Considering President Trump’s campaign promises to repeal the Affordable Care Act (ACA) and defund Planned Parenthood, it is no surprise that one of the ways women responded to the election was to get an intrauterine device, or IUD, while the highly effective form of contraception is still available free of charge under the ACA.

Access to birth control may not be the only issue women have on their minds as they consider the future, but it is an important one. According to a new Urban Institute study, most women believe that birth control has positive effects on women’s lives because, for instance, it helps them keep working, keeps them healthy, and reduces stress. In fact, 85.1 percent of women at risk of an unplanned pregnancy used some form of contraception over a six-month period in 2016.

What informs women’s birth control decisions? Cost and accessibility were reportedly the most important factors. Most women using prescription methods said that health insurance or another program paid for the full cost of their birth control.

Taken together, these estimates indicate that over two-thirds of women in the United States had access to affordable birth control under the ACA in 2016, saving consumers money and allowing women and their partners to better plan whether and when to have children. Evidence suggests that access to contraception may be connected to broad health, social, and economic benefits for women and their families. But proposed policies could jeopardize progress made on improving access to affordable contraception.

What ACA repeal could mean for women’s access to birth control

Although the path to ACA repeal is long and complex, the process has already begun in the House of Representatives, Senate, and White House. It is too early to say what repeal and replace will include, but recent Urban Institute analyses find that a partial repeal of the ACA through legislative reconciliation would increase the number of uninsured by 29.8 million people, including many women of reproductive age.

Increasing the number of women who are uninsured will threaten their access to birth control, as evidence shows that uninsured women fare worse across measures of birth control access and use than insured women. Even insured women may face increased birth control costs if the ACA requirement that insurance cover women’s preventive services (including all Food and Drug Administration–approved forms of contraception) with no cost sharing is eliminated, as legislators have indicated. For the average birth control pill user, annual costs for birth control may increase by $255.

And defunding Planned Parenthood could lead to immediate reductions in access to reproductive health services, including affordable health services, for millions of insured and uninsured women.

Will states step in?

States, anticipating federal policy changes that may reduce access to affordable birth control, are already discussing ways to use state policy to maintain current levels of access.

New York governor Andrew Cuomo has used regulatory actions to require health insurers to provide contraception and medically necessary abortions without cost sharing, and lawmakers in Oregon have proposed legislation to require insurers to cover several reproductive health services.

If major policy changes that reduce access to reproductive health services occur at the federal level, women may find themselves dependent on state policy changes to maintain access to affordable birth control. And women residing in states that do not take action may lose access to the affordable birth control they need and value.