July 20, 2024 • 61 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 in this classic episode.
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Speaker 1 (00:05):
Hey, this is Annie and Samantha.
Speaker 2 (00:06):
I'm welcome stuff I never told you, obrection if I
hurried you. So this is another classic inspired by your
recent episode about gynecology, Samantha, because you mentioned in there
that they Kristen Caroline, the past host told your story
(00:30):
about getting it. Yeah, yes, and so I was like,
I wonder what episode.
Speaker 3 (00:35):
That one is.
Speaker 2 (00:38):
I yes, I found that episode about IUDs and I
was like, must be this one, correct, So I thought,
you know, why not bring that one back so people
kill can check it out?
Speaker 3 (00:53):
Perfect?
Speaker 2 (00:53):
Perfect, Well, please enjoy this classic episode.
Speaker 1 (01:00):
Welcome to Stuff mom never told you from houstuffworks dot com. Hello,
and welcome to the podcast. I'm Kristen and I'm Caroline.
And today we're talking about larking at a lark. Yes,
not to be confused with LARPing. Let's go larking. We're
(01:23):
talking about long acting reversible contraceptioning to make larking work.
Speaker 3 (01:30):
Oh right, right right yeah, And you and I have
been historically evangelists for our larks. Our IUDs are intruderine devices.
Speaker 1 (01:40):
Which I so often accidentally call either IEDs or UTI's,
both of which get a look.
Speaker 3 (01:50):
Uh dude, roommate when his girlfriend was getting an IUD
texted me to say that she was getting an IED
and I laughed, and I laughed and I said, I
I think you mean i u D. And he said,
I think you're wrong. I think she's getting an IED.
Speaker 1 (02:06):
I really hope not. It's not gonna go Well. If
it is, Yeah, intermittent explosive devices that they i stand for.
Speaker 3 (02:14):
You could argue that it would prevent pregnancy.
Speaker 1 (02:18):
That that is true. That's one way to go about it.
But IUDs are not the only thing we're going to
talk about in the first half of the podcast. Because
IUDs are not the only form of a long acting,
reversible contraception. We've also got to talk about the implant
and IUDs and birth control. Implants are considered really the
(02:42):
gold standard of birth control. And this is according to
both the American College of Obstetricians and Gynecologists as well
as the American Academy of Pediatrics. So doctor people, doctor
people in the know, doctor people in the know for
human people of all.
Speaker 3 (03:01):
Ages, right exactly. And it turns out, according to these
doctor people in the know, that both iud's and implants
are just as effective as sterilization. But of course, they
are reversible and not invasive. I mean, one could argue
that it does hurt to get an IUD sometimes depending
(03:25):
but they're recommended as first line contraceptives.
Speaker 1 (03:29):
And since two thousand and two, IUD use among American
women has quadrupled, And anecdotally I've noticed in the past
maybe two or so years, similar to the mainstreaming of menstruation,
kind of the mainstreaming of IUDs, everybody's talking about iud's.
Speaker 3 (03:51):
Oh, mainstreaming of menstruation. Is that what everybody on Twitter
is talking about when they do hashtag MSM.
Speaker 1 (03:59):
Don't I win?
Speaker 3 (04:00):
Don't we wish? Yeah, it turns out that ten to
eleven percent of US women who are on birth control
use IUDs, which is up massively from just about one
and a half percent in two thousand and two. And
it is worth noting side note that forty percent of
gynecologists who use contraceptives use.
Speaker 1 (04:23):
IUDs according to Vox, and over at the Goupmaker Institute,
we learned that 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?
Speaker 3 (04:43):
Well, Okay, you go out during a supermoon. Uh huh,
and you howl into the phone to your gynecologists and
make an appointment to get one of these devices, which
work extremely well. Now, a lot of people say, oh, well,
surely they're not that different in their effectiveness from the pill.
(05:05):
But you've got to keep in mind that we are
all in perfect people, and when we use the pill
or the neuver ring or the patch with typical use
as opposed to perfect use, 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.
Speaker 1 (05:29):
So with that in mind, let's hop into how IUDs work.
So there are two main types of IUDs. First up,
we've got the original, the old copper IUD brand named Paragard.
It can last for up to twelve years twelve years,
(05:50):
and this to me is the one that does seem
like magic because there are no hormones involved. They just
insert this T shaped little little piece of uh copper
into your uterus. But what happens is it essentially bathes
our uterine linings in copper ions that create and I'm
(06:11):
not exaggerating here. It really creates a sperm killing force field,
although you can't expect heavier periods. But in exchange for that,
that force field creates just a point eight percent failure rate.
Speaker 3 (06:29):
I am hoping that it also has like that movie
magic sound effect when you have like some kind of
force field.
Speaker 1 (06:35):
Of wom you know, wom, woom woom. Are those the
sperm running into the force field?
Speaker 3 (06:40):
Yeah, h for sure. I'm bumping their little heads and
being like, never mind, guys, let's get out of here.
Speaker 1 (06:46):
This also reminds me of those uh you know, those
metal bracelets that people wear that are sold like in
the back of magazines.
Speaker 3 (06:52):
Yeah, but those don't do anything.
Speaker 1 (06:54):
I don't think that those create sperm force field.
Speaker 3 (06:56):
Now, a pair reguard copper IUD can last you three
presidential terms. I don't know why I would say anything
like that, but I'm just saying three presidential terms.
Speaker 1 (07:09):
Yeah, two Trump and one Pence. Dear God, I think
my uterus just actually withered up and died. Next up,
we have the hormonal IUDs, 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
(07:32):
so do I. It lasts five years. There's also on
the market now, Skyla, which lasts three years. And I
just learned there are two others called the Liletta and Kylina. Yeah,
and y'all, Kyleina is spelled k y l e e
n A. And I'm just saying that Kylie Jenner is
(07:53):
really missing a branding opportunity here. So with these hormonal IUDs,
they use a hormonal called levanagestrel that thickens your cervical mucus,
which is really the first defense as sperm travel through
the cervix on their way to the uterus. So they're like, okay,
(08:15):
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 should fertilization happen, for implanting then to then happen.
