“Population Bomb” by Jairus Khan // CC 2.0
Who among us wants to invite a T-shaped piece of plastic or metal to live in our uterus for the next 5 to 10 years, just for fun? No one! But if it’s to prevent pregnancy that’s a different story. IUDs may be uncomfortable and annoying but women still use them because they are so dang effective.
There are many ways to prevent pregnancy. Abstinence, Condoms, the Fertility Awareness Method, Birth Control Pills…and more. One form of contraception that has grown in popularity in recent years is the Intra-Uterine Device (IUD). One study found that teenagers who use long-acting reversible contraception (LARC) had fewer unplanned pregnancies. IUDs and sub-dermal implants are two LARCs. In light of this study, doctors have been recommending IUDs to teenagers as the most effective form of contraception. In the past, it was commonly held that only women who had already had children would be good candidates for IUDs, but today they are recommended for women regardless of whether or not they’ve had children. These devices are very effective at preventing pregnancy, and some even work without hormones. For many women, the IUD is a great option, effective contraception that they rarely have to think about.
But IUDs are not all butterflies and rainbows. I had one briefly, even after knowing my mom’s horror story with the Dalkon Shield in the late 60s. At the age of 27, I was done with the pill and all hormonal contraception, and as I didn’t have a history of heavy periods, my doctor said that the Paragard would be a good choice for me. So I got one. And…I freaking hated it! For the first three weeks after it was inserted, I had cramps so severe that even with intense pain killers, I found it hard to go about my life without thinking I was dying and/or wishing I was dead. My light 3-day periods turned into heavy 10-day affairs with crippling cramps the entire time. An additional unexpected and unpleasant side effect was a sudden inability to reach orgasm during sex. (Anyone else ever have this side effect?)
The one good thing about having the IUD was that one time when I sneezed while on my new heavier period and blood exploded out of my vagina like a gunshot wound, which I found HILARIOUS! But I digress…
A friend of mine says this about her Paragard:
“Here is the thing that is really driving me crazy about my goddamned IUD — my crotch has no idea what it’s doing anymore, and hence neither do I.”
Her cervical fluid is all out of whack, there is no longer any discernable pattern, so she doesn’t know where she is in her cycle. So, while she is using the IUD for contraception, and doesn’t need to chart her fertility for contraceptive purposes, the monthly cues her cervical fluid usually gives her about where she is in her cycle are no longer there.
She also brought up a study that found elevated levels of Mast Cells in the endometrium of women with IUDs. Mast Cells are what your body produces when it’s having an allergic reaction, like if you get hives after eating shellfish. So, are IUDs actually producing allergic reactions in women’s uteruses? That would probably help prevent pregnancy, but what about the woman who has to live with this every day?
Ultimately, I had my IUD removed after four months because I couldn’t stand it any more. All that blood and pain, and lack of orgasms, in a word, sucked! I really feel for women who have periods like this normally, it’s the worst! I was not going to subject myself to this if I didn’t have to.
Thinking I had fully exhausted all medical contraceptive options, I was resigned to using condoms or other barrier methods for the rest of my life. Luckily I didn’t have to do that! I soon found out about the Fertility Awareness Method and started charting my fertility. I can now have unprotected sex with my husband when I’m not fertile, and use barrier methods only when I am fertile. It’s the best possible solution for us.
IUDs are very effective, but as my story shows, having one in your uterus can be pretty gnarly. In general, I am very glad that IUDs exist. The side effects of today’s IUDs are minimal when compared to the ones in the 60s and 70s, but that doesn’t mean that they are the magic bullet of contraception (see a recent post by Laura Wershler expressing some overlapping views). For me and many other women, the Fertility Awareness Method is a wonderful contraceptive. I want more women to hear about it so it can be brought to light as a serious contender for mainstream contraceptive use.
Katie, there is no doubt that personal stories about experiences with various kinds of birth control are a powerful way to demonstrate that not all women’s contraceptive needs are being met with drug- or devised-based birth control. Your story does this so effectively.
