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Julia Weis chose pain over pills.
The San Antonio resident uses an intrauterine device (IUD) — a T-shaped piece of plastic, inserted through the vagina and cervix into the uterus, where it releases hormones to block sperm from fertilizing eggs.
“The insertion of the IUD felt like someone was taking a knife and stabbing it up inside of me,” she said. “I think it was probably one of the most painful things I've experienced in my life, and I've broken bones.”
“But it's something that I would do again, and I would do it every year if I needed to.”
She began taking birth control pills before high school to address period-induced cramps, and got her IUD in 2020 — the year before Texas’ Republican-controlled state government passed a widely unpopular law banning abortions after six weeks of pregnancy.
This is before most people know they’re pregnant. Senate Bill 8 (SB 8) also created a citizen-enforced bounty system. The U.S. Supreme Court will hear the Department of Justice’s challenge to the law on Nov. 1.
In the meantime, Texans who can get pregnant — but don’t want to — are weighing options, often without a comprehensive reproductive health education, supportive family members, health insurance or understanding doctors.
The first health care provider Weis spoke to about the IUD asked a series of extraneous questions.
“The doctor, who was an old man, was like, ‘Well, are you sure? You want to have babies soon, right? Are you married? You and your husband — you want to have babies?’” she recalled. “And I was like, ‘No!’ Like, ‘That's just not — that's not any of your business.’”
Weis knew exactly what she wanted.
“It was kind of this idea of, well, you never really know,” she said. “What if birth control is next — what if I'm not gonna be able to have access to this? I might as well get the one that lasts as long as possible.”
It’s not always easy to find a doctor who supports a patient’s choice of contraceptive — and that’s for people who can even access affordable health care. Texas has the highest number and highest percentage of people without health insurance of all states, and state lawmakers again declined to expand Medicaid during the most recent legislative session.
Kari White is an associate professor in the School of Social Work and Department of Sociology at the University of Texas at Austin, where she leads the Texas Policy Evaluation Project.
“There is a great need in the state for funding and programs that enable people — particularly those who are living on low incomes — to be able to obtain the contraceptive methods that they would like to use,” she said.
White said the state’s decade-long crackdown on abortion providers, like Planned Parenthood, has made it harder for people to obtain other contraceptives because those clinics typically provide many contraceptive services in addition to abortions.
“All of the instability that has taken place in Texas over the last decade related to the availability of contraceptive methods and services can be linked to that the efforts by state legislatures to try to curtail access to abortion,” she said. “These are points that are interrelated.”
The state’s puritanical approach to reproductive health extends from the clinic to the classroom.
Public schools in Texas are not required to teach sex education classes. If they do, they must “present abstinence from sexual activity as the preferred choice of behavior in relationship to all sexual activity for unmarried persons of school age.”
The abstinence-first approach is enshrined in law, and it hasn’t stopped the state from having one of the highest rates of teen births in the country.
At home, many parents don’t have open conversations about reproductive health.
Makayla Montoya Frazier didn’t know what birth control was until she was in high school.
“Half of my family was very Irish Catholic, and then the other half was Mexican Catholic,” she said. “So it wasn't something that they used, let alone they would tell their children that it was OK to use.”
She got an abortion when she was 18, and her doctor helped her find the best birth control option. It wasn’t easy.
“I had a birth control that made me gain weight. It made me crazy, and I was eating all the time,” she said. “I had really wild mood swings. My hormones were just up so much. I didn't feel like my body was my own in that sense.”
She stopped taking birth control altogether because of the side effects — until the abortion ban went into effect. She’s still looking for the best birth control option, and she’s helping other people do the same thing through the Buckle Bunnies Fund, a mutual aid group she organized.
“We're giving out a lot of Plan B right now just because, you know, that's a band aid over a bullet wound,” she said. “But it's the absolute most we can do.”
Plan B is an emergency contraceptive typically used within 72 hours after sex. It acts to prevent pregnancy by stopping the release of an egg from the ovary.
Victoria Acuña also had less-than-comprehensive conversations about reproductive health with her family while growing up in San Antonio.
“My house was a Latin household,” she said. “The only thing my dad ever said was, like, ‘Protect her body.’ And then that was it. There never was any sort of urgency to talk to us openly about (reproductive health).”
She started taking birth control pills late in high school, primarily to address acne.
The pills, like other hormonal birth control, temporarily stop ovulation and also thicken the mucus in the cervix, making it harder for sperm to reach eggs. But the regimen requires daily doses, which were difficult for Acuña to maintain.
And acne reduction isn’t the only side effect. Hormonal birth control can cause mood swings.
“I am somebody who does have mental illness, and I do work on treating that,” she said. “But the birth control pill added to that in a really, like, slight way. It made me feel a little more emotional — made me feel a little more scattered — and it also just made me feel a little more upset about things, and just harder to calm down.”
Acuña is now a graduate student in Boulder, Colorado. In March, she got a 4-centimeter-long, 2-millimeter-wide Nexplanon implant through her university’s health clinic. The thin rod rests in her upper arm, where it releases ovulation-preventing hormones for about four years.
“It's been really helpful in regulating periods, and removing that fact of having to take something every day,” she said. “It's already there, and you don't have to worry about it. I really enjoy it so far.”
The Nexplanon implant and IUDs are among the longest-lasting nonpermanent forms of birth control. But permanent surgical sterilization has actually been the most popular contraceptive in recent years, according to the Centers for Disease Control and Prevention.
Mayra Dee grew up in rural east Texas. She recalled a pervading social expectation that kids would grow up, get married and have their own kids. She was never interested in that path.
“My family back in East Texas is just very much like, ‘Don't worry, you'll get there, you'll want kids,’” she said. “And I'm just like, ‘Well, no. I know you think that, but no.’”
Since high school, she’s been interested in sterilization surgery that permanently blocks off the fallopian tubes, so sperm can’t reach eggs. When she got to college in Abilene, she asked her obstetrician-gynecologist about the procedure.
“She said flat out that no doctor is going to take me seriously until I’m at least 25,” Dee said.
She got an arm implant, but it became too painful, so she switched to the Depo-Provera shot — regular injections of ovulation-preventing hormones. It came with side effects.
“I was bloated. I was far more irritable,” she said. “I didn't feel like myself.”
She turned 25, talked to her doctor and they found an OB-GYN who was willing to perform the procedure.
“The relief that I had when I had my surgery… there was just so much contentedness, and I felt this relief that I couldn't even begin to describe,” she said. “I had an immense amount of privilege in my journey of being sterilized, and to not say that discredits everyone else's journey because I know the privilege that I had.”
Contraceptives aren’t just for people who have a uterus. Micaela Mize has partners use condoms during sex. She had sudden weight changes with birth control pills and suicidal depression with an arm implant, and then her cervix rejected an IUD.
“Nothing is working,” she said. “And I don't want to counteract my birth control with, like, a medication for depression or something like that.”
Asked if there was anything else she wanted to add, she quipped, “Get a vasectomy.”
