December 19, 2016 • 60 mins
IUDs and implants are among the most effective contraceptive options, but their popularity in the US is only now spiking. Cristen and Caroline explain the different types and explore how stigma and sterilization fears have slowed their spread.
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Episode Transcript
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Speaker 1 (00:03):
Welcome to stuff Mom Never told You from how stupp
works dot com. Hello, and welcome to the podcast. I'm
Kristen and I'm Caroline. And today we're talking about larking.
Lark Yes, not to be confused with lark ing. Um,
(00:25):
let's go larking. We're talking about long acting reversible contraception
ing to make larking work, right right right? Yeah? And
you and I have been historically evangelists for our larks.
Our I U D s are intrauterine devices, which I
so often accidentally call either I E D S or
(00:48):
U T I S, both of which get a look. Uh. Dude.
Roommate when his girlfriend was getting an I U D
texted me to say that she was getting an EYE
E D and I laughed, and I laughed and I said,
I think you mean I U D And he said,
I think you're wrong. I think she's getting an I
E D. I really hope not. It's not going to
(01:11):
go well. If it is uh intermittent explosive device they
stand for. You could argue that it would prevent pregnancy.
That that is true, that that's one way to go
about it. Um, But I D s are not the
only thing we're going to talk about in the first
half of the podcast. Because i u d s are
(01:32):
not the only form of a long acting, reversible contraception,
we've also got to talk about the implant uh and
io d s and birth control implants are considered really
the guild standard of birth control. And this is according
to both the American College of Obstetricians and Gynecologists as
(01:54):
well as the American Academy of Pediatrics. So doctor people,
doctor people in the know, doctor people in the note
for human people's of all ages, right exactly. And it
turns out, according to these doctor people in the know,
that both i u d s and implants are just
as effective as sterilization. But of course they are reversible
(02:19):
and not invasive. I mean, one could argue that it
does hurt to get an i u D sometimes depending um,
but they're recommended as first line contraceptives. And since two
thousand two, i u D use among American women has quadrupled,
and anecdotally I've noticed in the past maybe two or
(02:44):
so years, UM, similar to the mainstreaming of menstruation, kind
of the mainstreaming of i u d s, everybody's talking
about i u d s mainstreaming of menstruation. Is that
what everybody on Twitter is talking about when they do
hashtag M S M Don't I wish? Don't we wish? Uh? Yeah,
(03:06):
it turns out that ten to of US women who
are on birth control use i U d s, which
is up massively from just about one and a half
percent in two thousand two. And it is worth noting
side note that of gynecologists who use contraceptives use i
U d s. According to Vox and over at the
(03:29):
Gootmaker Institute, we learned that, uh, just one point three
percent of American women who use birth control use the implant.
So how do these magical devices and contraceptive potions work? Well, Okay,
you go out during a supermoon and you you howl
(03:52):
uh into the phone to your gynecologist and make an appointment,
uh to get one of these devices which work extremely well. Um. Now,
a lot of people say, oh, surely they're not that
different in their effectiveness from the pill. But you've got
to keep in mind that we are all imperfect people.
And when we use the pill or the new ver
(04:15):
ring or the patch with typical use as opposed to
perfect use, Uh, those three things have a nine percent
failure right right, and the birth control shot has a
six percent failure rate. In other words, that's how many
people will still get pregnant despite using those methods. So
with that in mind, let's hop into how i U
(04:37):
D s work. So there are two main types of
i U D s. First up, we've got the original,
the old copper i U D brand named Paraguard. It
can last for up to twelve years. Twelve years, and
this to me is the one that does seem like
magic because there are no hormones involved. They just in
(05:00):
certain this t shaped little piece of copper into your uterus.
But what happens is it essentially bathes our uterine linings
in copper ions that create and I'm not exaggerating here,
it really creates a sperm killing force field. Um, although
(05:22):
you can't expect heavier periods, But in exchange for that
that force field creates just a point eight percent failure rate.
I am hoping that it also has like that movie
magic sound effect when you have like some kind of
force field of wom are those the sperm running into
(05:43):
the force field, Yeah for sure and bumping their little
heads and being like never mind, guys, let's get out
of here. This also reminds me of those uh you
know those metal bracelets that people wear that are sold
like in the back of magazines. Yeah, but those don't
do anything. I don't think that those create sperm force field.
So a pareguard copper i u D can last you
(06:03):
three presidential terms. I don't know why I would say
anything like that, but I'm just saying three presidential terms,
yeah to Trump and one Pence. Dear God, I think
my uterus just actually withered up and uh and died.
Next up, we have the hormonal i u d s,
(06:23):
same type of device, T shaped, T shaped, little little
piece of plastic that goes into your uterus. Brand names
include the Marina, which I have so do I. It
lasts five years. There's also on the market now sky Law,
which last three years. And I just learned there are
(06:45):
two others called the Liletta and Kylina. Yeah, and y'all,
Kylina is spelled k y l e e n A.
And I'm just saying that Kylie Jenner is really missing
a branding opportunity here. Um. So, with these hormonal i
u d s, they use a hormonal called lavana. Gestule
(07:08):
that thickens your cervical mucus, which is really the first
offense as sperm travel through the cervix on their way
to the uterus, so they're like, okay, let's try they
get things up, slow it down. And on top of that,
it thins out the uterine lining, which makes it super
hard for the sperm to travel to and uh, should
(07:31):
fertilization happened for implanting too, then uh two then happen.
And with those, unlike the copper I U D, you
can expect lighter or in my case t M I
alert no periods. Yeah. I have actually had both of these,
so I can speak to both of them. I started
out with the Skyla. I was instructed or advised to
(07:52):
get the Skyla because I uh am teensy tiny inside
and also have never given birth, and my gynecologist was like,
the smaller one might be better for you. Uh. So
I had that for three years and I still got
a monthly period, but it was very very light, very light. Uh.
Now that I have the Marina, I no longer get
(08:14):
a monthly period, which is awesome. I still do get
PMS symptoms, my boobs get real big and sore. Uh
hashtag humble brag that's right. But yeah, but no period,
It's awesome. And what's fabulous is you can really depend
on these products. Uh. The Marina has a failure rate
of just point two percent and the Skyla failure rate
(08:38):
is just point four percent. Now, let's quickly, though, take
a myth busting detour to clear up a little bit
of misinformation actually a lot of bit of misinformation that's
out there about i u d s. Because this is
something anecdotally that I've run into in conversations with more
conservative friends of mine in particular, and that I have
(08:59):
a feeling a lot of listeners might have seen or
heard or might just be worried about. Uh. I u
d s are not aborti factions, um and and this
was something that came up in that hobby Lobby birth
control h case that went to the Supreme Court. Uh.
I u d s were one of the things that
the hobby Lot Hobby Lobby founders did not want to
(09:23):
cover because of the misinformation the fallacy that i u
d s are essentially little little abortion machines inside of us. Yeah,
let's get something straight real quick. So pregnancy is when
a fertilized egg is implanted, right, But contraceptives prevent fertilization
(09:48):
of an egg from happening, or they prevent the implantation
of a fertilized egg, which therefore prevents pregnancy. And it
turns out, and we talked about this on a long
ago EPI sode, the copper i u d s are
actually a fabulous emergency contraceptive even when used up to
five days after intercourse. Those copper i u d s
(10:10):
can prevent fertilization and possibly implantation, but they do not
disrupt implantation. Therefore, there is a difference there. There is
a line between preventing a pregnancy and disrupting a pregnancy. So,
like Kristen said, the idea that an i U D,
whether it's hormonal or copper, can lead to abortion is
(10:35):
again a complete fallacy. Yeah, and this information too is
coming from the American College of Obstetricians and Gynecologists. Were
not just We're not just reciting n SNBC headlines here,
folks hashtag ms and I don't know, I'm trying to
do a call back. Uh, So that's the situation with
(10:55):
i U d s. We also got to shout out
the implants. The brand names are implant On and next
plan On, and implants are really what they sound like.
They are thin, plastic match sticks sized progestin dispensers essentially,
(11:15):
uh and progestine is a synthetic form of the hormone progesterone,
and these little match sticks are implanted in your upper arm.
They last up to four years, and they work by
stopping ovulation and again thinning that cervical mucus. Yeah, and
so when you use an implant, you can expect spotting
(11:37):
in the first six months or a year, um, but
one out of three women who have the implants stop
having a period altogether. And you know, as we've gone along,
the failure rate has dropped and dropped and dropped to
the point where now if you get an implant, the
failure rate is just point oh five cent, which is fantastic. Yeah.
(11:58):
I mean, it was a while back, and I forget
what exactly it was about I U d s that
you and I were raving about, as we do on
social media, and there were a few people who helpfully
piped up saying, hey, hey, I E d s are
actually not the most effective, because in fact, it's implants um,
(12:18):
which I'm even after all the research we've done for
this episode, I've walked away still not quite clear on
why implants are as rare as they still are today.
Um So if anyone has any intel on that, please
give us a shout. And all of this might sound
too good to be true, right, I mean we're just
(12:41):
putting these like little match dicks and little T shaped
what's not inside our bodies and our youths are on lockdown? Yeah,
I mean, yeah, that is that is the delightful truth. Yeah,
it's really not too good to be true, which warms
my freaking heart because so often, I like, we talk
about things that are But um, we're gonna cite some
(13:04):
research coming out of Colorado that would be fabulous to
send to people in your family who perhaps might have
quibbles with either birth control itself for contraception um and
providing it to teens, or the issue of having birth
control and contraceptives paid for. And we're gonna have all
of these sources over at stuff I never told you
(13:26):
dot com on our source post for this episode, so
you can, you know, send those links onto your family.
So what happened in Colorado is a number of years back,
they received a substantial private grant to fund a program
which they launched offering low income teens and young women
(13:48):
free i u d s. And what happened is that
due to this program, between two thousand nine and Colorado's
teen pregnancy rate dropped forty percent. And also this is
important to underline for conservative family members as well and
(14:11):
people who are opposed to abortion in general. In addition
to the teen pregnancy rate dropping literally plummeting, the abortion
rate also dropped forty two And in addition to that,
people who are not too keen on taxpayer dollars going
(14:32):
to subsidize single motherhood, food stamp enrollment also dropped by
around between two thousand and ten and uh, and that's
just looking at the teen pregnancy rate. Pretty much the
same thing happened for single women under twenty five who
hadn't completed high school who also qualified for this free
(14:55):
i u D program. Um and money wise, do you
understand the impact back onto taxpayers? Each dollar a state
health department spends on long acting birth control i u
d s or implants translates to five dollars and eighty
(15:17):
five cents of Medicaid savings and Medicaid covers seventy of
team births. And these are a lot of percentages and
numbers that I've all tossed out, UM, but t L
d R. These i U D s literally changed these
young women's lives because the highest team pregnancy rates were
(15:38):
in the lowest income communities, as is often the case,
not just in Colorado but across the United States. And
the New York Times talked to one woman in particular,
UM who I believe she was one of the women
who was under twenty five and hadn't completed high school,
and she talked about how do to be able to
(16:00):
set and forget this contraception. It allowed her to really
set up the life that she wanted for herself, you know,
coming out of very disenfranchise circumstances. So Colorado has been
a standout example, UM of the power of these long acting,
(16:23):
reversible contraceptives. Because by the way, that drop in team
pregnancy rate is far and away faster than any other
states drop in teen pregnancies sounds great. I mean, how
could anyone not support this because people get squeamish when
it comes to young women and the government subsidizing birth control. UM.