In my previous post (thanks for the link in this post), I urged sexual and reproductive health-care providers to be as diligent about meeting the needs of women who don’t want to or can’t use the pill, patch, ring, Mirena, Implanon, copper IUD, etc, etc, as they are about urging women to use all of these methods effectively.
Before this can happen the sexual and reproductive health community to which I belong has to acknowledge that a dichotomy now exists within the pro-choice approach to birth control. I state “pro-choice” emphatically to differentiate my views from those of the anti-abortion,anti-contraceptive lobby.
A dichotomy is a division of a whole into two mutually exclusive, opposed, or contradictory groups. In this case the whole is “contraception” and the two mutually exclusive groups are: 1) those who are happy with drug- and devise-based contraception and 2) those who are not. (There is probably some overlap between these two groups as I imagine that many women in Group 1 would love to know more about Group 2.) Unfortunately, Group 1 gets all the support and attention from mainstream contraceptive advocates, researchers and care-providers, while it seems Group 2 is considered less than worthy of serious attention. (I won’t even go into the health consequences for both groups – nuisance, quality of life or serious side effects for women in Group 1, positive impacts on bone, breast and heart health, fertility, libido and muscle strength for women in Group 2 who reap the benefits of ovulatory cycles.)
I believe that sexual and reproductive health-care advocates and providers can and must find a way to do their work effectively within this dichotomy. We must acknowledge the right of women to choose the half of the contraceptive spectrum where they feel their health and birth control needs are best met. And it’s our obligation to do our best to help them succeed with whichever choices they make.
Katie, your story suggests you found FAM on your own, without assistance from your doctor. Is this accurate? And if so, how did you feel about it? Angry? Confused? Annoyed? Overjoyed?
I recently spoke with a young woman in her 20s who did not want to be on hormonal birth control. She had been using condoms, had an abortion and decided to go to Planned Parenthood to get a copper IUD. Both times she has gone she has been confronted with a representative who has tried their hardest to give her the Mirena or another hormonal method. She was told that the IUD would give her heavier periods (bonus points for accuracy perhaps) and probably be expelled by her uterus within a few weeks. She told me she was “scared” when she left and felt like she had no options. The woman had a lot of information about hbc to hand and told the rep her reasoning for not choosing hbc – in response she was just asked repeatedly “where did you hear that?” She was sent away with nothing because she wouldn’t comply with their agenda. She said I was the only person she had told and she didn’t want to discuss it with her self-described feminist friends because they were advocates for Planned Parenthood. She felt she couldn’t criticize the organization. She also felt she was the only one. When I started explaining to her that many women were in the same boat she realized that her intuitive thoughts and feelings about hbc were validated.
Sharing stories is massively important. So is being angry. Too many women blame themselves, their bodies or their lack of research. They don’t talk to their friends because they think they’re experience has no relevance to anyone else. They feel they must respect their friends’ choices.
I have a feeling however that the reluctance to support FAM as a serious contender isn’t just down to lack of education or branding problems. I’m afraid I don’t believe that knowledge has been forgotten, but suppressed.
Group 2 is not given attention because they aren’t compliant. Stories pop up every now and then (I was one of them) in national newspapers about the negative impact of hbc but they are always dismissed with – this is rare, this is unusual, this is just some nutso woman blaming hbc for her problems. Acknowledgment of widespread issues with these drugs and devices opens up a big old can of worms. In Elaine Tyler May’s book on the pill she quotes a pill-taker as saying something along the lines of “The pill is like the telephone in that I can’t imagine modern society without it.”
Can’t imagine modern society without it. What would society look like with a majority of women using natural birth control? Is it still this society?
