In terms of activism or service for women (this wouldn't apply to babies) that I and more prochoice people could agree on, I recently learned about a group called Support After Abortion that does exactly what the name suggests: it puts women who've had bad experiences with abortions in touch with resources to help their emotional recovery. The focus is on emotional healing/wellbeing for women who've already had a difficult experience with their reproductive decisions, and who are NOT involved in a church or another religious group that might help them resolve what they are feeling. (SAA did a recent study on this, which suggests that about a third of women who've undergone pill abortions had negative changes in their attitude towards abortion/themselves--a minority, but not a negligible one.)
In terms of my own family planning (which is in cooperation with my husband), I have had four pregnancies with various healthcare professionals, and never (mostly for geographic reasons) been able to do it with a doctor or midwife who trusts me/us to be able to make good decisions in this regard. I usually end up having to explain Marquette (the method we use) two or three times during pre-and post-natal care and turn down multiple other offers for other contraception, including the offer to have my tubes tied. On the one hand--I get why healthcare professionals keep asking: it's part of what they are supposed to do, like checking weight and taking blood pressure. Also, we have four kids who are close in age! But on the other hand, it gets tiring to explain the method, explain that no, none of these children were mistakes, explain that yes, I absolutely can do this post-partum and we can handle the abstinence ... and still get met with a skeptical, incredulous, "Well, if you really think that's what you want ..." It feels a little infantilizing. But on the other hand yet again, it is the job of a healthcare professional to take care of their patients/clients. It is just very difficult to do that in a respectful way when there are some deeply shared values that aren't held in common--because the doctor and patient each think they know what is best for the patient, and the gap is not one of technical knowledge, ultimately, but of ethics.
Oct 15, 2022·edited Oct 15, 2022Liked by Leah Libresco Sargeant
Such a good article, Leah, and I really appreciate your attention to this issue. I know friends who have had trouble getting their IUD out for the most benign of reasons, such as that their OB's office was very busy, and there just was no appointment available for a month or two, or their OB wanted to schedule a "pre-conception counseling" visit before removing the IUD when a woman had decided to try for a pregnancy. This seems minor, but for a woman in her thirties (or really at whatever age) any wait once the decision has been made to try for a baby can be really hard.
As far as activism or service goes, there is an organization in my city called “Almost Home” that shelters and provides programming (degree programs, job training, childcare, life skills and budgeting classes, etc) for unhoused teen mothers and their babies. The aim is to break the cycle of poverty two generations at a time. Supporting this org is neutral ground for my friends of different beliefs.
In response to the discussion on accessibility for LARC removal, I think outreach (not just transportation) for follow-up (not just removal) is crucial for the health of women in low-SES populations especially. My friend is a teen mom who lives below poverty level and agreed to an IUD after her child’s birth. She suffered from migraines and edema for over a year before being able to get to the doctor, who determined eventually that she was reacting to the IUD with dangerously high blood pressure. Her barriers not only included transportation and childcare, but the executive function skills to be able to schedule the appointment, schedule transportation, and remember the appointment. She was a teen with a lot of disadvantages, a profile that meant healthcare professionals cared to recommend the IUD to her but then neglected her needs for follow-up and risked her health in the end. Thinking about LARCs as effective devices to easily insert/remove oversimplifies the care of vulnerable women in particular and leads to harm.
A common complaint about IUDs is cramping and discomfort. While pain should *absolutely* be taken more seriously (esp. re: insertion), in most cases the cramping resolves in 3-6 months. It makes sense for a doc to share this information when a person suggests they want to get an IUD removed because of their pain.
It especially makes sense given that for way too many women, other forms of birth control are much more difficult to maintain. Many women report they can't convince their partner to consistently use a condom (also, condoms are frequently tampered with in DV scenarios) and refilling prescriptions also is a big burden (time, money, remembering to take it).
I'm also not convinced from your article that there are substantial barriers to a person getting an IUD removed if they want to get pregnant. You can go to any planned parenthood for the procedure, its covered by every insurance (thanks Obamacare!) and by existing public health programs:
One of the things that your article does a good job of pointing out is that an IUD is sometimes a bad fit for a woman's actual desires around pregnancy and conception. An IUD is a complete stop to fertility which requires planning to undo, and many women who contracept sometimes but not all of the time are doing so out of genuine ambivalence rather than failure to adhere to their desire not to conceive. It's an example where women who are presented with a Yes/No choice on whether they plan to conceive won't be counseled for their actual desires.
