How Unemployment Shaped My Reproductive Health Care—Analysis

Recent private-sector data indicates rising unemployment across the United States. Of all of life’s challenges, unemployment is the most stressful for me, because a steady income alleviates other worries. With a regular paycheck, I can handle grocery shopping, paying bills, and purchasing necessities like DC Metro fare and toiletries.

The job search only adds to that stress because it feels impossible. I’ve submitted more than 100 job applications, and I am not alone. Many companies simply aren’t hiring. The ones that are hiring also rely on AI to manage job applications, and our resumes are lost in the shuffle.

And for some Black women, basic reproductive health care is unaffordable. 

I would know. I am one of the 300,000 Black women who left the labor force between February and April 2025 this year. I became unemployed after my temporary contract as a campaign worker at a Latinx civic engagement organization ended in December 2025. In the months that followed, 300,000 more Black women left the labor force. As a result of my job loss, I lost my health insurance. And my intrauterine device (IUD)—the extremely effective birth control method I have relied on for the past decade—expires this year. I’m not sure I will be able to get a new one. 

I’m not sure I will be able to get a new one.

(Read more: Let White People Be the Face of Trump’s Hunger Crisis—Opinion)

Finding birth control without health insurance

I got my current IUD, called Mirena, seven years ago because of the Obama-era Affordable Care Act (ACA). It’s my second one. My employer at the time, a tech company in Washington, D.C., provided health insurance through the D.C. marketplace, and thanks to the ACA, the IUD was covered at no cost to me. 

But it wasn’t free for me to get it. This was my second IUD, so I knew I would need to take the afternoon off from work and rest after the procedure. I also had to pay for an Uber from the doctor’s office, because pairing the discomfort of getting an IUD with being packed into a steaming D.C. Metro Center to take the Red Line back home is a bad idea. Back then, I was also able to treat myself to a nice meal after the procedure—a chicken sandwich and fries from Royal, a Bib Gourmand-winning restaurant that makes the best spuds.

Now, I cannot afford those comforts. Since my temporary work ended early this year, I have forgone ride shares and dining out.

One thing I cannot go without is health insurance. I have been able to get coverage through Medicaid. But in August, I realized I would need to search for a new doctor and make an appointment for IUD removal and insertion on top of my ongoing job hunt. It felt overwhelming.

My old gynecologist does not take Medicaid. I searched for a new one that provided shame-free medical care and accepted Medicaid, many of them were in towns in Maryland—about 30 minutes from where I live. I have visited Planned Parenthood for STI testing in the past and considered returning to get my IUD replaced. But my closest Planned Parenthood clinic was defunded and no longer accepts Medicaid.

While I was worried, I knew I couldn’t be the only one in this predicament. As of September 2025, the unemployment rate for Black women was 6.7 percent. The overall unemployment rate is 4.3 percent. Black women as a group are suffering the most from the current U.S. economic downturn.

So I posed this question online, on LinkedIn, and in a private communications listserv: Are there any Black women out there making significant changes to their reproductive health-care plans due to being laid off?

I heard back from five people, all of whom were Black women. These women suffering from job losses let me know that they cannot access a wide range of reproductive health-care services, including replacing an IUD and treating endometriosis.

Planned Parenthood, which provides these kinds of services to more than 2 million people nationwide, is facing ongoing threats to its federal funding. Last month, a federal appeals court allowed President Donald Trump’s administration to enact the “big, beautiful bill”, which revoked Medicaid funding from Planned Parenthood. 

I talked to people who were as concerned as I was about changing doctors. One woman finally found a provider who correctly treated her endometriosis, but she can no longer afford her co-pays. And because she has endometriosis, a painful condition where uterine-like tissue grows outside of the uterus, she needs someone who knows her history and will treat her with dignity. 

I also talked to two women who were putting off having children. Child care is extraordinarily expensive, 12 states have near total abortion bans, and ten more have heavily restricted abortion. Additionally, as abortion is crucial medical care in case of emergency, some pregnant people in states with abortion bans don’t want to put their health at risk because they could be denied treatment. 

Even menstrual products have become difficult for some to afford. Inflation has caused pads and tampon prices to increase by 41 percent and 36 percent, respectively, since 2019.

In September, I received a letter from the D.C. Department of Health Care Finance telling me that I will be losing my Medicaid coverage on January 1.

The Trump administration’s recent cuts to Medicaid and federal ACA subsidies could leave up to 11.8 million more people without insurance coverage by 2034, according to health policy research nonprofit KFF. Restoring the ACA subsidies has become a key sticking point between Democrats and Republicans in the ongoing government shutdown negotiations.

These stressors affect many people who are unemployed. But they are perhaps most acutely affecting Black women as a population. 

At least one member of Congress has sounded the alarm.  

“Nearly 70 percent of Black women are the primary breadwinners in their households, providing for children, parents, and elders,” said Rep. Ayanna Pressley of Massachusetts in a Sept. 25 press conference. 

“Economists estimated that just 2 percent of Black women being fired this year has cost our economy $37 billion,” Pressley added.

But lawmakers have largely been silent on the issue.

Layoffs are coming—call the gynecologist

The Black women I talked to, who I found on LinkedIn and the communications listserv, are preparing for layoffs by scheduling medical appointments in advance, or requesting months worth of birth control pills. 

Monica, who requested a pseudonym to protect her privacy, is no stranger to navigating reproductive health through job loss. A writer in Washington, D.C., she was fired a few years ago from a federal job after taking time off for surgery and recovery to remove a two-pound uterine fibroid from her uterus. 

She eventually found work as a federal contractor at the Office of Veteran Affairs.