That is a distressing story about a Planned Parenthood clinic that needs to be more widely publicized. This illustrates exactly what I’ve been talking about for over two decades, but it seems to be getting worse with the latest PR overload about LARCs. That someone would be discouraged from trying a copper IUD is doubly disconcerting. This is not choice, to be told that only HBC will serve your needs and to basically be abandoned by sexual and reproductive health-care providers (SRHCPs) if you don’t comply.
I agree that it is time for anger and push-back against this failure to acknowledge and serve Group 2. And I also agree that fertility awareness knowledge is being withheld and suppressed, sometimes out of unacceptable ignorance, sometimes out of deep belief on the part of SRHCPs that they know better what is right for the women they are supposed to be serving. Whatever happened to self-determination? Isn’t this a cornerstone of feminism?
Like in that Monty Python Life of Brian scene – We’re all individuals!
We are self-determining – we get to choose between different brands of pill, the Ring, the patch, the implant, the Mirena or the injection. Tons of choice for us self-determining consumers.
Laura,
I completely agree! The focus on hormonal and device based contraception, while a wonderful choice for some, leaves those of us who do not want to or can’t use them feeling lost and alone, not to mention without effective contraception!
I was introduced to FAM by a roommate of mine. I was telling her about my irregular cycles, and she said that her sister had figured out her own fertility issue, and was able to have children, after doctors told her that she would not. She said that her sister had read Taking Charge of Your Fertility, started charting her cycles, found out the cause of her “infertility”, got it treated, and then had a baby. I was amazed that this was possible, and wanted to learn more. When I read TCOYF I was felt all the emotions you mentioned! At first I was skeptical: If something is this effective, and legit, why do more people not know about it? Then I was curious: So, what is this based on? Actual science? Why yes! This looks like it might actually work! Then I was excited: Oh my god! This might be the solution I’ve been looking for my whole life! Then I was frustrated: Why don’t more people talk about this, and why are there not good tools for charting!?!
Holly,
You should see the look on the faces of the nurses at Planned Parenthood when I go in for my yearly exam. The last time I was asked “What are you currently using as contraception?” and I said “The Fertility Awareness Method” I thought the poor woman was going to pass out. Her face went pale, and she looked at me like she’d seen a ghost. Then I explained that “I actually know how to use this method. I’ve been using it for years and I’ve never had a pregnancy scare. In fact my husband and I started a company to promote this method and make it easier for women to learn about and practice.” Then she started breathing again, and was very interested actually. She said that she thinks FAM is great, but that so few people know how to do it correctly that it makes her nervous whenever anyone says that that’s what they use to prevent pregnancy.
I love Planned Parenthood. I think they provide a very important resource for women’s health, and contraceptive options, but I do agree that they need to have more non-hormonal and non-device options.
I think their heart is in the right place, though it it was quite an ordeal for me to get my Paraguard taken out after only a few months of having it in. I HATED the thing but the nurse who was supposed to take it out tried to talk me out of it for a good 20 minutes. Finally I was like “Why do you want me to keep this item in my uterus so badly?” And she said, “I just don’t want to see you get rid of your very effective birth control.” Bless her, that’s sweet, but still, she didn’t have to live with the dang thing making her bleed like gangbusters and double over in cramps….
I think that’s very generous of you. I don’t think it’s anyone’s place to try to talk a woman out of having a device removed that is not essential in keeping her alive and is causing her suffering unnecessarily.
How many women would have not had the confidence to sit through that talk and still hold on to their decision? How many would just go home and suffer in silence? This is what happens with the pill all the time.
There are too many women who go through myriad side effects for months, years because they are convinced to just stay on the method for a while longer, or because they’re told their problems can’t be side effects or they’re told they have no other viable option.
Laura,
I agree that it’s time for pushback, but my perspective is a little different. I think that Planned Parenthood is a wonderful organization, trying to bail out a leaky boat. Many women simply have “to not get pregnant” as their goal, side effects be damned. Body literacy is not as popular now as (I hope) it will be in the future. If more women knew about the Fertility Awareness Method, and knew how their fertility actually worked there would be much less need for LARCs and hormonal contraceptives. But as it is, my view on Planned Parenthood is that they are trying to provide effective contraception as fast as they can, to as many women as possible. And while FAM is very effective, it’s not all that fast to explain to a woman how to practice the method correctly.