(16:52):
Republicans often aren't fans of it. So yeah, and so
this is according to an article about this from Colorado
and PR station. Uh. Despite the success of this program,
when that private grant money began to run out, the
state's GOP ended up blocking a bill to pay for
the program with tax money. But they were able to
(17:16):
push through two point five million dollars in the state
budget for it. Yeah. And I'm just curious to know
from the foundation that delivered that first substantial grant that
got the program off the ground, if it's possible that
this can happen in other places. Um. But again, this
(17:37):
is just a real world example of how these things
can really work and not just work for you know,
college educated, employed, middle class white ladies like you and me, Caroline. Um,
but y'all, it's not all candy and roses. I don't
don't actually know that any of it is candy and roses,
(17:58):
although you your I D doesn't get you roses, No,
just carnations. Um. But as a lot of people listening,
who are probably yelling at their phone or however they're
listening to this podcast right now, all is not perfect
when it comes to I U D s and implants
(18:19):
Because every body is different, and we're gonna get into
some of those not so fun facts when we come
right back from a quick break. Yeah, okay, so you
(18:41):
might imagine that when you are inserting something, inserting birth
control into your body, whether it is an iu D
into your uterus or an implant into your arm, it's
not the same as just popping a birth control pill
or wearing a patch. These things can hurt. Uh, But
we've got to get you the rundown right of what
(19:02):
happens when you're getting them. So when it comes to
an implant, Uh, you get an area on your upper
arm numbed, and then the insertion is basically like getting
a really big shot, she says, casually, pretending as though
she does not pass out when she gets shots. Um.
And the insertion, though, is generally faster and anecdotally a
(19:25):
little less painful than getting it removed, because getting it
removed involves an incision to remove it from underneath your skin. Now,
that's pretty straightforward. Uh. And it's not that I U
D insertion and removal is not straightforward. There's just several
more steps when it comes to an i U D. Yeah,
because instead of putting it in your arm. You gotta
get all the way up to your ute. So and yes,
(19:47):
you is my preferred term for uterus, because why not.
So the way that I U d s get inside
of us is unfortunately, it wouldn't be cool if we
could like swallow of them and they're just like, uh no,
I'm in your uterus. Nope, that's not how our bodies work.
So gynecologists, well, first you gotta go. You gotta get
(20:09):
in the stirrups. All right, So you're in the stirrups.
You're on a horse. You're on a horse. You gotta
find some stables. No, really, you're in the gynecologist room.
You're in your stirrups. And the gynecologist is going to
use something called a tenaculum clamp to straighten your cervical canal.
(20:30):
And they describe the discomfort with this as a pinch. Yeah,
Caroline is laughing because, um it, it's quite a pinch. Okay,
it's it's quite a pinch. Um think about think about
a pap smear. They're not comfortable. Now double or triple
a pap smear. You're getting close. So after they straighten
(20:53):
your cervical canal, they do something called sounding the uterus,
which is a term brand new now to Caroline and me,
and sounding the ute is our new battle cry. Imagine
me with a conk shell, but it's actually a uterus.
Whenever you want to gather nasty women everywhere if you
(21:15):
sound the ute. Actually sounding the uterus, though, is when
the doctor inserts a straw sized rod into the uterus
to measure its size and angle. And this is really
good because they got to figure out the right size
for the right sized i U D and the right
place to put it so it stays in place, etcetera, etcetera. Um.
(21:38):
So so that's how sounding the uterus works, not to
be confused with our battle cry of sounding the ute. Okay, well,
uh so then your doctor will remove the measuring rod
and pop in another rod that actually contains the iu D.
Christens making a face, girl, I know, Um it's because
of pop in. I think just just popping in. Hey, hey,
(22:00):
just popping in, just popping in with I'm Skyla or Kylina.
Can't talk right now? Okay, no, because I'm screaming. Um,
we're scaring people. We'll give you the low down here
in just a second. But so that that second rod
comes on up and it has the I U D
in it, and the DOC positions it in your cervix,
(22:23):
sticks it in there, and it's hanging out like the
kitten in the hanging their poster in in the bottom
of your uterus, right at your servis just but it
does not feel like claws or inside inside of you
do once it's in there, no, no, no, and and
it it does, it does hurt there. There is a
(22:45):
lucky minority, um, for whom this procedure feels like nothing
more than a pap smear followed by some minstrel cramps up.
My friend Samantha is one of those people. She uh
literally went running the same day, went back to work. Yeah, Christians,
make it a face, dude, I know. Um, Samantha has
(23:06):
always had incredibly severe menstrual cramps. She is used to
a higher degree of pain than that with which I
was accustomed, and so I warned her about the horrific
pain that I went through, and she proceeded to make
fun of me, probably for about the next year or so. Um.
For the middle group of people, Uh, it's a moderately painful, Yeah,
(23:29):
moderately painful process. That's most of us. For most people.
It's going to be moderately painful. For the rest of us,
including your friend Caroline Irvin. Here, it is severely painful. UM.
I I absolutely don't want to discourage anyone from getting
this procedure done. I think it's important to have really
effective birth control, and I U d s are incredibly effective,
(23:50):
as we have already laid out for you. UM. That
being said, I was not one of the lucky ones
who had low to moderate pain. I was one of
the ones who literally tasted color. UM. I developed apparently
circumstantial synesthesia during the procedure. It hurts so badly I
threw up. I almost passed out. I made the bad
mistake of taking no pain medicine, not even like a
(24:11):
tailean all um, and it it was. It was a nightmare.
But the thing is, like they give you the night
before you take UH medicine that dilates your cervix so
that your service is open so they can more easily
stick the I D in. Then ideally you will take
some type of pain medication and if you are highly,
(24:31):
highly anxious or scared, they might prescribe you like a
low dose of valium or something along those lines. UM.
I will say, and I think this is important to
say because I just told this to a friend and
colleague the other day, and this is what convinced her
after all this time of being afraid to go get
this procedure done. When I went to have my Skyla
(24:52):
removed so that I could get my marina, the removal
felt like nothing. I mean it did. It felt like
a p smear. It was uncomfortable, but not bad. In
the insertion of the marina was a little bit more
uncomfortable than a pap smear, but I wasn't I didn't
taste color. We'll just say that it was. It was
(25:13):
really fine. And I don't know if that's because my
cervix was like, oh, hey, you, we've seen your kind
here before um, or if maybe my child and all
was really kicking in that day, But I think it's
important to acknowledge that, yes, this can be a very
painful procedure. It is very helpful to have someone a partner,
a friend, a parent, someone go with you in case
(25:36):
you do need to be driven home. But I just
really want to hammer home that I don't want you
to avoid this procedure just because your pal Caroline throughout
the first time. Yeah. And and if you're nervous about
pain and have a low pain tolerance, just tell your
doctor and uh, they'll prescribe you something. And if anything,
(25:56):
definitely take the they're going to prescribe you. Probably regardless
like the horse pill, I'd be profen um. So just
take that. And even if you don't have someone who
can drive you, Uh, I survived both times driving myself,
so we can do it. Because also the great thing
is it is discomfort form. I mean the rest of
(26:17):
the day you're crampy. Um. But then you have birth
control for five years if you have the marina, which
is a presidential term plus a year, yes, which is good,
which is good to know. I think, uh my marina
right now. I'm on my second one and it should
last me right up through uh the end of Trump.
(26:38):
So happy for that. Um. We also don't need to
talk about possible side effects after you you get this
thing implanted, whether it's the i U D or the
implant um. And this info is coming from Planned Parenthood
Box and again the American College of Obstetricians and Kynecologists.
(27:00):
So typically with i U D s, the main side
effects you're gonna have are some unpredictable menstrual spotting and
bleeding at first. UM, I experienced this. I'll just leave
it at that. UM, you may also experience headaches, nausea, depression,
and breast tenderness. UH. Speaking to the depression aspects, I
(27:23):
u d s were implicated in a recent study that
went viral about birth control and female mental health, and
UH it was particularly like strongly correlated UM to women
getting iu d s and then UH later getting on antidepressants. Again,
there's some correlation causation issue there, but just something to
(27:47):
keep in mind if you struggle with mental health that
it's just something again to just talk to your doctor about. Right.
And again, personal experience. Obviously my experience is not everyone's.
But UM, I had been on the pill specifically yas
or yasmin for years, about a decade before I went
on an iu D and I never had never, never
(28:09):
had PMS with the pill, and I now on an
I E D, I do get PMS. And that's again
that's not going to be the same for everyone, but
I noticed that that was something that changed for me.
So things on an iu D versus the pill versus
no birth control whatsoever, they're not necessarily going to be
the same, and with implants, the major side effects sided
(28:30):
include change in sex drive. You might see a discoloring
or scarring of the skin over the implant site. You
may also experience headache, infections, or pain in the arm,
although that's very rare, UH, nausea, sore breasts, weight gain.
I mean, honestly, these are side effects that you see
with a lot of hormonal birth controls UM. And there
(28:53):
are some worst case scenarios though that I know, some
stuff Mom never told you listeners have experienced because you
all have told us about them, specifically i U D
expulsion and this is probably the most common uh scary
story that you hear when you're, you know, talking to
two friends about i u D s because for about
(29:15):
three to five percent of people who get them in
the first year, your uterus might be like, now, girl, Kylie,
go back to to Cabo. UM. You know they don't
live in Cabo Calabasas, scalabas Is. I know that, and
I'm ashamed of that, UM, but that's likely because the
(29:35):
gynecologists didn't insert it correctly. UM. If you're concerned about this, though,
watch out for cramping UM because that that might be
a sign that your your uterus is not happy, and
they're also in much rarer cases perforations that can happen um.
Your i U D can actually puncture your uterine wall,
(29:57):
which could potentially harm your bladder intestine and if left untreated,
might lead to hemorrhaging and sepsis. But that sounds awful,
It is awful, take heart, it is very very very rare. UM.
