The nurse practitioner who inserted my IUD worked with the precision and speed of someone on a pit crew. Or, really—just someone working in the gynecology department of a student clinic at one of the largest universities in the U.S. “You probably do a lot of these, huh?” I asked. She smiled. For weeks, I had been dreading the appointment. A steady stream of friends who had endured the procedure before me had warned me it hurt. Still, they said, reliable, long-lasting birth control was worth it. Indeed, for a few seconds the procedure was excruciating—but it was over quickly. “You’re good for five years,” the nurse told me as I left the exam room. It almost felt too good to be true. It was, in fact, worth it. The little device fit into my life so seamlessly that I usually forgot it was there; having an IUD meant I almost never had to think about birth control. No more phone alarms for pills, or obnoxious trips to CVS. Aside from some occasional spotting, my periods stopped. Years passed. I graduated; I moved; I got engaged. The whole time, the device was in there, doing its thing. This is the best-case scenario. But it is not the only one. Many women have severe pain during insertion. Why can’t I simply be knocked out for this process? they wonder. (It turns out, if you know who to ask, you can.) Others report negative side effects that they come to associate with their intrauterine device—acne, headaches, mood changes. Is this weird thing happening to my body because of my IUD? they ask. (In many cases, the answer is: Maybe.) There are decades’ worth of rigorous studies that validate the safety and efficacy of IUDs. Their message is quite clear: Adverse events happen, but severe ones are rare. Pregnancy with an IUD in place happens, but again, it is very rare. The IUD is, these studies show, a stellar form of birth control. And yet: Many women regard the IUD as a sort of poltergeist, liable to mess with everything from their temper to their appearance. One co-worker swears that an IUD caused one of her eyebrows to fall out, though she can’t prove it. Another swears it was her IUD that was responsible for her partner getting repeated yeast infections on his penis. (One doctor told her it wasn’t related. Another said it could be. It turns out the device can carry a biofilm.) And finally, when even I, a person who loves her IUD, went to get it replaced five years in, I was baffled to find out that actually, it was now good for eight years. (Cool, but … how?) It can be hard, as an individual woman, to access clear, compassionate answers to even seemingly basic questions about one’s IUD. On one of the online forums where women go to search for those answers: “It’s so frustrating that I have to go to Reddit,” one user recently wrote, “to figure out what other people experience.” Why, when it comes to a popular form of birth control, are women sometimes made to feel like we know so little? IUDs were not initially designed for women. They were designed to manage women. The development of the modern IUD is inextricably linked to the population control movement, as Chikako Takeshita documents in her book The Global Biopolitics of the IUD. In the 1950s, governments, international organizations, and wealthy funders began to fret over a “population explosion in the global South,” she writes. This, in their minds, could cause all sorts of problems: hunger, environmental destruction, political unrest, communism—all the way up to nuclear war. They needed to build a device that they could strategically deploy to ensure women, in certain areas, had fewer children. One of the key organizations pushing forward the development of such a device was the Population Council, Takeshita writes. It awarded research grants to the physicians who developed some of the earliest models, funded the first long-term study on IUD efficacy, supported distribution of devices, and organized several international conferences focused on IUDs. As Takeshita notes, at the first such gathering in 1962, the conference chairman, Alan Guttmacher, discussed the need for a contraceptive for the “masses”: Existing methods, he said, “are largely birth control for the individual, not for a nation.” The user’s experience in early IUD development was a secondary concern, an issue only insofar as a negative experience might cause a woman to have it removed. The first large-scale comparative study on the devices ran in the ’60s and involved tens of thousands of women testing five different types of IUDs—Lippes loops, Margulies spirals, Birnberg bows, steel rings, and double coils.
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