I don’t want to write too much about feelings; frankly, if I felt them less I could discuss them more. As always, my focus is on the young, the Southern, the under-resourced. If you live in a state where abortion is suddenly illegal, it is definitionally imperative that you do not become pregnant unless you desire to carry the fetus to term. To be clear — there are still ways for you to get an abortion. If you are pregnant, do not give up. In every state in America, you are able to access abortion pills through the mail. Read through Mayday Health for more information, and please feel free to leave a comment if you have any questions.
But again, now more than ever, it is better to avoid pregnancy if at all possible. The following is a list of things to start doing today to minimize, as much as possible, the chance of pregnancy*
If you’re on birth control pills, take them daily at the same time, no matter what.
Birth control pills have an efficacy of 99% when used correctly. When taken the way most people take them, the efficacy drops to 91%, meaning 9 out of every 100 people using the pill will get pregnant in one year. Taking the pill correctly actually involves a few steps (which you can read more about here), but the most common cause of error is missing pills, or taking multiple pills in the pack late (defined here are 3 hours late or more). Taking your pill “around bedtime” or “almost every day” is not enough in the South. Do what it takes to take it correctly; set alarms, swallow it with a friend, carry it in your purse so you always have it. Birth control was one of the biggest inventions of the 20th century. Use it correctly every single day.
Wear a condom (or double up somehow)
All contraception can fail. I don’t care if you’re on the pill or the shot or it’s a long-term relationship or if he hates them. Unless you have a device inserted into your body (ie, an implant or IUD), I strongly encourage you to wear condoms. It’s just how math works. The South has zero wiggle room. You want the math on your side. If condoms are absolutely not an option, you should still be utilizing multiple forms of contraception, even if that means the rhythm method or withdrawal (which are not encouraged but are better than nothing).
I do not care if your boyfriend doesn’t like them. If he refuses to wear them, I sincerely encourage you to reconsider that relationship. When you live in a state that doesn’t value your well-being, your partner, at the very least, must absolutely prioritize it.
If possible, get your period every month.
One of the benefits of hormonal contraception is that it can lessen or eliminate your periods, which is a godsend for people who have painful menstrual cycles. However, a pregnancy is considered to begin on the first day of your last period— meaning when you miss your first period, you’re already four weeks pregnant since doctors will count from day one of your last period. This is why the infamous six-week abortion ban in Texas is so misleading; a six-week ban just means two weeks after a missed period. In Texas, if you regularly use birth control pills to skip your period, there is almost no chance you would be aware of the pregnancy before the abortion deadline was reached. If you choose to skip your period in the South, you are dramatically limiting the amount of time you will have to act once you become aware of the pregnancy.
Therefore, I strongly recommend, if at all possible, picking a form of birth control that allows you to get your period so that you have monthly proof that you are not pregnant. If you are in a state that allows very limited abortion, missing a period you are expecting to get will give you the most time possible to schedule an appointment. And, if you are in a state that completely bans abortion, missing a period you are expecting to get will give you the most time possible to order abortion pills in the mail.
I understand that some people have truly unbearable periods and/or other gynecological conditions that demand a skipped period. In those cases, if financially possible, I recommend taking a pregnancy test every four weeks to achieve the same effect as a period. Ultimately, it is of course a personal choice to weigh the costs and benefits of skipping versus getting a period; today, more than any day before June 24, extra weight should be given to the benefits of monthly assurance.
Start checking all of your medications
In general, most medications don’t decrease the efficacy of birth control, even the antibiotics people most worry about. Still, as is the theme here, the South is not a place to focus on generality.
I advise you to check how every new prescription you take interacts with your pill, just in case; on websites like Drugs.com, you can look up the name of your pill and check on the “Drug Interactions” tab to see if your new medication is on there. Be sure to tell your doctor that you’re on the pill, so they can watch out for bad combinations when prescribing new medications.
If you take a medication that interacts poorly with your birth control, be sure to use a backup form of contraception (like condoms) starting from the first day you take the new medication until seven days after you stop taking the medication. Take your pill normally the whole time. The following is a list of the medications most known to decrease efficacy, but now is a good time to check every one of your prescriptions and make sure.
The antibiotic Rifampin, which is primarily prescribed to treat tuberculosis. This means the antibiotic you’re taking for your UTI, sinus infection, or chest cold won’t affect your pill.
Some HIV medications, anti-seizure medications, and diabetes medications.
Some herbal supplements, like St. John’s wart, which some people use to help them sleep.
In general, almost every medication you take will not affect your pill’s effectiveness. However, if you take medication for a chronic disease (like HIV, diabetes, etc), check to see how it interacts with your specific pill
Pre-buy Plan B so you can take it as quickly as possible
I go into more detail here, but the most important thing about the morning-after pill (most commonly known as Plan B) is that it is the most effective the faster you take it after unprotected sex. However, if you only buy it once you need it, you might be forced to buy the most expensive option, or you might have to waste time searching for available pills. If you buy your morning-after pills before you need them, you can get them for less money and take them the second you need them.
All forms of the morning pill, including generic versions, are equally effective. This means you don’t have to waste money on Plan B, which is generally the most expensive option. Next Choice One Dose, Take Action, and My Way are all less expensive and just as effective. If you don’t feel safe buying from the store, you can buy a version called AfterPill for 25 dollars (including shipping).
And, if you live in Mississippi, Alabama, or the Florida Panhandle, the Yellowhammer Fund will ship you an AfterPill for free once every three months.
Whether you buy online or in-person, pre-buying emergency contraception will guarantee the cheapest, quickest protection possible, meaning it will also be the most effective. We don’t know how access to emergency contraception in the South will change in the coming months, and it’s important to capitalize on any resources you have while they’re still available.
There is so much more to say, but I don’t know if it’s necessary to keep reminding the young Southern people who read this that things are going to get worse. You already know. I want to assure you that this shouldn’t be your job; at your age, you should not be forced to be held hostage by the minutiae of your body. But your own attention is, tragically and inhumanly, perhaps the most important tool you have right now. Research as much as possible. Try to understand how your body works and how you can work with it. Do not give up, and take care of yourselves and each other.
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*As is well known, abstinence is the only truly 100% effective way of preventing pregnancy. But I don’t consider that useful advice, especially when victims of sexual assault or abuse are denied the right to abstain.
Well-researched piece.
What’s the shelf-life on Plan-B?