It is about point one percent expulsion rate chance with that,
and these are just more even more reason to make
(30:21):
sure that you stick to your follow up appointment. Usually
your gynecologist will request that you come in about a
month after the fact to just make sure that everything
is where he or she left it. Basically, that's how
my doctor put it. UM. Another worst case scenario involves
a slightly elevated risk of pelvic inflammatory disease in the
(30:43):
first twenty days after you get your i U D
inserted um and when it comes to implants, incorrect insertion
can cause discomfort and in effectiveness. And in the very
very very super rare case of pregnancy with one of
these long acting reversible contraceptives, you do have an elevated
(31:03):
risk of ectopic pregnancy. When I put the call out
on Twitter to let people know that we were going
to be talking about this and they were welcome to
send us their questions or concerns. We did have one
listener who said, yes, I was one of those people
who had to endure an ectopic pregnancy. Uh So the
risk is there, and again it is very small. Uh
(31:24):
Now in terms of who shouldn't get one of these,
especially for I U d S, people with untreated S
t I S, uh no, because insertion can promote pelvic infection. Also,
a good kind ecologist is probably going to make sure
that you're tested before going anywhere near insertion. Speaking of
(31:46):
pelvic infection, not surprisingly, if you have a recent history
with those not going to be a good idea. People
with untreated cervical or uterine cancers, and with the implants,
people with breast cancer are advised against getting them. And
speaking of S T I S, it is worth emphasizing
that even though uh it, these these wonderful things dramatically
(32:11):
reduce our chances of getting pregnant, they do nothing to
reduce your chance of contracting S T I. So you know,
don't throw away your condoms folks. And we should also
mention UH when it comes to having sex with I
U d s that UH at the bottom of these
little T shaped devices, there are some strings that hang down,
(32:32):
just a little tiny strings UM. And if your sexual partners,
like I think I can feel the string, that's probably okay.
It's it's not terribly surprising, especially for a digital penetration UM.
But you might also want to monitor your string because
if you can't feel them at all, because you can
(32:53):
actually UM yourself uh reach up and and probably feel them.
And if you can't feel them at all after the
first few months, you might just want to call your
doctor to see if you need to come in, just
to ensure that it hasn't been knocked out of place
or that it's been UM expelled. I've actually called my
doctor before UM because a partner way back when was
(33:17):
concerned about feeling the strings UM and it was fun.
It was really fine. You know, just always pick up
a call, pick up the call and phone your nurse practitioner. Perfect.
So now we know what these things are today and
how they work and how effective they are, it's time
(33:37):
to get into the more fascinating story of how they
came to be. And we're going to do that when
we come right back from a quick break and as
(33:58):
we get into uh this history of the i u
D specifically, we want to go ahead and give a
shout out to Chicaco Takashita, whose dissertation Negotiating Acceptability of
the i U D Contraceptive Technology, Women's Bodies and Reproductive
Politics UH is a major source. It's a very well
(34:19):
as you might imagine, it's very in depth dissertation. Does
not even need to be said, it's full of chucks.
It's chock full of great information. Good job, um. But
basically i u d s have been around for a
really long time. But as we kind of touched on
at the top of the podcast, American women are really
just now coming around to it. It's much more common
(34:41):
overseas in Europe than it is here, and a lot
of that has to do with some horror stories that
we have and some terrible things that we endured in
the nineteen seventies thanks to this thing called the Delcon shield. Um,
you also have issues in the way, hurdles like insurance
(35:03):
not covering this device, which can be four dollars or more,
and just general lack of awareness. I mean, I spoke
with some friends after I got my i U D
inserted who were still under the impression that i U
D s were as dangerous as the Delcon shield was
back mid century. And so we will get to that.
But let's take a trip down I U D memory
(35:25):
lane first. Yeah. So, uh, just important to note Europeans,
by no means the first folks to figure out that
that putting a physical barrier between your vaginal canal and
your uterus can prevent pregnancy. Since ancient civilization. We have
used pessaries, we have used cervical caps, we have used
(35:48):
all sorts of of things similar to i U D
s um with with a similar kind of strategy in
mind of really blocking the sperm from reaching damn eggs. Uh.
But in the late nineteen twenties, even though a doctor
in Japan ten rae Ota was doing the exact same
(36:10):
kind of research and development at the exact same time,
German Ernst Graffenberg, he of G spot fame. Yeah, I
always forget that, even though we talked about him extensively
in our claracy episode. Well Ernst. Uh So, doctor Ernst
is a doctor g cited as the inventor of the
modern i U D UM and his was a small
(36:32):
ring made of silkworm gut and coiled silver that was
inserted into the uterus. And the cultural climate in Germany
was perfect for Graffenburg to get his proto i U
D on the map because a sex reform movement was
(36:52):
afoot and he presented as a male doctor his device
as scientia fick hashtag credibility. But they weren't very effective,
uh and they cost a lot of infections. Um. Turns
out silkworm gut not perfect um. And once we get
(37:16):
into the nineteen sixties, uh, interest in i U D
s is reignited thanks to the Population Council, which had
been established in nineteen fifty two. Um, and they do
remain the number one developer of i U D and
Lark technology. They were actually initially looking for a pregnancy
(37:36):
vaccine and considered the pill too expensive and user dependent.
But there are layers there to that idea of it
being too user dependent. Yeah. So essentially, what's happening m
are mostly a lot of white dudes making a lot
of classes and racist assumptions about how poor women, especially
(37:59):
women of color, both in the United States and in
developing countries simply cannot be trusted with their own reproductive health.
So they are more fans of the set it and
forget it type of contraception. UM and I didn't do
much deep digging on the Population Council, but in general
(38:19):
they I mean, their name kind of says it all.
Really they are I want to say, an NGO still
around UM whose mission is population control, you know, and
especially focusing in on developing countries and low income areas. Uh.
(38:41):
This does start to intersect, especially around this time UM
with EU genesis philosophy UM and again just a lot
of classism and racism. But nonetheless they were the pioneers,
the scientific pioneers of the i u D. And in
nineteen sixty two they hosted the first Inner National Conference
(39:01):
on the i u D. But they had great swag
bags of this world. Gut, how do I get through? Well,
what's on the bottom. It's just cigars, because it's just
all it's all dudes. Really, I mean, like in this
paper at least, I only read about dudes doing this
scientific research. And that's like another little question mark in
(39:24):
my brain of you know, what what is what is
really what is really the intent? But anyway, we'll get
we'll get into the more feminist lens that people have
looked at this R and D through in just a second. Yeah,
but a question mark was one was not one of
(39:44):
the shapes of early i U d s, but there
were several others. Early i U d s were rings, bows, loops, coils.
All of these different shapes were patented. Uh. And you
even had this crazy straw looking thing. Uh, this loop
that became the go to. Yeah, the lip is loop
became the what they thought was going to be the
(40:07):
key to population control in developing nations in particular. And listeners,
imagine your head how the I U D today is
very small and it's t shaped. The lip is loop.
It's just this zig zag back and forth and back
and forth that looks It's really there to confuse the
(40:30):
sperm more than anything, I think, So it just looks.
It looks incredibly painful. Um. But uh and I'm so
glad that it is not the current design. In nine though,
Population Council affiliated Chilean scientist Jack Zipper, who has the
best name of this podcast so far, Jack the Zipper,
(40:53):
Jack the Zipper Hold. Jack the Zipper discovers the anti
fertility effects of copper. He was doing some research on
fertility in rabbits and realizes this, this copper is a
really effective contraceptive. Hello proto pareguard copper I U d W.
That's the force field again, the sperm force field. UM.
(41:17):
But when you hit the nineteen seventies and eighties, there's
a bit of a drop off, UM, because of the
nightmare that was the dell Con Shield disaster. So this
scary looking thing which can look like a cartoon I
with eyelashes. It can also look like a bacterium or
(41:38):
some kind of fishing lure, depending on which way you
hold it. UM. It was used by nearly three million women,
and not only did it sometimes fail to prevent pregnancy,
but it injured about two hundred thousand women. It caused
in fertility, and fifteen women died fifteen women eyed in
(42:00):
the process of miscarriage because of this Dalkon shield. And
the thing is I had known about the dal Con
shield by name for years, but researching for this episode
was the first time I actually saw it. And seeing
is believing, y'all google dal Con shield d A L
K O N, because how it just it just looks
(42:24):
very It just looks very painful because there are these
little like protrusions off of it, and it just looks
like it would cut you up. Um. But surprisingly, it
wasn't this frightening looking evil eye design that caused all
the problems, but likelier the thread that served as just
(42:45):
bacterial infection canal um instigating all of these pelvic infections
that lead to so many problems as a result. Especially
in the eighties, as the company that released the dalco
On Shield was just flooded with lawsuits, insurance companies just
moonwalk away. They're like, nope, we are out of the
(43:07):
i U D game. But that's the US. Yeah. Um. Overseas,
same game was not happening. China, for instance, in nineteen
seventy nine establishes its one child policy, So basically the
propaganda and the policies that are being pushed were like, hey,
you've had one child, go with an i U D. Oh,
(43:29):
hey you've had to be sterilized. So that's that right, Um.
But there was you know, as all of this delco
On shield nightmare was happening in the US, UM, China
was definitely on the forefront of developing the i U D,
which in nineteen seventy nine when the program was kicked off.
(43:51):
They had gone to the Population Council and had been like, Hey,
what are y'all working on? We need something? Oh yeah,
this i U D thing. So it was fascinating see
how all of this globally is starting to weave together. UM.
Back to the United States. After a couple of years
where i u d s were nowhere to be found
(44:13):
in the US, the Pareguard the copper i U D
was made available to American uterus is once again UM
and in the nineties the Marina which Caroline and I
have was developed in Europe and became super popular quite quickly.
UM of French women on birth control today, for instance,
(44:33):
use i U D sent of Norwegian women on birth control,
use i U D s all of us To say
that I U D use in the US UM at
what ten eleven percent right now is still so much
lower than U USE abroad? Well yeah, and I mean
the FDA was watching for about a decade what was
(44:54):
happening in Europe, essentially making sure that there was not
going to be another del con Shield nightmare of death
and injury and unexpected pregnancy. And so I was actually
ignorant of that fact that the Marina and it's like
weren't even available until the new millennium. I kind of
(45:16):
just I had thought that they had been around for
and they have been around for longer, but I mean
available especially with insurance. Yeah, I mean, and and for
a while too. Even when they were made available again, um,
most doctors wouldn't allow women who had been pregnant before
to use them. Um. They were all sorts of concerns. Understandably,
(45:37):
you know, because fifteen women died hello, um, but there
were a lot of concerns around whether they were truly safe. Um.
