How Accessible Are IUDs?

Bianca I. Laureano

In 2005 the FDA approved insertion and use of IUDs among younger women who do not have children. The use of IUDs has since increased. Yet even today the IUD remains inaccessible to many who would otherwise choose it.

Earlier this month Newsweek reported that IUDs are becoming more popular as a form of contraceptive. Reporter Meredith Melnick discussed how the 2005 FDA approval of IUDs among younger women who do not have children has affected the increase in usage. I was not surprised when Melnick reported that some doctors do not support this method for younger women for various reasons. As someone who got an IUD in 2007 before I was in my 30s, I had a very hard time accessing the method of my choice.

Growing up with Puerto Rican hippie parents, I remember my mother telling me that the birth control pill kills Puerto Rican women. And it did. I knew at an early age that condoms were the method I was going to use before even considering a hormonal method, which was not appealing, and still isn’t. Even when the morning-after pill/emergency contraceptive came out I wasn’t too into the option for myself. However, as someone who provided counseling on all options to young people, I also knew where my personal boundaries stopped; it was my obligation never to interfere with my client’s options counseling. Several of my female-identified clients opted for hormonal methods.

My graduate research in sexuality, Latino communities living in the U.S., and women’s health complimented my family’s narrative of forced sterilization of women of Color in the Caribbean and women with disabilities in the US. Knowing these facts and choosing to work in a field that has such a troubling history, I considered myself an educated consumer when it came to birth control and contraceptive options. When I found a steady sexual partner I decided to look into getting and IUD, the only method outside of condom use that I knew was for me.

As someone who has the privilege of having health insurance in the U.S., I made an appointment to see my private physician. At the time I was employed fulltime and was insured via the union of which I was a member. We had pretty good health care, or so I thought, as I rarely had to pay out of pocket for seeing a physician or for prescriptions. I met with him and I shared that I was interested in the IUD. He informed me that my insurance did not cover the IUDs (there are twp available in the U.S., a ParaGard which can be used for up to 10 years, and a Mirena which can be used up to five years and has hormones). I asked him what methods were covered by my insurance and he said all hormonal methods (besides the hormonal IUD) and sterilization.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

I was in shock.

I told my doctor that we would need to talk further about my options and how much the IUD would cost out of pocket. He shared the IUD would be about $600 for insertion and for the actual IUD (apparently they are two different costs). I asked about sterilization and he shared that I had two options: a “traditional” tubal ligation which would require an overnight stay in a hospital and follow up appointments or a newer form of tubal ligation which is outpatient surgery called Essure. If I chose Essure I would have to also choose a hormonal birth control method to use as back up for three months. He also told me about the risks involved and the 30-day waiting period required for me to be sterilized.

As someone who knew the IUD would, basically, instantly work I was not too happy with these options. My physician and I continued to talk and he told me that before he would agree to perform any sterilization procedure on me that I would have to “prove to him I really wanted to be sterilized” because I had never been pregnant, was 28 years old, and he wanted to make sure I wouldn’t “regret” the decision. My response to his statement was honest, but it may have come off as me being flip. I asked him “how am I to prove to you I don’t want to be a parent?” I proceeded to share with him that I was not interested in pregnancy, childbearing, or parenting an infant child. I also shared that I was more committed to helping youth of Color age safely and successfully out of the child welfare system than I was to having a biological child.

What finally convinced him was when I told him that if I did decide to have a child I would come to him for fertility treatment. I signed the 30-day waiting period form for sterilization and made the decision to call my health insurance and ask how much of the $600 fee they would cover, if at all. To my surprise my health insurance said they would only cover $180 of my IUD. I asked how is it possible that they would cover 100 percent a tubal ligation which includes overnight stay in a hospital, general anesthesia (which has its own separate risks), antibiotics, and follow up examinations when an IUD, which takes less than 10 minutes to insert usually, costs significantly less, yet they do not cover in full. My insurance company said I could “appeal” their decision. When I asked how long that would take they said up to eight weeks (if that). I told the woman on the telephone that I did not want to be worried about my method eight weeks from now. I wanted the method sooner rather than later.