The fact is that women are not taught about FAM, or how their bodies really work, it’s not an openly discussed area of women’s health. So the level of knowledge around fertility is generally very low. I think Planned Parenthood is trying to help women prevent unwanted pregnancy, period. To me that’s what they have always represented, if you go into Planned Parenthood, the people in there are going to help you not get pregnant. And that is a big enough task on its own, and a very important one.
When I was 19 and having sex for the first time, I was happy that I was on the pill. As I grew older, I outgrew the pill, it no longer seemed like the best option for me, so I started looking for other methods. Finding out about FAM was life changing for me, and now you couldn’t pay me to go back on the pill. I guess what I’m trying to say is that I think Planned Parenthood is doing its job, helping women avoid unwanted pregnancy. The uptake of FAM depends on society at large embracing the knowledge of how a woman’s body works, and how to chart fertility to get the result you’re after. Doctors MUST be taught this method correctly and completely in med school. Teenagers MUST be taught this as part of sex education classes in middle and high school. Without that, we are fighting an uphill battle.
It’s simply unacceptable for our society to keep existing in this manner, where hormonal and device based contraception are seen as essential for pregnancy prevention. I think that they certainly have a place, but that overall they are too heavily relied upon. Sure Planned Parenthood could be better about suggesting FAM to women, but then who would support them in the correct use and practice of it? Do the people who work at PP even know how to practice, let alone teach FAM correctly? Who is responsible for teaching the sexual and reproductive health-care providers?
I know what you mean. But I feel that blaming Planned Parenthood for the state of reproductive health care knowledge in this country is counterproductive. Planned Parenthood is doing the best they can, fighting an uphill battle of their own. And at the end of the day it IS every woman’s responsibility to make her own choices. No health care provider can force you to do, or not do, anything.
I think the Pill has been hugely important to society at large. Without the invention of the Pill, I doubt that women of my generation would have “I don’t have to get pregnant if I don’t want to” as a forgone conclusion. But because we do “know” that, it gives us the opportunity to explore other options, aside from the pill. Despite the fact that the Fertility Awareness Method is quite low-tech, to me it seems like the modern alternative to the pill, for women who are interested their bodies, and preventing or achieving pregnancy on their own terms.
I really do think that FAM’s popularity is increasing, and will continue to do so as women understand that not only is a life free of unwanted pregnancy possible, it’s possible without any side effects, and with many added benefits. Who wouldn’t want that?
Katie, you make the point for me:
“Sure Planned Parenthood could be better about suggesting FAM to women, but then who would support them in the correct use and practice of it? Do the people who work at PP even know how to practice, let alone teach FAM correctly? Who is responsible for teaching the sexual and reproductive health-care providers?”
The point is that all mainstream sexual and reproductive health-care providers, PP clinics included, ARE RESPONSIBLE THEMSELVES for offering the full range of contraceptive choices, and for figuring out how to provide information and services to women who want to use barrier and FA methods of birth control effectively and confidently. They should have programs that either provide certified FAM training in their clinics or provide referrals to certified, secular-based instructors without prejudice. That’s it! What they must stop doing is discouraging any woman from choosing any method that she thinks is right for her, whether it be a copper IUD, a diaphragm or FAM.
Yes, this is “slow” birth control that takes time and resources. But failing to meet the needs of women who want to use alternatives – women who are discouraged from making these alternative choices and, in some cases, shamed for being irresponsible and non-compliant – is contributing to the unplanned pregnancy rate. When reproductive health-care providers urge women to reject these methods, send the clear message that they are not effective (ie the shocked look on the face of the nurse you saw) and refuse to acknowledge that these methods are right for some women, they are rejecting the pro-choice, feminist value of self-determination. This is not okay.