And it turns out yes they are. Um. But interestingly,
as we learned from a Time magazine piece, when the
Marina was first marketed in the US, it was targeted
at moms, basically being like, we know, y'all don't have
(45:58):
time to take a pill every day. You're busy with
your kids. Well yeah, I mean, there is that side
of it of like, you don't have time to worry
about your birth control. But there's also the side of like,
we are specifically marketing to moms over single women. We
don't want to promote uh, this birth control to single
(46:19):
women and have people just willing nillly ditch condoms for instance,
or think that they can just have unproductive sex forever,
unproductive set unproductive sex. Yeah, as then not having kids sex.
But that's the case today, I mean, thankfully, like people
are people are all about I E. D S. And
I wonder if that is at all correlated to like
(46:41):
the growing population of female O, B G Y N s. Um.
Just just a thought. If anyone knows, let me know. Um.
So what's not to love about all of this technology? Well,
there are some feminist scholars who haven'tterpreted their development and use,
(47:02):
particularly as it relates to the Population Council and their
implementation in developing countries and promotion among poor women in particular,
as coercive and even violent. Yeah, we read a lot
in the dissertation about sort of this history of forcing
(47:24):
women to be either sterilized or to have some type
of contraceptive to limit expanding families. Whereas here in the
West we tend to view it as a way to
control our lives. Uh. In a lot of countries, regions
like Indonesia or India, UM, it's viewed more as almost
(47:46):
punishment as a way to control women well, China, hello.
I mean that's like state propaganda right there. I mean, um,
they refer to it as state imposed fertility control, where
it's not you know, white women like jumping up fists
in the air choosing our choice, but rather the government
(48:06):
choosing your choice for you. And again going back to
those you know, classist and racist elements of you know,
let us let us choose on your behalf this set
and forget it kind of thing, because you probably don't
have the wherewithal to do for yourself. Um. So, And
and this was an area, these these biopolitics, feminist biopolitics
(48:29):
or something that I hadn't read before. And um, I'm
curious to read more about also because a lot of
that information, um and that perspective was coming out more
in the late nineties early two thousands. And I'm curious
to know whether there is still a similar sentiment now
(48:50):
that i U D s are more common and more affordable,
um in in the US in particular, But there are
also still a lot of barriers to you, especially in
developing countries, even though it is recommended by the World
Health Organization, because increasing i U D use could be
(49:11):
a major boon to maternal health and of course managed
population control UM. Still, as of according to NPR, of
women in developing nations have unmet family planning needs right
and so many of them more than get pregnant UM
(49:31):
within two years of having the previous child, the important
aspect of that stat being and many do not want
to Many want to wait, and the World Health Organization
does urge people in general to wait UH to I guess,
let their bodies recover essentially, especially if you've had a
traumatic childbirth UM. But some of the hurdles that people
(49:54):
are up against are things like menstrual taboos and very
real aeralization fears because we do have this history globally
UM of forcing women, particularly women of color, to be sterilized.
And Jill Philipovic a couple of years ago wrote a
terrific in depth piece for Cosmopolitan about the situation of,
(50:19):
or the challenge really of getting i u D access
to women in rural India because they tend to opt
for the pill over the paraguard. When it comes to
uh i u D s being sent, you know through
nonprofits and NGOs, it's usually going to be the copper
iu D because it is much cheaper than the hormonal
(50:41):
version as you might imagine, UM. And in these areas
the pill has chosen because with the paraguard, remember that
one of the major side effects is heavier periods, and
if you are in a developing area, you might also
ally have entrenched me menstrual taboos. But also I mean,
(51:04):
if you're on your period because of it, you can't
do anything really, I mean, it like puts you out
of commission and they literally cannot afford to do that,
right exactly. And you've also got the issue of the
difficulty of insertion um even right after childbirth. And you know,
another benefit of course of the paaraguard is it can
(51:25):
remain in for so much longer. So there there isn't
the every three years or every five years. Even there's
that nice ten to twelve years stretch where you can
just I mean, you can just set it and forget it.
Not to sound globe, um, but there have there have
been developments. UM. There is this new easy to use
(51:45):
quote unquote i U D insert or developed by Population
Services International, which I feel like these names need to
be improved. Doesn't Population Services International sound like something out
of nineteen four I think they're related to the the
old school population council. Well, all right then, um, but
this new inserter could make i u D S more
(52:08):
accessible and on top of that lower the chances of
getting i u D related infections. Um, the expulsion rates
are still comparable to those in the US right now. Yeah,
and those easy to use inserters are super important in
those areas where you aren't going to have just you know,
a buffet of trained obstetricians and perfectly sterilized areas and
(52:32):
instruments to use. Um. And apparently the existing inserter that
tends to come with a marina or paraguard is really
flimsy and kind of hard to use if you don't
really know what you're doing. Yeah, it's not as long
as as would be ideal. And they mentioned I think
this was still from Philip iis article right. She she mentions, how, um,
(52:54):
right now in the study, when i u D s
are inserted with these these new inserters that have been developed, Um,
the doctors leave the strings long still after childbirth and
want you to come back like a week or two later.
But even that is still a barrier to overcome. Researchers
and developers still want to get it down to know
(53:16):
we just we do just set it and forget it,
and that we do insert it and you go back
to your life, You go back to your village or wherever,
and you don't have to worry about coming back to
find a healthcare provider to trim those i u D strings.
And most often that does happen uh right after childbirth.
You know, they come in to have the baby and UH,
(53:37):
like a lot of women choose to then get a
tubal ligation for instance, UM, you can then get an
IUD inserted. UM. But here in the US even there's
still some mistrust around i u D s of course
their horror stories UM because of you know, people we
might know or have heard about who have had to
deal with those very painful expulsion or even rare perforations. UM.
(54:03):
And since though the election of Trump and even more
troubling lye uh former Indiana Governor Mike Pence as Vice president,
i U D searches have skyrocketed, skyrocketed, my friends, I
am not that is not hyperbole. You can see it.
(54:24):
You can see it in the Google UM. Because people
are worried about the repeal of the Affordable Care Act
and the possible repeal of Roe v Wade and out
of pocket hormonal I U D s can run you
eight hundred dollars um. So, there have been a lot
of women ever since that happened, ever since November nine,
(54:47):
who have said get an I U D. Yeah. Well,
I mean I posted the question on Facebook of how
many of you out there are thinking about this, are
in line or on the phone with your doctor to
at your contraceptives of whatever kind taken care of? And
I mean the response was overwhelming from women of all
ages and background saying I'm on the phone with my doctor,
(55:10):
I'm calling I'm going to plan parenthood. One woman literally
responded from her doctor's waiting room saying that she was
getting it taken care of. Yeah, so, I mean this,
this conversation is more relevant than ever before. Um and
even though we were only able to offer just a
tiny snapshot of a more global perspective, uh, it does
(55:33):
go to show how again, reproductive rights are very intersectional
issue and affect different people and in such different ways,
in the same way as birth control does. Um So
perspectives that you can share insights, questions, send them to
(55:55):
us mom staff at how stuff works dot com. Is
our email address. You can we Doesn't Mom Stuff podcast.
You can directly tweet and follow me at Kristen Conger
and me Caroline Irvin at the Caroline Irv And we've
got a couple of messages to share with you right now. Well, actually,
(56:21):
to be honest, we just have one letter to read,
and it's from Allison. So Allison saw on social media
that Kristen and I were gearing up to do an
episode on i U D s and she, a fellow
I D evangelists, had to write in. She says, I'm
not a medical professional or i U D. Salesperson. However,
I am the owner of one set of lady parts,
(56:44):
my lady parts. Allison writes, when I started college, I
was prescribed the pill for a regular minsie since back
in my day you couldn't get it covered if it
was just for stopping babies. And to make a long
story short, the hormonal birth control really made me sick,
serious depression, weight gain, mood swings, oh and debilitating cramps.
(57:05):
One time, I remember handing my roommate my car keys
while I curled up on my floor after class, telling
her to just take the car where she needed to go.
I can't sit up. I took it four more years
because I don't know doctors are smarter than me. I
was not living my empowered truth. Eventually, I chewed hormonal
birth control altogether because my side effects were so bad.
(57:25):
But I met an Englishman in two thousand nine and
I needed to get birth control stats. After talking to
my amazing lady O B g y N, who sets
my heart alight, and doing a little research, I told
her I wanted to try the i u D even
though I am nella Paris. I wanted to try the
iu D for a variety of reasons, but most importantly,
I wanted something effective, easy to use, and easy to reverse.
(57:48):
Oh that and it was covered by my insurance. Only
my regular appointment copay would apply. This was before the
legislation for covering birth control was passed, so my d
her and I talked about it, and because I had
a bad reaction to hormonal birth control, she recommended doing
the peaguard the copper i D. We giggled when she
said that she liked that one because she likes to
(58:09):
imagine the heads of the sperm popping off when met
with the inhospitable uterine environment. The copper creates. Did I
mention she sets my heart a light because she does.
We talked about how it would work, that it would
be good for ten years, and if I wanted to
take it out, she could do that any time, just
come in. When I've told friends about the insertion process,
I've described it like sticking a straw in your huha
(58:31):
then shooting a dart into your uterus. But it didn't
really hurt. I did have cramping, and at ten to
regret that I only took four hundred milligrams of ivy
proof in the weirdest thing was I got dizzy uh
and the nurse brought me an apple juice box that
they kept there for the kids and let me lie
down for ten minutes. I advocated the i U D
to my best girlfriend. After she had two children fourteen
months apart her, she and her husband decided their family
(58:54):
was complete, at least for now. She wanted to know
about my experience, and she talked to her O B
G y N and decided Marino was for her. I
will pretty much talk to anyone about my I E
D if they ask, and have called out I U
D deniers for just being lying liars like those who
say it's an abortifacient. Anyway, Englishman and I got hitched
in and I have four more years of effective, safe
(59:17):
and fabulous birth control that I can decide at any
time to keep or take out having children. It's not
something we want to do maybe ever, And that is
cool with my PAA guard because she's just in their
chilling popping the heads off sperm. Thank you so much
for listening to my story time. I've listened to you
both for a few years and appreciate so much your
candor and the important topics you discuss. Please let me
(59:38):
know if you have any questions I can answer. And
Allison signs her letter unicorns and empowerment and what a
fabulous way to end a letter. Thank you so much, Allison,
and thanks to everyone who's written into us. Mom Stuff
at how stuff works dot com is our email address.
And speaking of email, y'all, in light of the post
(01:00:01):
election hot mess happening, I've started a little tiny letter,
A little tiny letter how redundant is that If you'd
like to check it out and subscribe, it's called the
Do Better Digest, and you can subscribe at tiny letter
dot com slash Kristen which is c R I S
(01:00:22):
T e N and Rolling, so all of our social
media as well as all of our blogs, videos, and
stuff mom Never Told You podcasts with our sources so
you can learn even more about birth control and reproductive rights.
