I’ve been participating in a great online course on contraception through Coursera. The 5-week course is taught by Jerusalem Makonnen, a family nurse practitioner and professor at UCSF’s School of Nursing. It features weekly video lectures, readings and some short writing assignments that are peer-assessed. I’m learning a lot of great details about the various forms of contraception, their efficacy and safety, contraindications, as well as getting a better overview of contraception use and barriers globally.
This week we’re discussing long-term methods, which include intrauterine devices and sterilization. It’s been interesting to observe the rise in popularity of IUD’s…providers love them and so do many patients. I use the Paragard myself and have had no complications. However, when this article came out last December in the New York magazine, it definitely caught my attention.
There was something about the use of the words IUD and evangelism in the same sentence that gave me pause. Yes, it’s a wonderful birth control option. But it doesn’t work for everyone. I personally know several women for whom it caused several months of extreme discomfort before they opted for removal. And let’s not even get into the can of worms conversation about access. The fact of the matter is, IUD’s are often not financially feasible for folks without insurance coverage.
I guess what I’m really trying to say is that I think it’s important to find a balance when counseling women about their options. I worry a little that women will start to feel pressure to choose the all-exalted IUD even if it’s not something they feel comfortable with. As a clinician, I can see a lot of benefits to using an IUD…but I think one of the things clinicians can have a harder time grasping is the personal, religious, or philosophical reasons why a woman might not want a device placed in her uterus, even if she is fully committed to not getting pregnant.
As a peer pregnancy options counselor, doula and former patient support advocate at my local Planned Parenthood, I often speak with women who are hesitant to use contraception for a variety of reasons: worry about the effect of hormones in the body for long periods, worry about worse periods, or no periods. Some women I speak with express a hesitation to alter their cycles–they feel a deep spiritual connection to these cycles. Or, the thought of having a plastic device in their uterus…well, it just doesn’t sit right with them.
Ultimately, I think that while we can counsel and educate all we want about the benefits of long-term, reversible methods, it needs to come from a place of deep compassion, understanding, and genuine curiosity. This curiosity keeps us open and humble and prevents us from assuming that just because a contraceptive method is perfect on paper, that every woman will fall in love with it. I do appreciate that this course also covers counseling approaches. I can’t wait to actually be able to talk about this stuff with future clients…