Reproductive justice includes the right to stop contraception

Reproductive justice includes the right to stop contraception

By Kate Clancy

Contraception rebellion is all over social media these days. Many people are going off of hormonal contraception, digging out their implants, foregoing injections… and pulling on that little IUD string dangling from their cervix.

People are growing frustrated with hormonal and/or long-acting contraception for a variety of reasons. Some of the reactions I’ve seen use evidence from questionable evolutionary psychology studies, such as those that suggest hormonal contraception, by suppressing one’s typical ovarian function, will make it harder to find a compatible mate. Others are promoting companies selling “all-natural” or other herbal remedies to help manage period symptoms.

However, it would be a mistake to see this rebellion as a phase or a scam. Hormonal contraception can cause depression, and many are still mistrustful of medicine given how long it took clinicians to make this admission when it was known anecdotally and across a variety of studies for years. Many of my own college students tell me stories of going to the doctor for a health complaint, like a sprained ankle, and being pressured to start taking some sort of contraception, especially long-acting reversible contraceptives (LARC for short), like the hormonal IUD. And several friends have struggled to find a healthcare provider who will remove their IUD in a timely manner… even in the cases where it’s because theirs is expiring and they need a new one.

For those who need some form of contraception? They are going back to diaphragms—when they can find a provider who will fit them for one. They are using condoms. They are using the fertility awareness method. And yes, these are variable in their efficacy. But many of these methods give greater autonomy to people who would like more of a say in whether and when they use them, and still others are finding they no longer want to hormonally regulate their menstrual cycles.

Studies that interview LARC users, explore modern contraceptive counseling, and, I don’t know, actually talk to patients are all starting to converge on an important understanding of the actual calculus many of us with uteruses make when faced with reproductive decisions. Efficacy is a huge factor in our consideration of what type of contraceptive to use, and there are many happy LARC users out there. But efficacy does not necessarily overpower our various other desires, including the sexual desires that many lose with hormonal contraception. Others consider efficacy alongside the possibility of other unwanted side effects. Still others describe discomfort with the idea of more or less permanent menstrual suppression. And an increasing number of people do not like that so many forms of contraception require repeated appointments, delays in scheduling, and constant health insurance switches of which generic pills are covered.

Or consider increasingly the most popular form of contraception in doctors’ offices, the LARC of all LARCs: the hormonal IUD. First, you are very likely to already be interested in this option because your doctor is going to counsel you very hard that this is the best option. Interviews with doctors show that even though they are not supposed to let their own biases guide your decisions, they do encourage hormonal IUDs as their “favorite” and “most responsible” choice. And who doesn’t want to be responsible?

Let’s say you do in fact want a hormonal IUD. If so, most need to make another appointment for the actual IUD insertion. Depending on your provider and your insurance, you may get no more than ibuprofen for the pain (and insertion is painful for most people). If you change your mind and want it removed, you need to make another appointment. A 2020 mystery-caller study showed that only sixty percent of those clinics they called were willing to provide the caller with an IUD removal appointment, with an average of a ten day wait. Some clinics required a counseling appointment before the removal appointment, others would not remove an IUD they had not put in, and still others offered no sliding scale, making the median cost of IUD removal among these clinics about $262. Today, with reproductive options dwindling for many thanks to the Dobbs decision, these appointments may be getting even harder to book.

Research across many different samples of providers, and analysis of counseling materials, shows many providers are taught to and will try to coerce you to wait it out just a bit longer, to see if your symptoms go away, to see if maybe you can withstand the side effects after all. While there are of course wonderful doctors who center the reproductive autonomy of their patients, interviews with doctors do show many will intentionally be “pushy” if they think a patient needs extra convincing. They see early removal as “disappointing,” a “tragedy.” They feel guilty for their own failures if someone they’ve counseled to have an IUD put in asks to have it out early.

It’s no surprise, then, that many are looking up methods for IUD self-removal. In my book Period: The Real Story of Menstruation, I made a throwaway joke about it, saying I would not be including instructions on IUD self-removal even while I critique much of the historical and contemporary harms wrought by the eugenics undergirding much of gynecology.

Upon reflection, I wish I had.

Removing your own hormonal IUD is not that hard for most people. You can find vetted instructions online. If anything, for most people, the process of removing this device is far more medicalized than it needs to be.

Here’s what you do. If you can reach in to your vagina and feel the strings of your IUD, and you can get enough purchase on them to pull it out, then… you can. If not, then you probably do need help from a health provider to remove it.

If you are one of many people who find LARC absolutely transformative and life-changing: I am thrilled you have something that is effective, safe, and helps to resolve distressing or even deeply painful menstrual experiences. If you are one of nearly equal numbers for whom LARC disrupts your sex drive, makes you depressed, worsens menstrual symptoms, or you otherwise do not like how you feel on it? Well, I cannot offer medical advice. But I can tell you to direct your favorite search engine to “WebMD IUD removal.”

Kate Clancy is professor of anthropology at the University of Illinois, Urbana-Champaign, where she holds appointments in the Department of Gender and Women’s Studies and the Program in Ecology, Evolution, and Conservation Biology, and at the Beckman Institute for Advanced Science and Technology. She has written for National GeographicScientific American, and American Scientist.