Head on over to stuff Mom Never Told You dot
com for more on this and thousands of other topics.
(01:00:47):
Is it how stuff Works dot com
Welcome to stuff Mom Never told You from how stupp
works dot com. Hello, and welcome to the podcast. I'm
Kristen and I'm Caroline. And today we're talking about larking.
Lark Yes, not to be confused with lark ing. Um,
(00:25):
let's go larking. We're talking about long acting reversible contraception
ing to make larking work, right right right? Yeah? And
you and I have been historically evangelists for our larks.
Our I U D s are intrauterine devices, which I
so often accidentally call either I E D S or
(00:48):
U T I S, both of which get a look. Uh. Dude.
Roommate when his girlfriend was getting an I U D
texted me to say that she was getting an EYE
E D and I laughed, and I laughed and I said,
I think you mean I U D And he said,
I think you're wrong. I think she's getting an I
E D. I really hope not. It's not going to
(01:11):
go well. If it is uh intermittent explosive device they
stand for. You could argue that it would prevent pregnancy.
That that is true, that that's one way to go
about it. Um, But I D s are not the
only thing we're going to talk about in the first
half of the podcast. Because i u d s are
(01:32):
not the only form of a long acting, reversible contraception,
we've also got to talk about the implant uh and
io d s and birth control implants are considered really
the guild standard of birth control. And this is according
to both the American College of Obstetricians and Gynecologists as
(01:54):
well as the American Academy of Pediatrics. So doctor people,
doctor people in the know, doctor people in the note
for human people's of all ages, right exactly. And it
turns out, according to these doctor people in the know,
that both i u d s and implants are just
as effective as sterilization. But of course they are reversible
(02:19):
and not invasive. I mean, one could argue that it
does hurt to get an i u D sometimes depending um,
but they're recommended as first line contraceptives. And since two
thousand two, i u D use among American women has quadrupled,
and anecdotally I've noticed in the past maybe two or
(02:44):
so years, UM, similar to the mainstreaming of menstruation, kind
of the mainstreaming of i u d s, everybody's talking
about i u d s mainstreaming of menstruation. Is that
what everybody on Twitter is talking about when they do
hashtag M S M Don't I wish? Don't we wish? Uh? Yeah,
(03:06):
it turns out that ten to of US women who
are on birth control use i U d s, which
is up massively from just about one and a half
percent in two thousand two. And it is worth noting
side note that of gynecologists who use contraceptives use i
U d s. According to Vox and over at the
(03:29):
Gootmaker Institute, we learned that, uh, just one point three
percent of American women who use birth control use the implant.
So how do these magical devices and contraceptive potions work? Well, Okay,
you go out during a supermoon and you you howl
(03:52):
uh into the phone to your gynecologist and make an appointment,
uh to get one of these devices which work extremely well. Um. Now,
a lot of people say, oh, surely they're not that
different in their effectiveness from the pill. But you've got
to keep in mind that we are all imperfect people.
And when we use the pill or the new ver
(04:15):
ring or the patch with typical use as opposed to
perfect use, Uh, those three things have a nine percent
failure right right, and the birth control shot has a
six percent failure rate. In other words, that's how many
people will still get pregnant despite using those methods. So
with that in mind, let's hop into how i U
(04:37):
D s work. So there are two main types of
i U D s. First up, we've got the original,
the old copper i U D brand named Paraguard. It
can last for up to twelve years. Twelve years, and
this to me is the one that does seem like
magic because there are no hormones involved. They just in
(05:00):
certain this t shaped little piece of copper into your uterus.
But what happens is it essentially bathes our uterine linings
in copper ions that create and I'm not exaggerating here,
it really creates a sperm killing force field. Um, although
(05:22):
you can't expect heavier periods, But in exchange for that
that force field creates just a point eight percent failure rate.
I am hoping that it also has like that movie
magic sound effect when you have like some kind of
force field of wom are those the sperm running into
(05:43):
the force field, Yeah for sure and bumping their little
heads and being like never mind, guys, let's get out
of here. This also reminds me of those uh you
know those metal bracelets that people wear that are sold
like in the back of magazines. Yeah, but those don't
do anything. I don't think that those create sperm force field.
So a pareguard copper i u D can last you
(06:03):
three presidential terms. I don't know why I would say
anything like that, but I'm just saying three presidential terms,
yeah to Trump and one Pence. Dear God, I think
my uterus just actually withered up and uh and died.
Next up, we have the hormonal i u d s,
(06:23):
same type of device, T shaped, T shaped, little little
piece of plastic that goes into your uterus. Brand names
include the Marina, which I have so do I. It
lasts five years. There's also on the market now sky Law,
which last three years. And I just learned there are
(06:45):
two others called the Liletta and Kylina. Yeah, and y'all,
Kylina is spelled k y l e e n A.
And I'm just saying that Kylie Jenner is really missing
a branding opportunity here. Um. So, with these hormonal i
u d s, they use a hormonal called lavana. Gestule
(07:08):
that thickens your cervical mucus, which is really the first
offense as sperm travel through the cervix on their way
to the uterus, so they're like, okay, let's try they
get things up, slow it down. And on top of that,
it thins out the uterine lining, which makes it super
hard for the sperm to travel to and uh, should
(07:31):
fertilization happened for implanting too, then uh two then happen.
And with those, unlike the copper I U D, you
can expect lighter or in my case t M I
alert no periods. Yeah. I have actually had both of these,
so I can speak to both of them. I started
out with the Skyla. I was instructed or advised to
(07:52):
get the Skyla because I uh am teensy tiny inside
and also have never given birth, and my gynecologist was like,
the smaller one might be better for you. Uh. So
I had that for three years and I still got
a monthly period, but it was very very light, very light. Uh.
Now that I have the Marina, I no longer get
(08:14):
a monthly period, which is awesome. I still do get
PMS symptoms, my boobs get real big and sore. Uh
hashtag humble brag that's right. But yeah, but no period,
It's awesome. And what's fabulous is you can really depend
on these products. Uh. The Marina has a failure rate
of just point two percent and the Skyla failure rate
(08:38):
is just point four percent. Now, let's quickly, though, take
a myth busting detour to clear up a little bit
of misinformation actually a lot of bit of misinformation that's
out there about i u d s. Because this is
something anecdotally that I've run into in conversations with more
conservative friends of mine in particular, and that I have
(08:59):
a feeling a lot of listeners might have seen or
heard or might just be worried about. Uh. I u
d s are not aborti factions, um and and this
was something that came up in that hobby Lobby birth
control h case that went to the Supreme Court. Uh.
I u d s were one of the things that
the hobby Lot Hobby Lobby founders did not want to
(09:23):
cover because of the misinformation the fallacy that i u
d s are essentially little little abortion machines inside of us. Yeah,
let's get something straight real quick. So pregnancy is when
a fertilized egg is implanted, right, But contraceptives prevent fertilization
(09:48):
of an egg from happening, or they prevent the implantation
of a fertilized egg, which therefore prevents pregnancy. And it
turns out, and we talked about this on a long
ago EPI sode, the copper i u d s are
actually a fabulous emergency contraceptive even when used up to
five days after intercourse. Those copper i u d s
(10:10):
can prevent fertilization and possibly implantation, but they do not
disrupt implantation. Therefore, there is a difference there. There is
a line between preventing a pregnancy and disrupting a pregnancy. So,
like Kristen said, the idea that an i U D,
whether it's hormonal or copper, can lead to abortion is
(10:35):
again a complete fallacy. Yeah, and this information too is
coming from the American College of Obstetricians and Gynecologists. Were
not just We're not just reciting n SNBC headlines here,
folks hashtag ms and I don't know, I'm trying to
do a call back. Uh, So that's the situation with
(10:55):
i U d s. We also got to shout out
the implants. The brand names are implant On and next
plan On, and implants are really what they sound like.
They are thin, plastic match sticks sized progestin dispensers essentially,
(11:15):
uh and progestine is a synthetic form of the hormone progesterone,
and these little match sticks are implanted in your upper arm.
They last up to four years, and they work by
stopping ovulation and again thinning that cervical mucus. Yeah, and
so when you use an implant, you can expect spotting
(11:37):
in the first six months or a year, um, but
one out of three women who have the implants stop
having a period altogether. And you know, as we've gone along,
the failure rate has dropped and dropped and dropped to
the point where now if you get an implant, the
failure rate is just point oh five cent, which is fantastic. Yeah.
(11:58):
I mean, it was a while back, and I forget
what exactly it was about I U d s that
you and I were raving about, as we do on
social media, and there were a few people who helpfully
piped up saying, hey, hey, I E d s are
actually not the most effective, because in fact, it's implants um,
(12:18):
which I'm even after all the research we've done for
this episode, I've walked away still not quite clear on
why implants are as rare as they still are today.
Um So if anyone has any intel on that, please
give us a shout. And all of this might sound
too good to be true, right, I mean we're just
(12:41):
putting these like little match dicks and little T shaped
what's not inside our bodies and our youths are on lockdown? Yeah,
I mean, yeah, that is that is the delightful truth. Yeah,
it's really not too good to be true, which warms
my freaking heart because so often, I like, we talk
about things that are But um, we're gonna cite some
(13:04):
research coming out of Colorado that would be fabulous to
send to people in your family who perhaps might have
quibbles with either birth control itself for contraception um and
providing it to teens, or the issue of having birth
control and contraceptives paid for. And we're gonna have all
of these sources over at stuff I never told you
(13:26):
dot com on our source post for this episode, so
you can, you know, send those links onto your family.
So what happened in Colorado is a number of years back,
they received a substantial private grant to fund a program
which they launched offering low income teens and young women
(13:48):
free i u d s. And what happened is that
due to this program, between two thousand nine and Colorado's
teen pregnancy rate dropped forty percent. And also this is
important to underline for conservative family members as well and
(14:11):
people who are opposed to abortion in general. In addition
to the teen pregnancy rate dropping literally plummeting, the abortion
rate also dropped forty two And in addition to that,
people who are not too keen on taxpayer dollars going
(14:32):
to subsidize single motherhood, food stamp enrollment also dropped by
around between two thousand and ten and uh, and that's
just looking at the teen pregnancy rate. Pretty much the
same thing happened for single women under twenty five who
hadn't completed high school who also qualified for this free
(14:55):
i u D program. Um and money wise, do you
understand the impact back onto taxpayers? Each dollar a state
health department spends on long acting birth control i u
d s or implants translates to five dollars and eighty
(15:17):
five cents of Medicaid savings and Medicaid covers seventy of
team births. And these are a lot of percentages and
numbers that I've all tossed out, UM, but t L
d R. These i U D s literally changed these
young women's lives because the highest team pregnancy rates were
(15:38):
in the lowest income communities, as is often the case,
not just in Colorado but across the United States. And
the New York Times talked to one woman in particular,
UM who I believe she was one of the women
who was under twenty five and hadn't completed high school,
and she talked about how do to be able to
(16:00):
set and forget this contraception. It allowed her to really
set up the life that she wanted for herself, you know,
coming out of very disenfranchise circumstances. So Colorado has been
a standout example, UM of the power of these long acting,
(16:23):
reversible contraceptives. Because by the way, that drop in team
pregnancy rate is far and away faster than any other
states drop in teen pregnancies sounds great. I mean, how
could anyone not support this because people get squeamish when
it comes to young women and the government subsidizing birth control. UM.