And with those, unlike the copper IUD, you can expect
(08:38):
lighter or in my case, TMI alert no periods. Yeah.
Speaker 3 (08:43):
I have actually had both of these, so I can
speak to both of them. I started out with the scila.
I was instructed or advised to get the Scyla because
I am teens tiny inside and also have never given birth,
and my gynecologist was like, the smaller one might be
better for you. So I had that for three years
and I still got a monthly period, but it was very,
(09:06):
very light, very light. Now that I have the Marina,
I no longer get a monthly period, which is awesome.
I still do get PMS symptoms, my boobs get real
big and sore.
Speaker 1 (09:18):
Hashtag humble brag, that's.
Speaker 3 (09:20):
Right, but yeah, but no period. It's awesome. And what's
fabulous is you can really depend on these products. The
Morena has a failure rate of just zero point two
percent and the skyl Of failure rate is just point
four percent.
Speaker 1 (09:37):
Now, let's quickly, though, take a mythbusting detour to clear
up a little bit of misinformation, actually a lot of
bit of misinformation that's out there about iud'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 a feeling a lot of listeners might have seen
(09:59):
or heard or might just be worried about. IUDs are
not abortifations, and this was something that came up in
that Hobby Lobby birth control case that went to the
Supreme Court. IU d's were one of the things that
the hobby Lobby founders did not want to cover because
(10:22):
of the misinformation, the fallacy that IUDs are essentially little
abortion machines inside of us.
Speaker 3 (10:36):
Yeah, let's get something straight real quick. So, pregnancy is
when a fertilized egg is implanted, right, But contraceptives prevent
fertilization 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 episode, the copper IUDs are actually a fabulous
(11:00):
emergency contraceptive. Even when used up to five days after intercourse.
Those copper IUDs 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
(11:23):
a pregnancy. So, like Kristen said, the idea that an IUD,
whether it's hormonal or copper, can lead to abortion is
again a complete fallacy.
Speaker 1 (11:34):
Yeah, and this information too is coming from the American
College of Obstetricians and Gynecologists. We're not just We're not
just reciting NSNBC headlines here, folks, hashtag msn I don't know,
I'm trying to do a callback. So that's the situation
with IUDs. We also got to shout out the implants.
(11:57):
The brand names are implan On next plan On, and
implants are really what they sound like. They are thin
plastic match sticks sized progestin dispensers essentially, and progestin is
a synthetic form of the hormone progesterone, and these little
(12:18):
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.
Speaker 3 (12:31):
Yeah, and so when you use an implant, you can
expect spotting in the first six months or a year,
but one out of three women who have the implant
stop having a period all together. 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 zero point zero
(12:52):
five percent, which is fantastic.
Speaker 1 (12:54):
Yeah, I mean, it was a while back and I
forget what exactly it was about iud'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 d's are actually not the most effective, because in fact,
it's implants, which I'm even after all the research we've
(13:18):
done for this episode, I've walked away still not quite
clear on why implants are as rare as they still
are today. 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 putting these like little match sticks and a little
(13:41):
T shaped what's not inside our bodies and our utes
are on lockdown? Yeah, y'all, I mean, yeah, that is
That is the delightful truth.
Speaker 3 (13:51):
Yeah, it's really not too good to be true, which
warms my freaking heart because so often I feel like
we talk about things that are But we're going to
cite some 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 or contraception
(14:14):
and providing it to teens, or the issue of having
birth control and contraceptives paid for. And we're going to
have all of these sources over at stuffmon've never told
you dot com on our source post for this episode,
so you can, you know, send those links onto your family.
Speaker 1 (14:31):
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
free IUDs. And what happened is that due to this program,
(14:51):
between two thousand and nine and twenty thirteen, Colorado's teen
pregnancy rate dropped forty person And also this is important
to underline for conservative family members as well, people who
are opposed to abortion in general. In addition to the
(15:13):
teen pregnancy rate dropping forty percent, literally plummeting, the abortion
rate also dropped forty two percent. And in addition to that,
people who are not too keen on taxpayer dollars going
to subsidize single motherhood food stamp enrollment also dropped by
(15:35):
around twenty five percent between twenty ten and twenty thirteen.
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 IUD program. And money wise, do you understand
(15:59):
the impact back onto taxpayers. Each dollar a state health
department spends on long acting birth control IUDs or implants
translates to five dollars and eighty five cents of Medicaid savings,
and Medicaid covers seventy five percent of teen berths. And
(16:21):
these are a lot of percentages and numbers that have
all tossed out, but TLDR, these IUDs literally changed these
young women's lives because the highest teen pregnancy rates were
in the lowest income communities, as is often the case,
not just in Colorado but across the United States. And
(16:43):
the New York Times talked to one woman in particular,
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 due too being able to set
and forget this contraception, it allowed her to really set
(17:05):
up the life that she wanted for herself, you know,
coming out of very disenfranchised circumstances. So Colorado has been
a standout example of the power of these long acting
reversible contraceptives because by the way, that forty percent drop
in teen pregnancy rate is far and away faster than
(17:28):
any other states drop in teen pregnancies. Sounds great.
Speaker 3 (17:33):
I mean, how could anyone not support this?
Speaker 1 (17:37):
Because people get squeamish when it comes to young women
and the government subsidizing birth control, Republicans often aren't fans
of it.
Speaker 3 (17:52):
So yeah, and so this is according to an article
about this from Colorado's in PR station. 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
(18:12):
were able to push through two point five million dollars
in the state budget for it.
Speaker 1 (18:18):
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. But again, this is just a real
world example of how these things can really work and
(18:38):
not just work for you know, college educated, employed, middle
class white ladies like you and me, Caroline. But y'all,
it's not all candy and roses. I don't actually know
that any of it is candy and roses. Although you
your IUD doesn't get you roses, no, just carnations. But
(19:03):
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
iud's and implants because every body is different, and we're
going to get into some of those not so fun
facts when we come right back from a quick break.