It made no sense to me. It still doesn’t make sense to me. How can we live in a country where we talk about “choice” and where anti-choicers love to say: “you should have used a method” or “been responsible” when people who are being as responsible as they can be cannot access the method of their choice? How was my choice to decide what went into my body and what affected me (and who got money based on my care) gone?

After some research I found a city hospital that agreed to insert the IUD for me for free as they had federal funding. I was at a hospital that worked with many sex workers and young women of Color in helping them maintain their reproductive and sexual health. It was the best place for me to get this method and I was extremely excited. I never thought I’d be as excited as I was. Perhaps that excitement stemmed from “getting over” on the insurance companies, or that I knew I was getting the method I always wanted, it felt good. My physician asked me if I minded having a resident sit in so they could watch the IUD insertion. I agreed and after 10 minutes I had the method of my choice and was instantly relieved at having one of the oldest methods, with the most longitudinal studies, and highest effectiveness rate.

To say the IUD has rocked my world is an understatement. There were some side effects that I was told about, but was not completely ready for, such as bleeding within the first two months, and difficulty feeling the thread to check the IUD after my menstrual cycle. I had never had to prepare or “clean up” the way I learned to the first several months of IUD insertion. At the same time I found it almost impossible to find and feel the thread of my IUD through my vaginal canal. However, my partner did confirm the thread was there, and also claimed to have “felt” the thread but it was not painful.

The Newsweek article presents the opinion of several doctors and researchers and their positions on providing the IUD to patients. The only doctor of Color mentioned, Dr. Hilda Hutcherson, is cautious about offering the IUD to younger patients because of what can happen if someone has an IUD and contracts an STI. She makes connections between IUDs, STI infection and how the two together can amplify infertility if the STI is untreated and that “fertility is really important.” That is true, if someone wanted to become pregnant. I understand this position, and realize that the IUD only prevents pregnancy not an STI, as every other hormonal method. We also know that infertility may be the result of many untreated STIs. What I’m not in agreement with some doctors completely against the method (which is different from being cautious about it) is that restricting our choices is not the most effective way to be a provider to a patient.

Have we not learned from what happens when patients are not given all of their options? Not told of all of the possible outcomes of a method? The idea that women have options when they choose to be responsible is very much an illusion for many. The idea that sterilization is no longer an option that doctors push for some women, especially as a woman of Color, and a Puerto Rican woman, seems difficult to believe from my personal experience.

Earlier this year I went to a book release event for Dr. Iris Lopez’s recent text: Matters of Choice: Puerto Rican Women’s Struggle For Reproductive Choice, which follows three generations of Puerto Rican women over 25 years who have decided on sterilization as their birth control method. Her findings are fascinating and I encourage readers to engage with the text beyond this article. Dr. Lopez provides readers the opportunity to hear Puerto Rican women share their own testimonies about why they chose sterilization, and their choices challenge how I view sterilization as well. Although I considered sterilization, I didn’t want to have to go through the procedure. The discussions of feeling liberated by some participants opens up dialogue about power, modes of survival for women in abusive and/or violent relationships, and “traditional” US ideologies around “liberation” and what liberatory sexuality means.

I’m excited to see the IUD becoming more popular. I also think it may be a useful long-term method for people who may need it the most. In comparison to other hormonal methods for young women, I think the IUD can be a realistic option. Not only do some hormonal methods take a while to work (about 30 days is the “safe” window period often mentioned for hormones to become effective), they can also alter the menstrual cycle of many young women.

For some of the young women I’ve counseled continuing to menstruate was essential to their ability to use a method while feeling safe in their home where parents and/or guardians monitor their cycle. For young people who are not comfortable touching their genitals (think using the NuvaRing), want a menstrual cycle (so Depo-Provera is not an option), don’t want a method others can see (such as the patch, which only comes in 1 color, a perfect example of the normalization of Whiteness and light skin in our society and around the world in reproductive and sexual health), that they have to remember each day (oral birth control pills,), or that can be checked discreetly by a physician (vaginal sonogram) if a parent/guardian remains in the exam room during a gynecological exam (this happens a lot more than some people might want to admit). I see the IUD as an option for transgender men as well, the discretion based on who their partners are is one that I may add a new understanding of safety and security to a community often exclude when discussing contraceptives and birth control options.