(16:52):
Republicans often aren't fans of it. So yeah, and so
this is according to an article about this from Colorado
and PR station. Uh. Despite the success of this program,
when that private grant money began to run out, the
state's GOP ended up blocking a bill to pay for
the program with tax money. But they were able to
(17:16):
push through two point five million dollars in the state
budget for it. Yeah. And I'm just curious to know
from the foundation that delivered that first substantial grant that
got the program off the ground, if it's possible that
this can happen in other places. Um. But again, this
(17:37):
is just a real world example of how these things
can really work and not just work for you know,
college educated, employed, middle class white ladies like you and me, Caroline. Um,
but y'all, it's not all candy and roses. I don't
don't actually know that any of it is candy and roses,
(17:58):
although you your I D doesn't get you roses, No,
just carnations. Um. But as a lot of people listening,
who are probably yelling at their phone or however they're
listening to this podcast right now, all is not perfect
when it comes to I U D s and implants
(18:19):
Because every body is different, and we're gonna get into
some of those not so fun facts when we come
right back from a quick break. Yeah, okay, so you
(18:41):
might imagine that when you are inserting something, inserting birth
control into your body, whether it is an iu D
into your uterus or an implant into your arm, it's
not the same as just popping a birth control pill
or wearing a patch. These things can hurt. Uh, But
we've got to get you the rundown right of what
(19:02):
happens when you're getting them. So when it comes to
an implant, Uh, you get an area on your upper
arm numbed, and then the insertion is basically like getting
a really big shot, she says, casually, pretending as though
she does not pass out when she gets shots. Um.
And the insertion, though, is generally faster and anecdotally a
(19:25):
little less painful than getting it removed, because getting it
removed involves an incision to remove it from underneath your skin. Now,
that's pretty straightforward. Uh. And it's not that I U
D insertion and removal is not straightforward. There's just several
more steps when it comes to an i U D. Yeah,
because instead of putting it in your arm. You gotta
get all the way up to your ute. So and yes,
(19:47):
you is my preferred term for uterus, because why not.
So the way that I U d s get inside
of us is unfortunately, it wouldn't be cool if we
could like swallow of them and they're just like, uh no,
I'm in your uterus. Nope, that's not how our bodies work.
So gynecologists, well, first you gotta go. You gotta get
(20:09):
in the stirrups. All right, So you're in the stirrups.
You're on a horse. You're on a horse. You gotta
find some stables. No, really, you're in the gynecologist room.
You're in your stirrups. And the gynecologist is going to
use something called a tenaculum clamp to straighten your cervical canal.
(20:30):
And they describe the discomfort with this as a pinch. Yeah,
Caroline is laughing because, um it, it's quite a pinch. Okay,
it's it's quite a pinch. Um think about think about
a pap smear. They're not comfortable. Now double or triple
a pap smear. You're getting close. So after they straighten
(20:53):
your cervical canal, they do something called sounding the uterus,
which is a term brand new now to Caroline and me,
and sounding the ute is our new battle cry. Imagine
me with a conk shell, but it's actually a uterus.
Whenever you want to gather nasty women everywhere if you
(21:15):
sound the ute. Actually sounding the uterus, though, is when
the doctor inserts a straw sized rod into the uterus
to measure its size and angle. And this is really
good because they got to figure out the right size
for the right sized i U D and the right
place to put it so it stays in place, etcetera, etcetera. Um.
(21:38):
So so that's how sounding the uterus works, not to
be confused with our battle cry of sounding the ute. Okay, well,
uh so then your doctor will remove the measuring rod
and pop in another rod that actually contains the iu D.
Christens making a face, girl, I know, Um it's because
of pop in. I think just just popping in. Hey, hey,
(22:00):
just popping in, just popping in with I'm Skyla or Kylina.
Can't talk right now? Okay, no, because I'm screaming. Um,
we're scaring people. We'll give you the low down here
in just a second. But so that that second rod
comes on up and it has the I U D
in it, and the DOC positions it in your cervix,
(22:23):
sticks it in there, and it's hanging out like the
kitten in the hanging their poster in in the bottom
of your uterus, right at your servis just but it
does not feel like claws or inside inside of you
do once it's in there, no, no, no, and and
it it does, it does hurt there. There is a
(22:45):
lucky minority, um, for whom this procedure feels like nothing
more than a pap smear followed by some minstrel cramps up.
My friend Samantha is one of those people. She uh
literally went running the same day, went back to work. Yeah, Christians,
make it a face, dude, I know. Um, Samantha has
(23:06):
always had incredibly severe menstrual cramps. She is used to
a higher degree of pain than that with which I
was accustomed, and so I warned her about the horrific
pain that I went through, and she proceeded to make
fun of me, probably for about the next year or so. Um.
For the middle group of people, Uh, it's a moderately painful, Yeah,
(23:29):
moderately painful process. That's most of us. For most people.
It's going to be moderately painful. For the rest of us,
including your friend Caroline Irvin. Here, it is severely painful. UM.
I I absolutely don't want to discourage anyone from getting
this procedure done. I think it's important to have really
effective birth control, and I U d s are incredibly effective,
(23:50):
as we have already laid out for you. UM. That
being said, I was not one of the lucky ones
who had low to moderate pain. I was one of
the ones who literally tasted color. UM. I developed apparently
circumstantial synesthesia during the procedure. It hurts so badly I
threw up. I almost passed out. I made the bad
mistake of taking no pain medicine, not even like a
(24:11):
tailean all um, and it it was. It was a nightmare.
But the thing is, like they give you the night
before you take UH medicine that dilates your cervix so
that your service is open so they can more easily
stick the I D in. Then ideally you will take
some type of pain medication and if you are highly,
(24:31):
highly anxious or scared, they might prescribe you like a
low dose of valium or something along those lines. UM.
I will say, and I think this is important to
say because I just told this to a friend and
colleague the other day, and this is what convinced her
after all this time of being afraid to go get
this procedure done. When I went to have my Skyla
(24:52):
removed so that I could get my marina, the removal
felt like nothing. I mean it did. It felt like
a p smear. It was uncomfortable, but not bad. In
the insertion of the marina was a little bit more
uncomfortable than a pap smear, but I wasn't I didn't
taste color. We'll just say that it was. It was
(25:13):
really fine. And I don't know if that's because my
cervix was like, oh, hey, you, we've seen your kind
here before um, or if maybe my child and all
was really kicking in that day, But I think it's
important to acknowledge that, yes, this can be a very
painful procedure. It is very helpful to have someone a partner,
a friend, a parent, someone go with you in case
(25:36):
you do need to be driven home. But I just
really want to hammer home that I don't want you
to avoid this procedure just because your pal Caroline throughout
the first time. Yeah. And and if you're nervous about
pain and have a low pain tolerance, just tell your
doctor and uh, they'll prescribe you something. And if anything,
(25:56):
definitely take the they're going to prescribe you. Probably regardless
like the horse pill, I'd be profen um. So just
take that. And even if you don't have someone who
can drive you, Uh, I survived both times driving myself,
so we can do it. Because also the great thing
is it is discomfort form. I mean the rest of
(26:17):
the day you're crampy. Um. But then you have birth
control for five years if you have the marina, which
is a presidential term plus a year, yes, which is good,
which is good to know. I think, uh my marina
right now. I'm on my second one and it should
last me right up through uh the end of Trump.
(26:38):
So happy for that. Um. We also don't need to
talk about possible side effects after you you get this
thing implanted, whether it's the i U D or the
implant um. And this info is coming from Planned Parenthood
Box and again the American College of Obstetricians and Kynecologists.
(27:00):
So typically with i U D s, the main side
effects you're gonna have are some unpredictable menstrual spotting and
bleeding at first. UM, I experienced this. I'll just leave
it at that. UM, you may also experience headaches, nausea, depression,
and breast tenderness. UH. Speaking to the depression aspects, I
(27:23):
u d s were implicated in a recent study that
went viral about birth control and female mental health, and
UH it was particularly like strongly correlated UM to women
getting iu d s and then UH later getting on antidepressants. Again,
there's some correlation causation issue there, but just something to
(27:47):
keep in mind if you struggle with mental health that
it's just something again to just talk to your doctor about. Right.
And again, personal experience. Obviously my experience is not everyone's.
But UM, I had been on the pill specifically yas
or yasmin for years, about a decade before I went
on an iu D and I never had never, never
(28:09):
had PMS with the pill, and I now on an
I E D, I do get PMS. And that's again
that's not going to be the same for everyone, but
I noticed that that was something that changed for me.
So things on an iu D versus the pill versus
no birth control whatsoever, they're not necessarily going to be
the same, and with implants, the major side effects sided
(28:30):
include change in sex drive. You might see a discoloring
or scarring of the skin over the implant site. You
may also experience headache, infections, or pain in the arm,
although that's very rare, UH, nausea, sore breasts, weight gain.
I mean, honestly, these are side effects that you see
with a lot of hormonal birth controls UM. And there
(28:53):
are some worst case scenarios though that I know, some
stuff Mom never told you listeners have experienced because you
all have told us about them, specifically i U D
expulsion and this is probably the most common uh scary
story that you hear when you're, you know, talking to
two friends about i u D s because for about
(29:15):
three to five percent of people who get them in
the first year, your uterus might be like, now, girl, Kylie,
go back to to Cabo. UM. You know they don't
live in Cabo Calabasas, scalabas Is. I know that, and
I'm ashamed of that, UM, but that's likely because the
(29:35):
gynecologists didn't insert it correctly. UM. If you're concerned about this, though,
watch out for cramping UM because that that might be
a sign that your your uterus is not happy, and
they're also in much rarer cases perforations that can happen um.
Your i U D can actually puncture your uterine wall,
(29:57):
which could potentially harm your bladder intestine and if left untreated,
might lead to hemorrhaging and sepsis. But that sounds awful,
It is awful, take heart, it is very very very rare. UM.