Speaker 3 (19:37):
Yeah, okay, so you might imagine that when you are
inserting something, inserting birth control into your body, whether it
is an IUD 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,
but we've got to get you the rundown right of
(19:59):
what 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.
And the insertion, though, is generally faster and anecdotally a
(20:22):
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. And it's not that IUD insertion and
removal is not straightforward. There's just several more steps when
it comes to an IUD.
Speaker 1 (20:38):
Yeah, because instead of putting it in your arm, you
gotta get all the way up to your ute. So,
and yes, ute is my preferred term for uterus, because
why not. So the way that IUDs get inside of
us is Unfortunately, it wouldn't be cool if we could
like swallow them and they're just like, no, no, no, I'm
(20:59):
in your uterus. Nope, that's not how our bodies work.
So gynecologists, well, first you gotta go. You gotta get
in the stirrups, all right, So you're in the stirrups.
Speaker 3 (21:08):
You're on a horse.
Speaker 1 (21:09):
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. And they describe the
(21:29):
discomfort with this as a pinch. Yeah, Caroline's laughing, because
it is quite a pinch. Okay, it's it's quite a pinch.
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 your cervical canal, they do something called
(21:53):
sounding the uterus, which is a term brand new now
to Caroline and me, and sounding the ute is our
new battle cry.
Speaker 3 (22:04):
Yeah, imagine me with a conk shell, but it's actually
a uterus.
Speaker 1 (22:08):
Whenever you want to gather nasty women everywhere, you 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
(22:28):
the right sized iu D and the right place to
put it so it stays in place, et cetera, et cetera.
So so that's how sounding the uterus works. Not to
be confused with our battle cry of sounding the ute.
Speaker 3 (22:41):
Oh okay, well, uh so then your doctor will remove
the measuring rod and pop in another rod that actually
contains the IUD. Christens making a face, girl, I know,
and it's because of.
Speaker 1 (22:53):
Pop in I think, just popping it in.
Speaker 3 (22:56):
Hey, hey, guys, just popping in there. Just popping in
with I'm Skyla good In Metscha or Kylina. You can't
talk right now, okay, okay, no, because I'm screaming. 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 IUD in it, and
(23:16):
the doc positions it in your cervix, sticks it in there,
and it's hanging out like the kitten in the hang
in there poster in the bottom of your uterus, right
at your cervix.
Speaker 1 (23:31):
Just but it does not feel like claws or inside
inside of you. You don't once it's in there.
Speaker 3 (23:37):
No, yeah, no, no, and and it does it does
hurt there. There is a lucky minority for whom this
procedure feels like nothing more than a perhap smear followed
by some minstrel cramps. Uh. My friend Samantha is one.
Speaker 1 (23:52):
Of those people.
Speaker 3 (23:53):
She uh literally went running the same day, went back
to work. Yeah, A Christen's making a face.
Speaker 1 (23:59):
Do I know?
Speaker 3 (24:01):
Samantha has 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. For the middle group of people, it's
(24:24):
a moderately painful, yeah, not really painful process.
Speaker 1 (24:27):
That's most of us. For most people, it's going to
be moderately painful.
Speaker 3 (24:30):
For the rest of us, including your friend Caroline Irvine here,
it is severely painful. 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 iud's are incredibly effective,
as we have already laid out for you. That being said,
(24:50):
I was not one of the lucky ones who had
low to moderate pain. I was one of the ones
who literally tasted color. I developed apparently circumstantial sinis desia
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 tile in all,
(25:12):
and it was a nightmare. But the thing is, like
they give you the night before you take a medicine
that dilates your cervix so that your cervix is open
so they can more easily stick the ID in. Then
ideally you will take some type of pain medication, and
if you are highly, highly anxious or scared, they might
prescribe you like a low dose of valume or something
(25:33):
along those lines. 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 removed so that I could get my morina,
the removal felt like nothing.
Speaker 1 (25:55):
I mean it did.
Speaker 3 (25:56):
It felt like a pap smear. It was uncomfortable, but
not bad. And the insertion of the marina was a
little bit more uncomfortable than a perhaps mirror, but I
wasn't I didn't taste color. We'll just say that it was.
It was 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, or if maybe my tail and
(26:20):
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 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
(26:41):
Caroline throughout the first time.
Speaker 1 (26:44):
Yeah, 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, definitely take the they're
gonna prescribe you probably regardless, like the horsepill, ibuprofen. Yeah,
so just take that. And even if you don't have
someone who can drive you, I survive both times driving myself,
(27:07):
so we can do it. Because also the great thing
is it is discomfort for I mean in the rest
of the day you're crampy, But then you have birth
control for five years if you have the marina, which.
Speaker 3 (27:20):
Is a presidential term plus a year.
Speaker 1 (27:23):
Yes, which is good, which is good to know. I
think my marina right now, I'm on my second one
and it should last me right up through the end
of Trump. So happy for that. We also don't need
to talk about possible side effects after you get this
(27:44):
thing implanted, whether it's the IUD or the implant. And
this info is coming from Planned Parenthood Vox and again
the American College of Obstetricians and Gynecologists. So typically with
iud's the main side effects you're going to have are
some unpredictable menstrual spotting and bleeding. At first, I experienced this.
(28:09):
I'll just leave it at that. You may also experience headaches, nausea, depression,
and breast tenderness. Speaking to the depression aspects, IUDs were
implicated in a recent study that went viral about birth
control and female mental health, and it was particularly like
(28:33):
strongly correlated to women getting IUDs and then later getting
on antidepressants. Again, there's some correlation causation issue there, but
just something to keep in mind if you struggle with
mental health that it's just something again to just talk
to your doctor about. Right.