In terms of activism or service for women (this wouldn't apply to babies) that I and more prochoice people could agree on, I recently learned about a group called Support After Abortion that does exactly what the name suggests: it puts women who've had bad experiences with abortions in touch with resources to help their emotional recovery. The focus is on emotional healing/wellbeing for women who've already had a difficult experience with their reproductive decisions, and who are NOT involved in a church or another religious group that might help them resolve what they are feeling. (SAA did a recent study on this, which suggests that about a third of women who've undergone pill abortions had negative changes in their attitude towards abortion/themselves--a minority, but not a negligible one.)
In terms of my own family planning (which is in cooperation with my husband), I have had four pregnancies with various healthcare professionals, and never (mostly for geographic reasons) been able to do it with a doctor or midwife who trusts me/us to be able to make good decisions in this regard. I usually end up having to explain Marquette (the method we use) two or three times during pre-and post-natal care and turn down multiple other offers for other contraception, including the offer to have my tubes tied. On the one hand--I get why healthcare professionals keep asking: it's part of what they are supposed to do, like checking weight and taking blood pressure. Also, we have four kids who are close in age! But on the other hand, it gets tiring to explain the method, explain that no, none of these children were mistakes, explain that yes, I absolutely can do this post-partum and we can handle the abstinence ... and still get met with a skeptical, incredulous, "Well, if you really think that's what you want ..." It feels a little infantilizing. But on the other hand yet again, it is the job of a healthcare professional to take care of their patients/clients. It is just very difficult to do that in a respectful way when there are some deeply shared values that aren't held in common--because the doctor and patient each think they know what is best for the patient, and the gap is not one of technical knowledge, ultimately, but of ethics.
Such a good article, Leah, and I really appreciate your attention to this issue. I know friends who have had trouble getting their IUD out for the most benign of reasons, such as that their OB's office was very busy, and there just was no appointment available for a month or two, or their OB wanted to schedule a "pre-conception counseling" visit before removing the IUD when a woman had decided to try for a pregnancy. This seems minor, but for a woman in her thirties (or really at whatever age) any wait once the decision has been made to try for a baby can be really hard.
As far as activism or service goes, there is an organization in my city called “Almost Home” that shelters and provides programming (degree programs, job training, childcare, life skills and budgeting classes, etc) for unhoused teen mothers and their babies. The aim is to break the cycle of poverty two generations at a time. Supporting this org is neutral ground for my friends of different beliefs.
In response to the discussion on accessibility for LARC removal, I think outreach (not just transportation) for follow-up (not just removal) is crucial for the health of women in low-SES populations especially. My friend is a teen mom who lives below poverty level and agreed to an IUD after her child’s birth. She suffered from migraines and edema for over a year before being able to get to the doctor, who determined eventually that she was reacting to the IUD with dangerously high blood pressure. Her barriers not only included transportation and childcare, but the executive function skills to be able to schedule the appointment, schedule transportation, and remember the appointment. She was a teen with a lot of disadvantages, a profile that meant healthcare professionals cared to recommend the IUD to her but then neglected her needs for follow-up and risked her health in the end. Thinking about LARCs as effective devices to easily insert/remove oversimplifies the care of vulnerable women in particular and leads to harm.
A common complaint about IUDs is cramping and discomfort. While pain should *absolutely* be taken more seriously (esp. re: insertion), in most cases the cramping resolves in 3-6 months. It makes sense for a doc to share this information when a person suggests they want to get an IUD removed because of their pain.
It especially makes sense given that for way too many women, other forms of birth control are much more difficult to maintain. Many women report they can't convince their partner to consistently use a condom (also, condoms are frequently tampered with in DV scenarios) and refilling prescriptions also is a big burden (time, money, remembering to take it).
I'm also not convinced from your article that there are substantial barriers to a person getting an IUD removed if they want to get pregnant. You can go to any planned parenthood for the procedure, its covered by every insurance (thanks Obamacare!) and by existing public health programs:
https://www.plannedparenthood.org/learn/birth-control/iud/how-does-iud-removal-work
One of the things that your article does a good job of pointing out is that an IUD is sometimes a bad fit for a woman's actual desires around pregnancy and conception. An IUD is a complete stop to fertility which requires planning to undo, and many women who contracept sometimes but not all of the time are doing so out of genuine ambivalence rather than failure to adhere to their desire not to conceive. It's an example where women who are presented with a Yes/No choice on whether they plan to conceive won't be counseled for their actual desires.