It is about point one percent expulsion rate chance with that,
and these are just more even more reason to make
(30:21):
sure that you stick to your follow up appointment. Usually
your gynecologist will request that you come in about a
month after the fact to just make sure that everything
is where he or she left it. Basically, that's how
my doctor put it. UM. Another worst case scenario involves
a slightly elevated risk of pelvic inflammatory disease in the
(30:43):
first twenty days after you get your i U D
inserted um and when it comes to implants, incorrect insertion
can cause discomfort and in effectiveness. And in the very
very very super rare case of pregnancy with one of
these long acting reversible contraceptives, you do have an elevated
(31:03):
risk of ectopic pregnancy. When I put the call out
on Twitter to let people know that we were going
to be talking about this and they were welcome to
send us their questions or concerns. We did have one
listener who said, yes, I was one of those people
who had to endure an ectopic pregnancy. Uh So the
risk is there, and again it is very small. Uh
(31:24):
Now in terms of who shouldn't get one of these,
especially for I U d S, people with untreated S
t I S, uh no, because insertion can promote pelvic infection. Also,
a good kind ecologist is probably going to make sure
that you're tested before going anywhere near insertion. Speaking of
(31:46):
pelvic infection, not surprisingly, if you have a recent history
with those not going to be a good idea. People
with untreated cervical or uterine cancers, and with the implants,
people with breast cancer are advised against getting them. And
speaking of S T I S, it is worth emphasizing
that even though uh it, these these wonderful things dramatically
(32:11):
reduce our chances of getting pregnant, they do nothing to
reduce your chance of contracting S T I. So you know,
don't throw away your condoms folks. And we should also
mention UH when it comes to having sex with I
U d s that UH at the bottom of these
little T shaped devices, there are some strings that hang down,
(32:32):
just a little tiny strings UM. And if your sexual partners,
like I think I can feel the string, that's probably okay.
It's it's not terribly surprising, especially for a digital penetration UM.
But you might also want to monitor your string because
if you can't feel them at all, because you can
(32:53):
actually UM yourself uh reach up and and probably feel them.
And if you can't feel them at all after the
first few months, you might just want to call your
doctor to see if you need to come in, just
to ensure that it hasn't been knocked out of place
or that it's been UM expelled. I've actually called my
doctor before UM because a partner way back when was
(33:17):
concerned about feeling the strings UM and it was fun.
It was really fine. You know, just always pick up
a call, pick up the call and phone your nurse practitioner. Perfect.
So now we know what these things are today and
how they work and how effective they are, it's time
(33:37):
to get into the more fascinating story of how they
came to be. And we're going to do that when
we come right back from a quick break and as
(33:58):
we get into uh this history of the i u
D specifically, we want to go ahead and give a
shout out to Chicaco Takashita, whose dissertation Negotiating Acceptability of
the i U D Contraceptive Technology, Women's Bodies and Reproductive
Politics UH is a major source. It's a very well
(34:19):
as you might imagine, it's very in depth dissertation. Does
not even need to be said, it's full of chucks.
It's chock full of great information. Good job, um. But
basically i u d s have been around for a
really long time. But as we kind of touched on
at the top of the podcast, American women are really
just now coming around to it. It's much more common
(34:41):
overseas in Europe than it is here, and a lot
of that has to do with some horror stories that
we have and some terrible things that we endured in
the nineteen seventies thanks to this thing called the Delcon shield. Um,
you also have issues in the way, hurdles like insurance
(35:03):
not covering this device, which can be four dollars or more,
and just general lack of awareness. I mean, I spoke
with some friends after I got my i U D
inserted who were still under the impression that i U
D s were as dangerous as the Delcon shield was
back mid century. And so we will get to that.
But let's take a trip down I U D memory
(35:25):
lane first. Yeah. So, uh, just important to note Europeans,
by no means the first folks to figure out that
that putting a physical barrier between your vaginal canal and
your uterus can prevent pregnancy. Since ancient civilization. We have
used pessaries, we have used cervical caps, we have used
(35:48):
all sorts of of things similar to i U D
s um with with a similar kind of strategy in
mind of really blocking the sperm from reaching damn eggs. Uh.
But in the late nineteen twenties, even though a doctor
in Japan ten rae Ota was doing the exact same
(36:10):
kind of research and development at the exact same time,
German Ernst Graffenberg, he of G spot fame. Yeah, I
always forget that, even though we talked about him extensively
in our claracy episode. Well Ernst. Uh So, doctor Ernst
is a doctor g cited as the inventor of the
modern i U D UM and his was a small
(36:32):
ring made of silkworm gut and coiled silver that was
inserted into the uterus. And the cultural climate in Germany
was perfect for Graffenburg to get his proto i U
D on the map because a sex reform movement was
(36:52):
afoot and he presented as a male doctor his device
as scientia fick hashtag credibility. But they weren't very effective,
uh and they cost a lot of infections. Um. Turns
out silkworm gut not perfect um. And once we get
(37:16):
into the nineteen sixties, uh, interest in i U D
s is reignited thanks to the Population Council, which had
been established in nineteen fifty two. Um, and they do
remain the number one developer of i U D and
Lark technology. They were actually initially looking for a pregnancy
(37:36):
vaccine and considered the pill too expensive and user dependent.
But there are layers there to that idea of it
being too user dependent. Yeah. So essentially, what's happening m
are mostly a lot of white dudes making a lot
of classes and racist assumptions about how poor women, especially
(37:59):
women of color, both in the United States and in
developing countries simply cannot be trusted with their own reproductive health.
So they are more fans of the set it and
forget it type of contraception. UM and I didn't do
much deep digging on the Population Council, but in general
(38:19):
they I mean, their name kind of says it all.
Really they are I want to say, an NGO still
around UM whose mission is population control, you know, and
especially focusing in on developing countries and low income areas. Uh.
(38:41):
This does start to intersect, especially around this time UM
with EU genesis philosophy UM and again just a lot
of classism and racism. But nonetheless they were the pioneers,
the scientific pioneers of the i u D. And in
nineteen sixty two they hosted the first Inner National Conference
(39:01):
on the i u D. But they had great swag
bags of this world. Gut, how do I get through? Well,
what's on the bottom. It's just cigars, because it's just
all it's all dudes. Really, I mean, like in this
paper at least, I only read about dudes doing this
scientific research. And that's like another little question mark in
(39:24):
my brain of you know, what what is what is
really what is really the intent? But anyway, we'll get
we'll get into the more feminist lens that people have
looked at this R and D through in just a second. Yeah,
but a question mark was one was not one of
(39:44):
the shapes of early i U d s, but there
were several others. Early i U d s were rings, bows, loops, coils.
All of these different shapes were patented. Uh. And you
even had this crazy straw looking thing. Uh, this loop
that became the go to. Yeah, the lip is loop
became the what they thought was going to be the
(40:07):
key to population control in developing nations in particular. And listeners,
imagine your head how the I U D today is
very small and it's t shaped. The lip is loop.
It's just this zig zag back and forth and back
and forth that looks It's really there to confuse the
(40:30):
sperm more than anything, I think, So it just looks.
It looks incredibly painful. Um. But uh and I'm so
glad that it is not the current design. In nine though,
Population Council affiliated Chilean scientist Jack Zipper, who has the
best name of this podcast so far, Jack the Zipper,
(40:53):
Jack the Zipper Hold. Jack the Zipper discovers the anti
fertility effects of copper. He was doing some research on
fertility in rabbits and realizes this, this copper is a
really effective contraceptive. Hello proto pareguard copper I U d W.
That's the force field again, the sperm force field. UM.
(41:17):
But when you hit the nineteen seventies and eighties, there's
a bit of a drop off, UM, because of the
nightmare that was the dell Con Shield disaster. So this
scary looking thing which can look like a cartoon I
with eyelashes. It can also look like a bacterium or
(41:38):
some kind of fishing lure, depending on which way you
hold it. UM. It was used by nearly three million women,
and not only did it sometimes fail to prevent pregnancy,
but it injured about two hundred thousand women. It caused
in fertility, and fifteen women died fifteen women eyed in
(42:00):
the process of miscarriage because of this Dalkon shield. And
the thing is I had known about the dal Con
shield by name for years, but researching for this episode
was the first time I actually saw it. And seeing
is believing, y'all google dal Con shield d A L
K O N, because how it just it just looks
(42:24):
very It just looks very painful because there are these
little like protrusions off of it, and it just looks
like it would cut you up. Um. But surprisingly, it
wasn't this frightening looking evil eye design that caused all
the problems, but likelier the thread that served as just
(42:45):
bacterial infection canal um instigating all of these pelvic infections
that lead to so many problems as a result. Especially
in the eighties, as the company that released the dalco
On Shield was just flooded with lawsuits, insurance companies just
moonwalk away. They're like, nope, we are out of the
(43:07):
i U D game. But that's the US. Yeah. Um. Overseas,
same game was not happening. China, for instance, in nineteen
seventy nine establishes its one child policy, So basically the
propaganda and the policies that are being pushed were like, hey,
you've had one child, go with an i U D. Oh,
(43:29):
hey you've had to be sterilized. So that's that right, Um.
But there was you know, as all of this delco
On shield nightmare was happening in the US, UM, China
was definitely on the forefront of developing the i U D,
which in nineteen seventy nine when the program was kicked off.
(43:51):
They had gone to the Population Council and had been like, Hey,
what are y'all working on? We need something? Oh yeah,
this i U D thing. So it was fascinating see
how all of this globally is starting to weave together. UM.
Back to the United States. After a couple of years
where i u d s were nowhere to be found
(44:13):
in the US, the Pareguard the copper i U D
was made available to American uterus is once again UM
and in the nineties the Marina which Caroline and I
have was developed in Europe and became super popular quite quickly.
UM of French women on birth control today, for instance,
(44:33):
use i U D sent of Norwegian women on birth control,
use i U D s all of us To say
that I U D use in the US UM at
what ten eleven percent right now is still so much
lower than U USE abroad? Well yeah, and I mean
the FDA was watching for about a decade what was
(44:54):
happening in Europe, essentially making sure that there was not
going to be another del con Shield nightmare of death
and injury and unexpected pregnancy. And so I was actually
ignorant of that fact that the Marina and it's like
weren't even available until the new millennium. I kind of
(45:16):
just I had thought that they had been around for
and they have been around for longer, but I mean
available especially with insurance. Yeah, I mean, and and for
a while too. Even when they were made available again, um,
most doctors wouldn't allow women who had been pregnant before
to use them. Um. They were all sorts of concerns. Understandably,
(45:37):
you know, because fifteen women died hello, um, but there
were a lot of concerns around whether they were truly safe. Um.
And it turns out yes they are. Um. But interestingly,
as we learned from a Time magazine piece, when the
Marina was first marketed in the US, it was targeted
at moms, basically being like, we know, y'all don't have
(45:58):
time to take a pill every day. You're busy with
your kids. Well yeah, I mean, there is that side
of it of like, you don't have time to worry
about your birth control. But there's also the side of like,
we are specifically marketing to moms over single women. We
don't want to promote uh, this birth control to single
(46:19):
women and have people just willing nillly ditch condoms for instance,
or think that they can just have unproductive sex forever,
unproductive set unproductive sex. Yeah, as then not having kids sex.