Speaker 3 (28:50):
And again, personal experience. Obviously my experience is not everyone's.
But I had been on the pill specifically yaz or
Yasmin for you years, about a decade before I went
on an IUD, and I never had never, never had
PMS with the pill, and I now on an ID,
I do get PMS, and that's again that's not going
(29:12):
to be the same for everyone. But I noticed that
that was something that changed for me. So things on
an IUD versus the pill versus no birth control whatsoever,
they're not necessarily going to be the same.
Speaker 1 (29:23):
And with implants, the major side effects sited 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, nausea, sore breasts, weight gain. I mean, honestly,
(29:43):
these are side effects that you see with a lot
of hormonal birth controls. And there 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 IUD expulsion. And this is probably the
most common scary story that you hear when you're, you know,
(30:07):
talking two friends about iud's because for about three to
five percent of people who get them in the first year,
your uterus might be like ha, now girl, Kylie, go
back to to Cabo. You know, they don't live in Cabo.
Calabases calabases. I know that, and I'm ashamed of that,
(30:30):
but that's likely because the gynecologists didn't insert it correctly.
If you're concerned about this though, watch out for cramping
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. Your IUD can actually puncture
(30:53):
your uterine wall, which could potentially harm your bladder and
intestine and if left untreated, lead to hemorrhaging and sepsis.
But that sounds awful, it is awful, Take heart, It
is very very very rare. It is about zero point
one percent expulsion rate chance with.
Speaker 3 (31:13):
That, and these are just more even more reason to
make 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. Another worst case scenario involves
(31:36):
a slightly elevated risk of pelvic inflammatory disease in the
first twenty days after you get your IUD inserted, and
when it comes to implants, incorrect insertion can cause discomfort
and ineffectiveness, and in the very very very super rare
case of pregnancy with one of these long acting reversible contraceptives,
(31:59):
you do have an element 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, their concerns,
we did have one listener who said, yes, I was
one of those people who had to endure an ectopic pregnancy.
So the risk is there, and again it is very small.
Speaker 1 (32:21):
Now in terms of who shouldn't get one of these,
especially for iud's people with untreated STIs, no, because insertion
can promote pelvic infection. Also, a good gynecologist is probably
going to make sure that you're tested before going anywhere
near insertion. Speaking of pelvic infection, not surprisingly if you
(32:45):
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 STIs, it is worth
emphasizing that even though it these these wonderful things dramatically
(33:08):
reduce our chances of getting pregnant, they do nothing to
reduce your chance of contracting st I. So you know,
don't throw away your condoms folks. And we should also
mention when it comes to having sex with IUDs that
at the bottom of these little T shaped devices there
are some strings that hang down, just a little tiny strings,
(33:30):
And if your sexual partner is like I think I
can feel the string, that's probably okay. It's it's not
terribly surprising, especially for digital penetration. But you might also
want to monitor your string because if you can't feel
them at all, because you can actually yourself reach up
(33:55):
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 expelled. I've
actually called my doctor before because a partner way back
when was concerned about feeling the strings, and it was fine.
(34:17):
It was totally fine. You know, just always pick up
the 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
to get into the more fascinating story of how they
(34:38):
came to be. And we're going to do that when
we come right back from a quick.
Speaker 3 (34:42):
Break and as we get into this history of the IUD, specifically,
we want to go ahead and give a shout out
(35:03):
to Chikako Takashida, whose dissertation Negotiating Acceptability of the IUD,
Contraceptive Technology, Women's Bodies and Reproductive Politics is a major source.
It's a very well, as you might imagine, it's a
very in depth dissertation. Does that even need to be said?
It's full of Chuck's chock full of great information.
Speaker 1 (35:22):
Good job.
Speaker 3 (35:24):
But basically, iud'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 overseas in Europe
than it is here, and a lot of that has
to do with some horror stories that we have and
(35:48):
some terrible things that we endured in the nineteen seventies
thanks to this thing called the Dalkon shield. You also
have issues in the way, hurdles like in shurance not
covering this device, which can be four hundred dollars or more,
and just general lack of awareness. I mean, I spoke
with some friends after I got my IUD inserted who
(36:09):
were still under the impression that IUDs 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 IUD memory lane first.
Speaker 1 (36:23):
Yeah, so 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 pessories, we
have used cervical caps, we have used all sorts of
(36:47):
things similar to iud's with a similar kind of strategy
in mind of really blocking the sperm from reaching dim eggs.
But in the late nineteen twenties, even though a doctor
in Japan tenray Ota was doing the exact same kind
(37:07):
of research and development at the exact same time, German
Ernst Grafenberg, he of g spot fame.
Speaker 3 (37:14):
Yeah, I always forget that, even though we talked about
him extensively in our Clitteracy episode.
Speaker 1 (37:18):
Oll Ernst. So doctor Ernst is a doctor g cited
as the inventor of the modern IUD, and his was
a small ring made of silkworm gut and coiled silver
that was inserted into the uterus and the cultural climate
in Germany was perfect for Graefenberg to get his proto
(37:46):
IUD on the map because a sex reform movement was afoot,
and he presented as a male doctor his device as
scientific hashtag credibility.
Speaker 3 (38:03):
But they weren't very effective and they cause a lot
of infections. Turns out silkworm gut not perfect. And once
we get into the nineteen sixties, interest in iud's is
reignited thanks to the Population Council, which had been established
in nineteen fifty two, and they do remain the number
(38:26):
one developer of IUD and Lark technology. They were actually
initially looking for a pregnancy vaccine and considered the pill
too expensive and user dependent, but there are layers there
to that idea of it being too user dependent.
Speaker 1 (38:45):
Yeah, so essentially what's happening are mostly a lot of
white dudes making a lot of classist and racist assumptions
about how poor women, especially women of color, both in
the United States and in developing countries, simply not be
trusted with their own reproductive health. So they are more
(39:05):
fans of the set it and forget it type of contraception.
And I didn't do much deep digging on the population Council.