Even though the FDA has approved the IUD for all ages, there remain challenges even in obtaining information. Earlier this week my homegirl, reproductive justice activist and college student Bianca M. Velez shared on twitter: “When asking for a pamphlet of further info re: ParaGard on the website, it asks if the reader is 18 or older.” How accessible did you think IUDs were?

Culture & Conversation Human Rights

Let’s Stop Conflating Self-Care and Actual Care

Katie Klabusich

It's time for a shift in the use of “self-care” that creates space for actual care apart from the extra kindnesses and important, small indulgences that may be part of our self-care rituals, depending on our ability to access such activities.

As a chronically ill, chronically poor person, I have feelings about when, why, and how the phrase “self-care” is invoked. When International Self-Care Day came to my attention, I realized that while I laud the effort to prevent some of the 16 million people the World Health Organization reports die prematurely every year from noncommunicable diseases, the American notion of self-care—ironically—needs some work.

I propose a shift in the use of “self-care” that creates space for actual care apart from the extra kindnesses and important, small indulgences that may be part of our self-care rituals, depending on our ability to access such activities. How we think about what constitutes vital versus optional care affects whether/when we do those things we should for our health and well-being. Some of what we have come to designate as self-care—getting sufficient sleep, treating chronic illness, allowing ourselves needed sick days—shouldn’t be seen as optional; our culture should prioritize these things rather than praising us when we scrape by without them.

International Self-Care Day began in China, and it has spread over the past few years to include other countries and an effort seeking official recognition at the United Nations of July 24 (get it? 7/24: 24 hours a day, 7 days a week) as an important advocacy day. The online academic journal SelfCare calls its namesake “a very broad concept” that by definition varies from person to person.

“Self-care means different things to different people: to the person with a headache it might mean a buying a tablet, but to the person with a chronic illness it can mean every element of self-management that takes place outside the doctor’s office,” according to SelfCare. “[I]n the broadest sense of the term, self-care is a philosophy that transcends national boundaries and the healthcare systems which they contain.”

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

In short, self-care was never intended to be the health version of duct tape—a way to patch ourselves up when we’re in pieces from the outrageous demands of our work-centric society. It’s supposed to be part of our preventive care plan alongside working out, eating right, getting enough sleep, and/or other activities that are important for our personalized needs.

The notion of self-care has gotten a recent visibility boost as those of us who work in human rights and/or are activists encourage each other publicly to recharge. Most of the people I know who remind themselves and those in our movements to take time off do so to combat the productivity anxiety embedded in our work. We’re underpaid and overworked, but still feel guilty taking a break or, worse, spending money on ourselves when it could go to something movement- or bill-related.

The guilt is intensified by our capitalist system having infected the self-care philosophy, much as it seems to have infected everything else. Our bootstrap, do-it-yourself culture demands we work to the point of exhaustion—some of us because it’s the only way to almost make ends meet and others because putting work/career first is expected and applauded. Our previous president called it “uniquely American” that someone at his Omaha, Nebraska, event promoting “reform” of (aka cuts to) Social Security worked three jobs.

“Uniquely American, isn’t it?” he said. “I mean, that is fantastic that you’re doing that. (Applause.) Get any sleep? (Laughter.)”

The audience was applauding working hours that are disastrous for health and well-being, laughing at sleep as though our bodies don’t require it to function properly. Bush actually nailed it: Throughout our country, we hold Who Worked the Most Hours This Week competitions and attempt to one-up the people at the coffee shop, bar, gym, or book club with what we accomplished. We have reached a point where we consider getting more than five or six hours of sleep a night to be “self-care” even though it should simply be part of regular care.

Most of us know intuitively that, in general, we don’t take good enough care of ourselves on a day-to-day basis. This isn’t something that just happened; it’s a function of our work culture. Don’t let the statistic that we work on average 34.4 hours per week fool you—that includes people working part time by choice or necessity, which distorts the reality for those of us who work full time. (Full time is defined by the Internal Revenue Service as 30 or more hours per week.) Gallup’s annual Work and Education Survey conducted in 2014 found that 39 percent of us work 50 or more hours per week. Only 8 percent of us on average work less than 40 hours per week. Millennials are projected to enjoy a lifetime of multiple jobs or a full-time job with one or more side hustles via the “gig economy.”