Look, nobody is a bigger Planned Parenthood supporter than I am. I have been involved with PP affiliated organizations at the local, provincial and national level in Canada for over 25 years. I’ve represented Canada at several international PP meetings. I agree that the pressure PP is under in the U.S. is brutal. Threats and efforts to defund PP clinics that serve the reproductive and general health needs of millions of women are abhorrent. And the fight to ensure that women will be able to have their contraceptive prescriptions covered by their health insurance is a vitally important one. (Why aren’t they pushing to have FAM instruction covered, too?) But fighting the onslaught of anti-choice and anti-contraceptive opinion does not justify leaving women who don’t want to use hormonal birth control – in any of its forms, from pill to LARC – out in the cold. And that’s pretty much where they are.
Hi Laura,
For some reason the site is not letting me comment on your latest post directly, so I’ll respond here.
I think we are pretty much on the same page here, we both would like Planned Parenthood to have more non-hormonal, non-device options for women.
I think one thing that has our perspectives be a little different on this topic is the countries we live in. Living in the US, I see Planned Parenthood having to fight to stay alive, and I just want this wonderful organization to keep existing. It would be nice if they were more FAM friendly, but I’d prefer that they just continue to be able to provide care and contraception to women, period. FAM can come later. Planned Parenthood is a non-profit organization, as you know, and I hate to see people who are proponents of their work come down on them for not being perfect. I think the solution to the problem lies in getting FAM taught in high schools and med schools.
Guess we’ll have to agree to disagree. If mainstream sexual and reproductive health educators and care providers don’t take the initiative in acknowledging FAM as a viable birth control option, and provide women access to information support to use FAM, you can be sure it won’t get any attention from schools and medical schools. Who do you think put sexual and reproductive health on the agenda in the first place? In both Canada and the U.S.? Grassroots, non-profit organizations have always taken the lead in the area of sexual health and still do, shifting from contraception to broader sexuality issues related to abortion, STIs, sexual identity, youth sexuality and gender issues.
I find it hard to understand why you think that encouraging inclusion of secular-based FAM information within the sexual health clinic realm, PP included, is without merit. I’ve been doing it diplomatically and assertively for decades, and have found my colleagues in Canada to be quite open to the idea. Certainly the logistics of paying much more than lip service to FAM are challenging, but progress has been made.
Much of the difficulty, especially in the U.S., is caused by historic tensions between the religious-based natural family planning groups, who are anti-choice, and pro-choice SRH groups. Facilitating a better understanding of the various methods of natural birth control and the differences between religious-based and secular-based approaches, is an important step in garnering support from SRH groups. As is continuing to point out that if we are pro-choice, then all choices have to be made available.
You may see no value in trying to do this, but I believe that my credibility as a veteran PP-affiliated sexual and reproductive advocate compels me to work within, not without, the community I’ve been a part of for 26 years.
Hi Laura,
I don’t know where you got the idea that I think “encouraging inclusion of secular-based FAM information within the sexual health clinic realm, PP included, is without merit.” I very clearly stated the opposite.
Yes, by all means, PLEASE DO work within the Planned Parenthood community to encourage the adoption of FAM as a viable form of contraception. I am in no way saying you shouldn’t or that the idea is without merit. It just seemed, from my perpective, not knowing your extensive history with Planned Parenthood, that you were complaining about them, an organization I love dearly. I’m sorry for my ignorance. You have clearly been a part of this larger conversation long before I set foot on the scene.
I don’t think it’s a matter of agreeing to disagree, you may think that my idea has no merit, but we both agree that yours does. 🙂 I think the more angles we approach this from the better. Any efforts to bring FAM forward as a viable option for more women are A-OK in my book.
Yes, I think we both agree the more opportunities for this information to be made available to girls and women the better. And this post definitely generated lots of interesting discussion!
Hi Laura,
Agreed! 🙂 Thanks for engaging. It’s fun talking to you.