But in general they I mean, their name kind of
says it all. Really they are, I want to say,
an NGO still around whose mission is population control, you know,
(39:30):
and especially focusing in on developing countries and low income areas.
This does start to intersect, especially around this time, with
eugenicis philosophy, and again just a lot of classism and racism.
But nonetheless they were the pioneers, the scientific pioneers of
(39:52):
the IUD, and in nineteen sixty two they hosted the
first international conference on the IUD.
Speaker 3 (40:00):
I bet they had great swag, all the goodie bags
full of silkworm gut. How do I get through all
what's at the bottom.
Speaker 1 (40:09):
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 my brain of you know,
what what is what is really? What is really the intent?
(40:29):
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.
Speaker 3 (40:37):
Yeah, but a question mark was one was not one
of the shapes of early IUDs, but there were several others.
Early iu d's were rings, bows, loops, coils. All of
these different shapes were patented. And you even had this
crazy straw looking thing, this loop, that became the go to.
Speaker 1 (40:58):
Yeah, the lip is became what they thought was going
to be the key to population control in developing nations
in particular. And listeners, imagine your head. How the IUD
today is very small, It's t shaped. The lip is
(41:20):
loop is just this zigzag back and forth and back
and forth.
Speaker 3 (41:25):
That looks it's really there to confuse the sperm more
than anything.
Speaker 1 (41:29):
You think, So it just it looks incredibly painful. But
and I'm so glad that it is not the current design.
In nineteen sixty nine, though, Population Council affiliated Chilean scientist
Jack Zipper, who has the best name of this podcast
so far, Jack the Zipper, Jack the Zipper Hold. Jack
(41:51):
the Zipper discovers the anti fertility effects of copper. He
was doing some research on fertility in rabbits and realizes, hmm,
this copper is a really effective contraceptive. Hello, proto parreguard
copper IUD.
Speaker 3 (42:08):
Woom, that's the force field again.
Speaker 1 (42:10):
The sperm forest field.
Speaker 3 (42:12):
Yeah, but when you hit the nineteen seventies and eighties,
there's a bit of a drop off because of the
nightmare that was the Dalkon Shield disaster. So this scary
looking thing which can look like a cartoon eye with eyelashes.
It can also look like a bacterium or some kind
(42:35):
of fishing lure, depending on which way you hold it.
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 infertility, and
fifteen women died.
Speaker 1 (42:56):
Fifteen women died in the process of miscarriage because of
this Dalkon shield. And the thing is I had known
about the Dalcon 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 Dalcon Shield d A
L K O N because how ugh it It just
(43:20):
looks 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. But surprisingly, it
wasn't this frightening looking evil eye design that caused all
the problems, but likelier, the thread that served as just
(43:42):
a bacterial infection canal, instigating all of these pelvic infections
that led to so many problems as a result, especially
in the eighties, as the company that released the Dalcon
shield was just flooded with lawsuits and Sheer company is
just moonwalk away. They're like, nope, we are out of
(44:04):
the IUD game. But that's the US.
Speaker 3 (44:09):
Yeah, 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 were being pushed
were like, hey, you've had one child, go with an IUD.
Oh hey, you've had to be sterilized.
Speaker 1 (44:29):
So that's that right. But there was, you know, as
all of this Dalkon shield nightmare was happening in the US,
China was definitely on the forefront of developing the IUD,
which in nineteen seventy nine, when the program was kicked off,
they had gone to the Population Council and had been like, hey,
(44:51):
what are y'all working on? We need something? Oh yeah,
this IUD thing. So it was fascinating to see how
all of this globally is starting to weave together back
to the United States. In nineteen eighty eight, after a
couple years where IUDs were nowhere to be found in
the US, the Paraguard the copper IUD was made available
(45:14):
to American uteruses once again, and in the nineties the
Marina which Caroline and I have was developed in Europe
and became super popular quite quickly. Twenty three percent of
French women on birth control today, for instance, use IUDs.
Twenty seven percent of Norwegian women on birth control use IUDs.
(45:37):
All of this to say that IUD use in the
US at what ten eleven percent right now is still
so much lower than use abroad.
Speaker 3 (45:48):
Well, yeah, and I mean the FDA was watching for
about a decade what was happening in Europe, essentially making
sure that there was not going to be another Delcon
shield nightmare of death and injury and unexpected regnancy. And
so I was actually ignorant of that fact that the
Marina and it's like weren't even available until the new millennium.
(46:13):
I kind of just had thought that they had been
around for and they have been around for longer, but
I mean available especially with insurance.
Speaker 1 (46:21):
Yeah, I mean, and for a while too, even when
they were made available again, most doctors wouldn't allow women
who had been pregnant before to use them. They were
all sorts of concerns, understandably, you know, because fifteen women
died hello, But there were a lot of concerns around
whether they were truly safe. And it turns out yes
(46:43):
they are. 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 time to take a pill every day,
you're busy with your kids.
Speaker 3 (46:59):
Well 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 this birth control to single women
and have people just willing nilly ditch condoms, for instance,
(47:20):
or think that they can just have unproductive sex forever.
Speaker 1 (47:23):
Unproductive sex. Unproductive sex, yeah, as in not having kids sex.
But that's the case today, I mean, thankfully, Like are
people are all about id's and I wonder if that
is at all correlated to like the growing population of
female obgyns, just just a thought. If anyone knows, let
(47:46):
me know. So, what's not to love about all of
this technology? Well, there are some feminist scholars who have
interpreted their development and use, particularly as it relates to
the Population Council and their implementation in developing countries and
(48:07):
promotion among poor women in particular, as coercive and even violent.
Speaker 3 (48:14):
Yeah, we read a lot in the dissertation about sort
of this history of forcing 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. In a lot
(48:36):
of countries, regions like Indonesia or India, it's viewed more
as almost punishment, as a way to control women.
Speaker 1 (48:45):
Well China, hellow, I mean that's like state propaganda right there.