Despite worker productivity skyrocketing during the past 40 years, we don’t work fewer hours or make more money once cost of living is factored in. As Gillian White outlined at the Atlantic last year, despite politicians and “job creators” blaming financial crises for wage stagnation, it’s more about priorities:

Though productivity (defined as the output of goods and services per hours worked) grew by about 74 percent between 1973 and 2013, compensation for workers grew at a much slower rate of only 9 percent during the same time period, according to data from the Economic Policy Institute.

It’s no wonder we don’t sleep. The Centers for Disease Control and Prevention (CDC) has been sounding the alarm for some time. The American Academy of Sleep Medicine and the Sleep Research Society recommend people between 18 and 60 years old get seven or more hours sleep each night “to promote optimal health and well-being.” The CDC website has an entire section under the heading “Insufficient Sleep Is a Public Health Problem,” outlining statistics and negative outcomes from our inability to find time to tend to this most basic need.

We also don’t get to the doctor when we should for preventive care. Roughly half of us, according to the CDC, never visit a primary care or family physician for an annual check-up. We go in when we are sick, but not to have screenings and discuss a basic wellness plan. And rarely do those of us who do go tell our doctors about all of our symptoms.

I recently had my first really wonderful check-up with a new primary care physician who made a point of asking about all the “little things” leading her to encourage me to consider further diagnosis for fibromyalgia. I started crying in her office, relieved that someone had finally listened and at the idea that my headaches, difficulty sleeping, recovering from illness, exhaustion, and pain might have an actual source.

Considering our deeply-ingrained priority problems, it’s no wonder that when I post on social media that I’ve taken a sick day—a concept I’ve struggled with after 20 years of working multiple jobs, often more than 80 hours a week trying to make ends meet—people applaud me for “doing self-care.” Calling my sick day “self-care” tells me that the commenter sees my post-traumatic stress disorder or depression as something I could work through if I so chose, amplifying the stigma I’m pushing back on by owning that a mental illness is an appropriate reason to take off work. And it’s not the commenter’s fault; the notion that working constantly is a virtue is so pervasive, it affects all of us.

Things in addition to sick days and sleep that I’ve had to learn are not engaging in self-care: going to the doctor, eating, taking my meds, going to therapy, turning off my computer after a 12-hour day, drinking enough water, writing, and traveling for work. Because it’s so important, I’m going to say it separately: Preventive health care—Pap smears, check-ups, cancer screenings, follow-ups—is not self-care. We do extras and nice things for ourselves to prevent burnout, not as bandaids to put ourselves back together when we break down. You can’t bandaid over skipping doctors appointments, not sleeping, and working your body until it’s a breath away from collapsing. If you’re already at that point, you need straight-up care.

Plenty of activities are self-care! My absolutely not comprehensive personal list includes: brunch with friends, adult coloring (especially the swear word books and glitter pens), soy wax with essential oils, painting my toenails, reading a book that’s not for review, a glass of wine with dinner, ice cream, spending time outside, last-minute dinner with my boyfriend, the puzzle app on my iPad, Netflix, participating in Caturday, and alone time.

My someday self-care wish list includes things like vacation, concerts, the theater, regular massages, visiting my nieces, decent wine, the occasional dinner out, and so very, very many books. A lot of what constitutes self-care is rather expensive (think weekly pedicures, spa days, and hobbies with gear and/or outfit requirements)—which leads to the privilege of getting to call any part of one’s routine self-care in the first place.

It would serve us well to consciously add an intersectional view to our enthusiasm for self-care when encouraging others to engage in activities that may be out of reach financially, may disregard disability, or may not be right for them for a variety of other reasons, including compounded oppression and violence, which affects women of color differently.

Over the past year I’ve noticed a spike in articles on how much of the emotional labor burden women carry—at the Toast, the Atlantic, Slate, the Guardian, and the Huffington Post. This category of labor disproportionately affects women of color. As Minaa B described at the Huffington Post last month:

I hear the term self-care a lot and often it is defined as practicing yoga, journaling, speaking positive affirmations and meditation. I agree that those are successful and inspiring forms of self-care, but what we often don’t hear people talking about is self-care at the intersection of race and trauma, social justice and most importantly, the unawareness of repressed emotional issues that make us victims of our past.

