Of the many bombshells encapsulated in Britney Spears's Thursday statement protesting her conservatorship, there was one in particular that evoked a collective horror. "I want to be able to get married and have a baby," she told the Los Angeles Superior Court. "I was told right now in the conservatorship, I'm not able to get married or have a baby, I have a [IUD] inside of myself right now so I don't get pregnant. I wanted to take the [IUD] out so I could start trying to have another baby. But this so-called team won't let me go to the doctor to take it out because they don't want me to have children – any more children."
This is how reproductive coercion works in our world. It's about forcing women to become mothers when they are not physically, financially, or emotionally prepared to do so. And it's about obstructing their ability to become mothers when it is not socially or economically advantageous to their oppressors and abusers. In May, the Guttmacher Institute published a report on the ways in which long-acting reversible contraceptives have been exploited, issuing a call "to avoid creating programs that contribute to racist, ableist and coercive contraceptive policies and discourse—or that broadly target marginalized groups rather than prioritize individual needs."
Reading Spears's chilling comments this week, I was thinking of these issues, and was reminded of a conversation last winter with author Elizabeth Catte, whose book "Pure America" traced the history of the state of Virginia's eugenics program. "People who want to control women have taken tremendous advantage of their anatomy," she said then. "Out of the gate, people assume that women are less rational actors, that they're more prone to fluctuations of their moods, that things like menstruation and childbirth affect women negatively to such a degree that they can't be in control of their own bodies." And when it comes to a useful female worker, whether it's a housemaid or a pop superstar doing a Vegas residency, it's obvious who gains when, as Catte put it, there's "no pregnancy to interrupt your productivity."
Spears's accusation feels poignantly harrowing right now, coming in the midst of a long overdue public conversation about the hard realities of the intrauterine device experience. For many women, an IUD can be an emancipating, stress-free form of birth control, a worthwhile tradeoff for an uncomfortable trip to the gynecologist to have it inserted. For others, it can be an agonizing ordeal. But whatever the circumstances, whether it's an embryo or an IUD, the notion of any woman having to carry anything inside her body against her will is a nightmare. "Your reproductive health is your own — and no one should make decisions about it for you," Planned Parenthood president Alexis McGill Johnson tweeted on Wednesday.
The intrauterine device, or IUD, has a checkered history. In the early 20th century, Dr. Richard Richter pioneered the concept of a device that could be implanted in the uterus to ward off sperm. Over time, IUDs were tweaked and refined, notably with the introduction of copper, which acts as a spermicide. Along with the rise of the pill in the sixties, the IUD's popularity also grew. It's easy to see why: they are highly effective, easily reversible and long-acting. An IUD can also, however, cause serious complications, evidenced most notoriously by the Dalkon Shield.
Introduced in the early seventies, the shield looked like a crab and was marketed as a safer birth control at a moment when oral contraceptives had higher doses of estrogen — and more side effects. The shield, however, turned out to be far more of a health hazard. As Rainey Horwitz explains in the Embryo Project, its string "drew vaginal bacteria into the uterus, resulting in septic infection, miscarriage, and an array of other related complications, including death…. the Dalkon Shield was correlated to an increased rate of pregnancy-associated complications, including septic pregnancies, or a bacterial infection of the placenta and fetus. Those complications were serious enough that they usually led to hospitalization." Writing in the New York Times in 1987, Gina Kolata reported "as many as 200,000 American women have testified that they were injured by the device." And that's just the ones who spoke up.
The modern IUD, fortunately, bears little resemblance to its recklessly barbaric ancestor. Now, popular brands like Mirena and Skyla release the progestin hormone to prevent pregnancy, which can also ease period pain and flow. Today, the Kaiser Family Foundation estimates 14% of American women who use contraception rely on IUDs.
I have had my own chaotic relationship with the IUD. Because of other health issues, I had to have my Mirena inserted and removed, inserted and removed, repeatedly over the course of several years. In my life, I've had only a small handful of pain experiences I would describe as "out of body," the kind that made me think, "I know what Anna whispered in 'Martyrs.'" Certain migraines. A baby's head crowning. And the mind-shaking feeling of someone reaching inside of you and performing an action that feels like having your reproductive organs pinched really, really hard. Planned Parenthood describes the process of IUD removal as "A health care provider gently pulls on the string, and the IUD's arms fold up and it slips out," and for some people, that snug scenario is surely true. For me, I feel like that sentence could end with, "and then you are tenderly scraped from the ceiling."
Mileage varies wildly. In a 2016 roundup in Self, 17 women described their own IUD experiences; they ranged from "It didn't hurt as much as I thought it would!" to "My whole abdomen was seized up in excruciating pain." One consistency is that women are rarely honestly apprised of what getting an IUD may be like, nor are they adequately offered pain relief.
In a stunning feature this week for The Times, Caitlin Moran published a story headlined "Why we all need pain relief when getting an IUD fitted." As the author posed, "Why is it presumed that women will be fine with having their cervix artificially dilated with a pair of metal barbecue tongs before having what is basically the wire coat hanger from a doll's house inserted into their uterus?" Soon after, BBC Breakfast host Naga Munchetty opened up about her own experience, telling radio listeners, "I won't go into all the details, but my screams were so loud that my husband tried to find out what room I was in to make it stop." And though she said she fainted twice, "At no point was it suggested that I could have any anesthetic or sedation… I felt violated, weak and angry."
On Wednesday, Telegraph writer Lucy Cohen added her voice to the chorus, recalling that when she went for her IUD, "I have never felt pain like it. Nothing can describe that profound agony as the 'sound' (a medical instrument used to probe), hits your uterus. Or the invasive and violating feeling of having your cervix clamped."
Cohen soon realized that her friends had similar tales, so she felt inspired to conduct a survey that eventually attracted 1,300 women. The results were sobering. A full 93% said they'd experienced pain in their IUD fitting — with 43% rating it as "extremely painful, almost unbearable, or excruciating." But what really leaps out here is Cohen's observation that "More than half (53%) said they were not advised to take any pain relief at all. Their stories were unbelievably depressing: stories of medical professionals dismissing women's pain and making them feel they were being excessively dramatic about it."
The word "violation" leaps out in these accounts. Even in a healthcare procedure freely chosen, one that benefits the woman, the ways in which the process unfolds can be deeply upsetting, insensitive and invasive. Now imagine that added indignity of having no agency in the narrative.
Spears' situation is sadly not unique — in 2016, Illinois woman Melanie Jones sued a local Catholic hospital, claiming doctors refused to remove her IUD after it had become dislodged and was causing pain and bleeding. And in a 2019 Huffington Post story, several Canadian women shared their stories of doctors refusing to remove their devices, even as they complained of pain. "I had to change gynecologists twice just to get it removed," said one.
As the National Women's Health Network writes, "Any attempt to force a woman into using an IUD, or to prevent her from removing it, is an injustice and a violation of your rights." Britney Spears now says she is enduring just such an injustice and violation. And as she makes her demands for autonomy, she's highlighting the tyranny of limiting our reproductive choices, and the horror of of a woman being made to carry her shackles inside of her self.
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