I mean they refer to it as state imposed fertility control,
where it's not you know, white women like jumping up
in the air choosing our choice, but rather the government
choosing your choice for you. And again going back to
(49:06):
those you know, classiest 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. So and this
was an area, these these biopolitics, feminist biopolitics, were something
(49:26):
that I hadn't read before, and I'm curious to read
more about also because a lot of that information 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 that iud's are more
(49:49):
common and more affordable in the US in particular, but
there are also still a lot of barriers to use,
especially in developing countries, even though it is recommended by
the World Health Organization because increasing iuduse could be a
major boon to maternal health and of course managed population control. Still,
(50:15):
as of twenty fifteen, according to NPR, sixty one percent
of women in developing nations have unmet family planning.
Speaker 3 (50:23):
Needs right and so many of them, more than fifty percent,
get pregnant 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 to
(50:44):
i guess let their bodies recover essentially, especially if you've
had a traumatic childbirth. But some of the hurdles that
people are up against are things like menstrual taboos and
very real sterilization fears, because we do have this his
street globally of forcing women, particularly women of color, to
(51:05):
be sterilized.
Speaker 1 (51:06):
And Jill Philipovic a couple of years ago wrote a
terrific in depth piece for Cosmopolitan about the situation of,
or the challenge really of getting IUD access to women
in rural India because they tend to opt for the
pill over the paraguard. When it comes to iud's being sent,
(51:31):
you know, through nonprofits and NGOs, it's usually going to
be the copper IUD because it is much cheaper than
the hormonal version, as you might imagine, And in these areas,
the pill is chosen because what the paraguard. Remember that
one of the major side effects is heavier periods, And
(51:53):
if you are in a developing area, you might already
have entrenched menstrual taboos. But I mean, if you're on
your period because of that, 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.
Speaker 3 (52:11):
And you've also got the issue of the difficulty of
insertion even right after childbirth. And you know, another benefit
of course of the paraguard is it can remain in
for so much longer, so there isn't the every three
years or every five years. Even there's that nice ten
to twelve year stretch where you can just I mean,
(52:33):
you can just set it and forget it. Not to
sound globe, but there have been developments. There is this
new easy to use quote unquote IUD insert or developed
by Population Services International, which I feel like these names
need to be improved. Doesn't Population Services International sound like
(52:53):
something out of nineteen eighty four.
Speaker 1 (52:55):
I think they're related to the old school Population Council.
Speaker 3 (52:58):
Well, all right then, but this new inserter could make
IUDs more accessible and on top of that lowered the
chances of getting IUD related infections. The expulsion rates are
still comparable to those in the US right now.
Speaker 1 (53:15):
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 instruments to use, and apparently the existing inserter
(53:36):
that tends to come with a mariner or paraguard is
really flimsy and kind of hard to use if you
don't really know what you're doing.
Speaker 3 (53:42):
Yeah, it's not as long as as would be ideal.
And they mentioned I think this was still from Philipovic's article.
Right she she mentions how right now in the study,
when IUDs are inserted with these these new inserters that
have been developed, the doctors leave the strings long still
(54:02):
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 no, 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
(54:25):
trim those IUD strings.
Speaker 1 (54:26):
And most often that does happen right after childbirth. You know,
they come in to have the baby and like a
lot of women choose to then get a tubal ligation.
For instance, you can then get an IUD inserted. But
here in the US even there's still some mistrust around iud's.
(54:47):
Of course, there are horror stories because of you know,
people we might know or have heard about who have
had to deal with those very painful expulsions or even
rare perforations. And since though the election of Trump and
even more troublingly, former Indiana Governor Mike Pence as Vice president,
(55:13):
IUD searches have skyrocketed, skyrocketed, my friends, I am not
That is not hyperbole. You can see it. You can
see it in the Google 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
IUDs can run you eight hundred dollars. So there have
(55:38):
been a lot of women ever since that happened, ever
since November ninth, who have said get an IUD. Yeah.
Speaker 3 (55:48):
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 get your contraceptives of whatever kind taking of? And
I mean the response was overwhelming from women of all
ages and backgrounds saying I'm on the phone with my doctor.
I'm calling I'm going to planned parenthood. One woman literally
(56:10):
responded from her doctor's waiting room saying that she was
getting it taken care of.
Speaker 1 (56:15):
Yeah. So, I mean, this conversation is more relevant than
ever before, and even though we were only able to
offer just a tiny snapshot of a more global perspective,
it does go to show how again, reproductive rights are
very intersectional issue and affect different people in such different ways,
(56:41):
in the same way as birth control does. So perspectives
that you can share insights, questions, send them to us.
Mom staff at HowStuffWorks dot com is our email address.
You can tweet us at mom Stuff Podcasts. You can
directly tweet and follow me at Kristin Conger.
Speaker 3 (57:04):
And me Caroline Irvin at the Caroline IRV.
Speaker 1 (57:08):
And we've got a couple of messages to share with
you right now.
Speaker 3 (57:14):
Per well, actually, to be honest, we just have one
letter to read and it's from Allison. So. Allison saw
on social media that Kristin and I were gearing up
to do an episode on iud's and she, a fellow
IUD evangelist, had to write in. She says, I'm not
(57:35):
a medical professional or IUD salesperson. However, I am the
owner of one set of lady parts, my Lady Parts.