But that's the case today, I mean, thankfully, like people
are people are all about I E. D S. And
I wonder if that is at all correlated to like
(46:41):
the growing population of female O, B G Y N s. Um.
Just just a thought. If anyone knows, let me know. Um.
So what's not to love about all of this technology? Well,
there are some feminist scholars who haven'tterpreted their development and use,
(47:02):
particularly as it relates to the Population Council and their
implementation in developing countries and promotion among poor women in particular,
as coercive and even violent. Yeah, we read a lot
in the dissertation about sort of this history of forcing
(47:24):
women to be either sterilized or to have some type
of contraceptive to limit expanding families. Whereas here in the
West we tend to view it as a way to
control our lives. Uh. In a lot of countries, regions
like Indonesia or India, UM, it's viewed more as almost
(47:46):
punishment as a way to control women well, China, hello.
I mean that's like state propaganda right there. I mean, um,
they refer to it as state imposed fertility control, where
it's not you know, white women like jumping up fists
in the air choosing our choice, but rather the government
(48:06):
choosing your choice for you. And again going back to
those you know, classist and racist elements of you know,
let us let us choose on your behalf this set
and forget it kind of thing, because you probably don't
have the wherewithal to do for yourself. Um. So, And
and this was an area, these these biopolitics, feminist biopolitics
(48:29):
or something that I hadn't read before. And um, I'm
curious to read more about also because a lot of
that information, um and that perspective was coming out more
in the late nineties early two thousands. And I'm curious
to know whether there is still a similar sentiment now
(48:50):
that i U D s are more common and more affordable,
um in in the US in particular, But there are
also still a lot of barriers to you, especially in
developing countries, even though it is recommended by the World
Health Organization, because increasing i U D use could be
(49:11):
a major boon to maternal health and of course managed
population control UM. Still, as of according to NPR, of
women in developing nations have unmet family planning needs right
and so many of them more than get pregnant UM
(49:31):
within two years of having the previous child, the important
aspect of that stat being and many do not want
to Many want to wait, and the World Health Organization
does urge people in general to wait UH to I guess,
let their bodies recover essentially, especially if you've had a
traumatic childbirth UM. But some of the hurdles that people
(49:54):
are up against are things like menstrual taboos and very
real aeralization fears because we do have this history globally
UM of forcing women, particularly women of color, to be sterilized.
And Jill Philipovic a couple of years ago wrote a
terrific in depth piece for Cosmopolitan about the situation of,
(50:19):
or the challenge really of getting i u D access
to women in rural India because they tend to opt
for the pill over the paraguard. When it comes to
uh i u D s being sent, you know through
nonprofits and NGOs, it's usually going to be the copper
iu D because it is much cheaper than the hormonal
(50:41):
version as you might imagine, UM. And in these areas
the pill has chosen because with the paraguard, remember that
one of the major side effects is heavier periods, and
if you are in a developing area, you might also
ally have entrenched me menstrual taboos. But also I mean,
(51:04):
if you're on your period because of it, you can't
do anything really, I mean, it like puts you out
of commission and they literally cannot afford to do that,
right exactly. And you've also got the issue of the
difficulty of insertion um even right after childbirth. And you know,
another benefit of course of the paaraguard is it can
(51:25):
remain in for so much longer. So there there isn't
the every three years or every five years. Even there's
that nice ten to twelve years stretch where you can
just I mean, you can just set it and forget it.
Not to sound globe, um, but there have there have
been developments. UM. There is this new easy to use
(51:45):
quote unquote i U D insert or developed by Population
Services International, which I feel like these names need to
be improved. Doesn't Population Services International sound like something out
of nineteen four I think they're related to the the
old school population council. Well, all right then, um, but
this new inserter could make i u D S more
(52:08):
accessible and on top of that lower the chances of
getting i u D related infections. Um, the expulsion rates
are still comparable to those in the US right now. Yeah,
and those easy to use inserters are super important in
those areas where you aren't going to have just you know,
a buffet of trained obstetricians and perfectly sterilized areas and
(52:32):
instruments to use. Um. And apparently the existing inserter that
tends to come with a marina or paraguard is really
flimsy and kind of hard to use if you don't
really know what you're doing. Yeah, it's not as long
as as would be ideal. And they mentioned I think
this was still from Philip iis article right. She she mentions, how, um,
(52:54):
right now in the study, when i u D s
are inserted with these these new inserters that have been developed, Um,
the doctors leave the strings long still after childbirth and
want you to come back like a week or two later.
But even that is still a barrier to overcome. Researchers
and developers still want to get it down to know
(53:16):
we just we do just set it and forget it,
and that we do insert it and you go back
to your life, You go back to your village or wherever,
and you don't have to worry about coming back to
find a healthcare provider to trim those i u D strings.
And most often that does happen uh right after childbirth.
You know, they come in to have the baby and UH,
(53:37):
like a lot of women choose to then get a
tubal ligation for instance, UM, you can then get an
IUD inserted. UM. But here in the US even there's
still some mistrust around i u D s of course
their horror stories UM because of you know, people we
might know or have heard about who have had to
deal with those very painful expulsion or even rare perforations. UM.
(54:03):
And since though the election of Trump and even more
troubling lye uh former Indiana Governor Mike Pence as Vice president,
i U D searches have skyrocketed, skyrocketed, my friends, I
am not that is not hyperbole. You can see it.
(54:24):
You can see it in the Google UM. Because people
are worried about the repeal of the Affordable Care Act
and the possible repeal of Roe v Wade and out
of pocket hormonal I U D s can run you
eight hundred dollars um. So, there have been a lot
of women ever since that happened, ever since November nine,
(54:47):
who have said get an I U D. Yeah. Well,
I mean I posted the question on Facebook of how
many of you out there are thinking about this, are
in line or on the phone with your doctor to
at your contraceptives of whatever kind taken care of? And
I mean the response was overwhelming from women of all
ages and background saying I'm on the phone with my doctor,
(55:10):
I'm calling I'm going to plan parenthood. One woman literally
responded from her doctor's waiting room saying that she was
getting it taken care of. Yeah, so, I mean this,
this conversation is more relevant than ever before. Um and
even though we were only able to offer just a
tiny snapshot of a more global perspective, uh, it does
(55:33):
go to show how again, reproductive rights are very intersectional
issue and affect different people and in such different ways,
in the same way as birth control does. Um So
perspectives that you can share insights, questions, send them to
(55:55):
us mom staff at how stuff works dot com. Is
our email address. You can we Doesn't Mom Stuff podcast.
You can directly tweet and follow me at Kristen Conger
and me Caroline Irvin at the Caroline Irv And we've
got a couple of messages to share with you right now. Well, actually,
(56:21):
to be honest, we just have one letter to read,
and it's from Allison. So Allison saw on social media
that Kristen and I were gearing up to do an
episode on i U D s and she, a fellow
I D evangelists, had to write in. She says, I'm
not a medical professional or i U D. Salesperson. However,
I am the owner of one set of lady parts,
(56:44):
my lady parts. Allison writes, when I started college, I
was prescribed the pill for a regular minsie since back
in my day you couldn't get it covered if it
was just for stopping babies. And to make a long
story short, the hormonal birth control really made me sick,
serious depression, weight gain, mood swings, oh and debilitating cramps.
(57:05):
One time, I remember handing my roommate my car keys
while I curled up on my floor after class, telling
her to just take the car where she needed to go.
I can't sit up. I took it four more years
because I don't know doctors are smarter than me. I
was not living my empowered truth. Eventually, I chewed hormonal
birth control altogether because my side effects were so bad.
(57:25):
But I met an Englishman in two thousand nine and
I needed to get birth control stats. After talking to
my amazing lady O B g y N, who sets
my heart alight, and doing a little research, I told
her I wanted to try the i u D even
though I am nella Paris. I wanted to try the
iu D for a variety of reasons, but most importantly,
I wanted something effective, easy to use, and easy to reverse.
(57:48):
Oh that and it was covered by my insurance. Only
my regular appointment copay would apply. This was before the
legislation for covering birth control was passed, so my d
her and I talked about it, and because I had
a bad reaction to hormonal birth control, she recommended doing
the peaguard the copper i D. We giggled when she
said that she liked that one because she likes to
(58:09):
imagine the heads of the sperm popping off when met
with the inhospitable uterine environment. The copper creates. Did I
mention she sets my heart a light because she does.
We talked about how it would work, that it would
be good for ten years, and if I wanted to
take it out, she could do that any time, just
come in. When I've told friends about the insertion process,
I've described it like sticking a straw in your huha
(58:31):
then shooting a dart into your uterus. But it didn't
really hurt. I did have cramping, and at ten to
regret that I only took four hundred milligrams of ivy
proof in the weirdest thing was I got dizzy uh
and the nurse brought me an apple juice box that
they kept there for the kids and let me lie
down for ten minutes. I advocated the i U D
to my best girlfriend. After she had two children fourteen
months apart her, she and her husband decided their family
(58:54):
was complete, at least for now. She wanted to know
about my experience, and she talked to her O B
G y N and decided Marino was for her. I
will pretty much talk to anyone about my I E
D if they ask, and have called out I U
D deniers for just being lying liars like those who
say it's an abortifacient. Anyway, Englishman and I got hitched
in and I have four more years of effective, safe
(59:17):
and fabulous birth control that I can decide at any
time to keep or take out having children. It's not
something we want to do maybe ever, And that is
cool with my PAA guard because she's just in their
chilling popping the heads off sperm. Thank you so much
for listening to my story time. I've listened to you
both for a few years and appreciate so much your
candor and the important topics you discuss. Please let me
(59:38):
know if you have any questions I can answer. And
Allison signs her letter unicorns and empowerment and what a
fabulous way to end a letter. Thank you so much, Allison,
and thanks to everyone who's written into us. Mom Stuff
at how stuff works dot com is our email address.
And speaking of email, y'all, in light of the post
(01:00:01):
election hot mess happening, I've started a little tiny letter,
A little tiny letter how redundant is that If you'd
like to check it out and subscribe, it's called the
Do Better Digest, and you can subscribe at tiny letter
dot com slash Kristen which is c R I S
(01:00:22):
T e N and Rolling, so all of our social
media as well as all of our blogs, videos, and
stuff mom Never Told You podcasts with our sources so
you can learn even more about birth control and reproductive rights.
Head on over to stuff Mom Never Told You dot
com for more on this and thousands of other topics.
(01:00:47):
Is it how stuff Works dot com
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