So this time, when Monica got the notice that she would be among the roughly 60,000 federal workers to be fired by the Department of Government Efficiency (DOGE), taking care of her reproductive health needs were top on her priority list.

“I made all my doctor’s appointments in August and had a pap smear,” she said. 

She also stockpiled a year’s worth of birth control pills, which she takes to help with heavy bleeding.

Aaliyah Bailey, who moved from St. Louis to southern Illinois in 2025, also had to alter her health-care plans when she lost her job in January 2025.  

Bailey had an IUD inserted seven years ago and needed to consider getting a new one. (Hormonal IUDs like the Mirena may be used for up to 8 years; for copper IUDs like Paragard, the range is up to 10 years, according to Yale Medicine.) But she couldn’t get in with her St. Louis, Missouri gynecologist to replace it in time. 

“By the time I was able to make an appointment with my regular gynecologist, I didn’t have the time to schedule an appointment for a new IUD,” she said, “so the doctor wrote the prescription for the pill.” 

She took her previous IUD out in 2023 and went without birth control for a couple of years, until she visited this doctor in January of 2025.

Now Bailey is self-employed—making about $1,000 a month—and cannot afford the cheapest option insurance through the Illinois marketplace. She uses GoodRx to get her birth control for about $10 each month.

But she hasn’t found a new gynecologist in Illinois she’s comfortable enough with to get a new IUD. The procedure requires a lot of care and sensitivity; it can be painful to have the device inserted into the uterus, so patients often feel most comfortable having their IUD inserted by a provider with whom they have rapport.

Bailey recently tried to get a longer-term supply of birth control to relieve the burden of having to remember to visit the pharmacy monthly, but she said her doctor’s prescription for a three-month supply was denied because Medicaid wouldn’t cover it.

Bailey, who has a 7-year-old child from a previous relationship, considered in vitro fertilization (IVF) in early 2024 to have additional children with her current partner.

“That is absolutely on hold now,” she said, because IVF can cost between $15,000 and $30,000 for a single cycle.

(Read more: Access Barriers Create Worse IVF Outcomes for Black Parents)

Pregnancy is a risk some can’t afford to take

More kids aren’t just on pause for Nikki, a Black mom in Virginia. She’s done.

After getting laid off in February, Nikki, who asked to be identified only by her first name to protect her privacy, had a hysterectomy. 

Children are expensive. Nikki already had two. She said she had considered a tubal ligation a few years ago, but wasn’t sure if she was actually done having kids. Now, between unemployment, a costly separation from her partner, and Trump’s 2024 election to a second term, she felt like she couldn’t risk another pregnancy.

Nikki lives in the swing state of Virginia. Abortion is legal there, but she was concerned that at some point she might not be allowed to terminate a pregnancy if needed. 

She said she felt like the circumstances forced her hand. 

“I don’t regret the decision to have the hysterectomy,” Nikki said. She added that she resents that uncertainty about the economy amidst massive job losses, and the ripple effects on her finances for the future forced her choice. She may not have elected to take extreme measures in a less volatile political and economic climate.

Many Black women are putting off care

Some people rush to get care before their benefits run out. Without health insurance, others are delaying essential health care or foregoing it altogether, including me.

To save money, I have decided to not see my primary care doctor and psychiatrist unless absolutely necessary. 

When I was employed and well insured, I was at my healthiest. I was able to see the same regular providers and build rapport with them; they understood my medical history. Illness was prevented. Illness was treated.

Now, I will be on my own if I get sick.  

Michelle White of New York City can relate. Earlier this year, White was working in nonprofit public relations in New York. 

“For the first time in my life, I had good insurance,’” she said. With her health insurance, she was finally able to meet with a doctor that specialized in endometriosis.

She went all-in on her health. 

“I met with a gynecologist that specialized in endometriosis,” she said. “I also met with an endocrinologist that did a full panel that I always wanted for my hormonal health.” 

She had the tests done, then lost her job. In March 2025, her company restructured and eliminated 40 percent of its staff. White was among them. 

White said that continuing to see those doctors without insurance would cost up to $500 per visit. 

“And when you’re on a fixed income, that is not feasible,” she said, referring to the unemployment benefits she collected weekly from April to August 2025. Her benefits have since run out, and she is relying on savings and the generosity of her loved ones to get by.

Finding ways to help others

Some Black women who joined the ranks of the unemployed against their will have found an opportunity to help others in their situation.

After Taylor DeBerry of Las Vegas was laid off in mid-2024 from her job as a social media manager at a marketing company, her first period stressed her out. It was time to purchase maxipads, but her regular brand, L. Pads, was too expensive. 

“I drove to the dollar store to see if they had another brand that was cheaper, but switching brands is difficult,” she said in an interview with Rewire News Group. “I trust the brand I like.”

She ended up purchasing a cheaper brand, called B Pure, which is about $1.25 for ten pads from the Dollar Tree. She wondered if other unemployed people struggled with the same dilemma of whether to buy the brand they trust or the brand they can afford.  

“If I’m stressed about going to the dollar store,” DeBerry said, “I can’t be the only one experiencing this.” 

In September, DeBerry started a nonprofit called Periods of Transition to provide people who have been laid off with free menstrual products. In less than two months, DeBerry has raised more than $5,700 on GoFundMe and Threads, and has provided period products to 140 people. 

Government intervention could help

Like Pressley, the lawmaker who has spoken out about the alarming unemployment numbers, Black women are hoping Congress intervenes to ensure their health-care coverage and improve employment rates.

White, of New York, wants more sweeping, top-down change. 

“My hope is that we see a completely different health-care system in my lifetime,” White said. 

“I hope that the administration can look at the numbers,” she added, referring to the over 300,000 Black women who have lost their jobs this year. “There’s gotta be some form of relief.”

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