Alison writes. When I started college, I was prescribed the
pill for irregular MINSI 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, moodswingsh
(58:00):
and debilitating cramps. 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 eschewed hormonal birth control altogether because my side effects
(58:21):
were so bad. But I met an Englishman in two
thousand and nine and I needed to get birth control
stat After talking to my amazing lady obgyn who sets
my heart alight, and doing a little research, I told
her I wanted to try the IUD even though I
am nella Paris. I wanted to try the IUD for
a variety of reasons, but most importantly, I wanted something effective,
(58:43):
easy to use, and easy to reverse. Oh that, and
it was covered by my insurance one hundred percent. Only
my regular appointment COPE would apply. This was before the
legislation for covering birth control was passed, so my doctor
and I talked about it, and because I had a
bad reaction to hormonal birth control, she recommended doing the
paraguard the copper id. We giggled when she said that
(59:05):
she liked that one because she likes to 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 alight 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 anytime, just come in. When I've
told friends about the insertion process, I've described it like
(59:26):
sticking a straw in your huha then shooting a dart
into your uterus. But it didn't really hurt. I did
have cramping and a tinge of regret that I only
took four hundred milligrams of ibuprofen. 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 IUD to my best girlfriend after she had two
(59:47):
children fourteen months apart her she and her husband decided
their family was complete, at least for now. She wanted
to know about my experience, and she talked to her
obgyn and decided the marina was for her. I will
pretty much talk to anyone about my ID if they ask,
and have called out IUD deniers for just being lying
liars like those who say it's an abortifacient. Anyway, Englishman
(01:00:09):
and I got hitched in twenty fourteen, and I have
four more years of effective, safe 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 paraguard
because she's just in their chill and popping the heads
off sperm. Thank you so much for listening to my
story time. I've listened to you both for a few
(01:00:30):
years and appreciate so much your candor and the important
topics you discuss. Please let me know if you have
any questions I can answer. And Alison signs her letter
unicorns and empowerment and what a fabulous way to end
a letter. Thank you so much, Alison.
Speaker 1 (01:00:47):
And thanks to everyone who's written into us moms stuff
at HowStuffWorks dot com is our email address. And speaking
of email, y'all, in light of the post 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
(01:01:10):
Digest and you can subscribe at tiny letter dot com.
Slash Kristen, which is c R I S T E
n everlinks 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
(01:01:31):
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, visit houstuffworks dot
com
Hey, this is Annie and Samantha.
Speaker 2 (00:06):
I'm welcome stuff I never told you, obrection if I
hurried you. So this is another classic inspired by your
recent episode about gynecology, Samantha, because you mentioned in there
that they Kristen Caroline, the past host told your story
(00:30):
about getting it. Yeah, yes, and so I was like,
I wonder what episode.
Speaker 3 (00:35):
That one is.
Speaker 2 (00:38):
I yes, I found that episode about IUDs and I
was like, must be this one, correct, So I thought,
you know, why not bring that one back so people
kill can check it out?
Speaker 3 (00:53):
Perfect?
Speaker 2 (00:53):
Perfect, Well, please enjoy this classic episode.
Speaker 1 (01:00):
Welcome to Stuff mom never told you from houstuffworks dot com. Hello,
and welcome to the podcast. I'm Kristen and I'm Caroline.
And today we're talking about larking at a lark. Yes,
not to be confused with LARPing. Let's go larking. We're
(01:23):
talking about long acting reversible contraceptioning to make larking work.
Speaker 3 (01:30):
Oh right, right right yeah, And you and I have
been historically evangelists for our larks. Our IUDs are intruderine devices.
Speaker 1 (01:40):
Which I so often accidentally call either IEDs or UTI's,
both of which get a look.
Speaker 3 (01:50):
Uh dude, roommate when his girlfriend was getting an IUD
texted me to say that she was getting an IED
and I laughed, and I laughed and I said, I
I think you mean i u D. And he said,
I think you're wrong. I think she's getting an IED.
Speaker 1 (02:06):
I really hope not. It's not gonna go Well. If
it is, Yeah, intermittent explosive devices that they i stand for.
Speaker 3 (02:14):
You could argue that it would prevent pregnancy.
Speaker 1 (02:18):
That that is true. That's one way to go about it.
But IUDs are not the only thing we're going to
talk about in the first half of the podcast. Because
IUDs are not the only form of a long acting,
reversible contraception. We've also got to talk about the implant
and IUDs and birth control. Implants are considered really the
(02:42):
gold standard of birth control. And this is according to
both the American College of Obstetricians and Gynecologists as well
as the American Academy of Pediatrics. So doctor people, doctor
people in the know, doctor people in the know for
human people of all.
Speaker 3 (03:01):
Ages, right exactly. And it turns out, according to these
doctor people in the know, that both iud's and implants
are just as effective as sterilization. But of course, they
are reversible and not invasive. I mean, one could argue
that it does hurt to get an IUD sometimes depending
(03:25):
but they're recommended as first line contraceptives.
Speaker 1 (03:29):
And since two thousand and two, IUD use among American
women has quadrupled, And anecdotally I've noticed in the past
maybe two or so years, similar to the mainstreaming of menstruation,
kind of the mainstreaming of IUDs, everybody's talking about iud's.
Speaker 3 (03:51):
Oh, mainstreaming of menstruation. Is that what everybody on Twitter
is talking about when they do hashtag MSM.
Speaker 1 (03:59):
Don't I win?
Speaker 3 (04:00):
Don't we wish? Yeah, it turns out that ten to
eleven percent of US women who are on birth control
use IUDs, which is up massively from just about one
and a half percent in two thousand and two. And
it is worth noting side note that forty percent of
gynecologists who use contraceptives use.
Speaker 1 (04:23):
IUDs according to Vox, and over at the Goupmaker Institute,
we learned that 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?
Speaker 3 (04:43):
Well, Okay, you go out during a supermoon. Uh huh,
and you howl into the phone to your gynecologists and
make an appointment to get one of these devices, which
work extremely well. Now, a lot of people say, oh, well,
surely they're not that different in their effectiveness from the pill.
(05:05):
But you've got to keep in mind that we are
all in perfect people, and when we use the pill
or the neuver ring or the patch with typical use
as opposed to perfect use, 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.
Speaker 1 (05:29):
So with that in mind, let's hop into how IUDs work.
So there are two main types of IUDs. First up,
we've got the original, the old copper IUD brand named Paragard.
