are planning to get pregnant should have conversations with their doctors about what might happen if there is a reason to terminate the pregnancy.

"I would tell people who are pregnant, please enjoy your pregnancy, but don't do it by yourself," Dr. White says. She implores people to seek care for their pregnancy early – it's the best way to monitor the health of the parent and baby, and detect complications early.

"It is more important than ever to have a good sense of what it is that you want in terms of pregnancy," Dr. White says. "Find a doctor or a midwife or a clinical person who you can partner with, who you feel comfortable being open and honest with about everything and ... who will be open and honest with you about what's going to be possible."

Whatever your options, there are people who are willing to help. "There are legions of doctors and health care professionals who are getting ready for what is happening," says Dr. White. "We are going to be working really hard to put systems in place that everybody can still get the care that they need."


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The audio portion of this episode was produced by Mansee Khurana. We'd love to hear from you! Email us at or send a voice note to LifeKit@npr.org.

Copyright 2022 NPR. To see more, visit NPR.org.


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