The often-quoted Audre Lorde wrote in A Burst of Light: “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”

While her words ring true for me, they are certainly more weighted and applicable for those who don’t share my white and cisgender privilege. As covered at Ravishly, the Feminist Wire, Blavity, the Root, and the Crunk Feminist Collective recently, self-care for Black women will always have different expressions and roots than for white women.

But as we continue to talk about self-care, we need to be clear about the difference between self-care and actual care and work to bring the necessities of life within reach for everyone. Actual care should not have to be optional. It should be a priority in our culture so that it can be a priority in all our lives.

News Politics

Debbie Wasserman Schultz Resigns as Chair of DNC, Will Not Gavel in Convention

Ally Boguhn

Donna Brazile, vice chair of the DNC, will step in as interim replacement for Wasserman Schultz as committee chair.

On the eve of the Democratic National Convention in Philadelphia, Rep. Debbie Wasserman Schultz (D-FL) resigned her position as chair of the Democratic National Committee (DNC), effective after the convention, amid controversy over leaked internal party emails and months of criticism over her handling of the Democratic primary races.

Wasserman Schultz told the Sun Sentinel on Monday that she would not gavel in this week’s convention, according to Politico.

“I know that electing Hillary Clinton as our next president is critical for America’s future,” Wasserman Schultz said in a Sunday statement announcing her decision. “Going forward, the best way for me to accomplish those goals is to step down as Party Chair at the end of this convention.”

“We have planned a great and unified Convention this week and I hope and expect that the DNC team that has worked so hard to get us to this point will have the strong support of all Democrats in making sure this is the best convention we have ever had,” Wasserman Schultz continued.

Just prior to news that Wasserman Schultz would step down, it was announced that Rep. Marcia Fudge (D-OH) would chair the DNC convention.

Donna Brazile, vice chair of the DNC, will step in as interim replacement for Wasserman Schultz as committee chair.

Wasserman Schultz’s resignation comes after WikiLeaks released more than 19,000 internal emails from the DNC, breathing new life into arguments that the Democratic Party—and Wasserman Schultz in particular—had “rigged” the primary in favor of nominating Hillary Clinton. As Vox‘s Timothy B. Lee pointed out, there seems to be “no bombshells” in the released emails, though one email does show that Brad Marshall, chief financial officer of the DNC, emailed asking whether an unnamed person could be questioned about “his” religious beliefs. Many believe the email was referencing Sen. Bernie Sanders’ (I-VT).

Another email from Wasserman Schultz revealed the DNC chair had referred to Sanders’ campaign manager, Jeff Weaver, as a “damn liar.”

As previously reported by Rewire before the emails’ release, “Wasserman Schultz has been at the center of a string of heated criticisms directed at her handling of the DNC as well as allegations that she initially limited the number of the party’s primary debates, steadfastly refusing to add more until she came under pressure.” She also sparked controversy in January after suggesting that young women aren’t supporting Clinton because there is “a complacency among the generation” who were born after Roe v. Wade was decided.

“Debbie Wasserman Schultz has made the right decision for the future of the Democratic Party,” said Sanders in a Sunday statement. “While she deserves thanks for her years of service, the party now needs new leadership that will open the doors of the party and welcome in working people and young people. The party leadership must also always remain impartial in the presidential nominating process, something which did not occur in the 2016 race.”

Sanders had previously demanded Wasserman Schultz’s resignation in light of the leaked emails during an appearance earlier that day on ABC’s This Week.

Clinton nevertheless stood by Wasserman Schultz in a Sunday statement responding to news of the resignation. “I am grateful to Debbie for getting the Democratic Party to this year’s historic convention in Philadelphia, and I know that this week’s events will be a success thanks to her hard work and leadership,” said Clinton. “There’s simply no one better at taking the fight to the Republicans than Debbie—which is why I am glad that she has agreed to serve as honorary chair of my campaign’s 50-state program to gain ground and elect Democrats in every part of the country, and will continue to serve as a surrogate for my campaign nationally, in Florida, and in other key states.”

Clinton added that she still looks “forward to campaigning with Debbie in Florida and helping her in her re-election bid.” Wasserman Schultz faces a primary challenger, Tim Canova, for her congressional seat in Florida’s 23rd district for the first time this year.