It can last for up to twelve years twelve years,
(05:50):
and this to me is the one that does seem
like magic because there are no hormones involved. They just
insert this T shaped little little piece of uh copper
into your uterus. But what happens is it essentially bathes
our uterine linings in copper ions that create and I'm
(06:11):
not exaggerating here. It really creates a sperm killing force field,
although you can't expect heavier periods. But in exchange for that,
that force field creates just a point eight percent failure rate.
Speaker 3 (06:29):
I am hoping that it also has like that movie
magic sound effect when you have like some kind of
force field.
Speaker 1 (06:35):
Of wom you know, wom, woom woom. Are those the
sperm running into the force field?
Speaker 3 (06:40):
Yeah, h for sure. I'm bumping their little heads and
being like, never mind, guys, let's get out of here.
Speaker 1 (06:46):
This also reminds me of those uh you know, those
metal bracelets that people wear that are sold like in
the back of magazines.
Speaker 3 (06:52):
Yeah, but those don't do anything.
Speaker 1 (06:54):
I don't think that those create sperm force field.
Speaker 3 (06:56):
Now, a pair reguard copper IUD can last you three
presidential terms. I don't know why I would say anything
like that, but I'm just saying three presidential terms.
Speaker 1 (07:09):
Yeah, two Trump and one Pence. Dear God, I think
my uterus just actually withered up and died. Next up,
we have the hormonal IUDs, 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
(07:32):
so do I. It lasts five years. There's also on
the market now, Skyla, which lasts three years. And I
just learned there are two others called the Liletta and Kylina. Yeah,
and y'all, Kyleina is spelled k y l e e
n A. And I'm just saying that Kylie Jenner is
(07:53):
really missing a branding opportunity here. So with these hormonal IUDs,
they use a hormonal called levanagestrel that thickens your cervical mucus,
which is really the first defense as sperm travel through
the cervix on their way to the uterus. So they're like, okay,
(08:15):
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 should fertilization happen, for implanting then to then happen.
And with those, unlike the copper IUD, you can expect
(08:38):
lighter or in my case, TMI alert no periods. Yeah.
Speaker 3 (08:43):
I have actually had both of these, so I can
speak to both of them. I started out with the scila.
I was instructed or advised to get the Scyla because
I am teens tiny inside and also have never given birth,
and my gynecologist was like, the smaller one might be
better for you. So I had that for three years
and I still got a monthly period, but it was very,
(09:06):
very light, very light. Now that I have the Marina,
I no longer get a monthly period, which is awesome.
I still do get PMS symptoms, my boobs get real
big and sore.
Speaker 1 (09:18):
Hashtag humble brag, that's.
Speaker 3 (09:20):
Right, but yeah, but no period. It's awesome. And what's
fabulous is you can really depend on these products. The
Morena has a failure rate of just zero point two
percent and the skyl Of failure rate is just point
four percent.
Speaker 1 (09:37):
Now, let's quickly, though, take a mythbusting detour to clear
up a little bit of misinformation, actually a lot of
bit of misinformation that's out there about iud'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 a feeling a lot of listeners might have seen
(09:59):
or heard or might just be worried about. IUDs are
not abortifations, and this was something that came up in
that Hobby Lobby birth control case that went to the
Supreme Court. IU d's were one of the things that
the hobby Lobby founders did not want to cover because
(10:22):
of the misinformation, the fallacy that IUDs are essentially little
abortion machines inside of us.
Speaker 3 (10:36):
Yeah, let's get something straight real quick. So, pregnancy is
when a fertilized egg is implanted, right, But contraceptives prevent
fertilization 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 episode, the copper IUDs are actually a fabulous
(11:00):
emergency contraceptive. Even when used up to five days after intercourse.
Those copper IUDs 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
(11:23):
a pregnancy. So, like Kristen said, the idea that an IUD,
whether it's hormonal or copper, can lead to abortion is
again a complete fallacy.
Speaker 1 (11:34):
Yeah, and this information too is coming from the American
College of Obstetricians and Gynecologists. We're not just We're not
just reciting NSNBC headlines here, folks, hashtag msn I don't know,
I'm trying to do a callback. So that's the situation
with IUDs. We also got to shout out the implants.
(11:57):
The brand names are implan On next plan On, and
implants are really what they sound like. They are thin
plastic match sticks sized progestin dispensers essentially, and progestin is
a synthetic form of the hormone progesterone, and these little
(12:18):
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.
Speaker 3 (12:31):
Yeah, and so when you use an implant, you can
expect spotting in the first six months or a year,
but one out of three women who have the implant
stop having a period all together. 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 zero point zero
(12:52):
five percent, which is fantastic.
Speaker 1 (12:54):
Yeah, I mean, it was a while back and I
forget what exactly it was about iud'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 d's are actually not the most effective, because in fact,
it's implants, which I'm even after all the research we've
(13:18):
done for this episode, I've walked away still not quite
clear on why implants are as rare as they still
are today. 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 putting these like little match sticks and a little
(13:41):
T shaped what's not inside our bodies and our utes
are on lockdown? Yeah, y'all, I mean, yeah, that is
That is the delightful truth.
Speaker 3 (13:51):
Yeah, it's really not too good to be true, which
warms my freaking heart because so often I feel like
we talk about things that are But we're going to
cite some 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 or contraception
(14:14):
and providing it to teens, or the issue of having
birth control and contraceptives paid for. And we're going to
have all of these sources over at stuffmon've never told
you dot com on our source post for this episode,
so you can, you know, send those links onto your family.
Speaker 1 (14:31):
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
free IUDs. And what happened is that due to this program,
(14:51):
between two thousand and nine and twenty thirteen, Colorado's teen
pregnancy rate dropped forty person And also this is important
to underline for conservative family members as well, people who
are opposed to abortion in general. In addition to the
(15:13):
teen pregnancy rate dropping forty percent, literally plummeting, the abortion
rate also dropped forty two percent. And in addition to that,
people who are not too keen on taxpayer dollars going
to subsidize single motherhood food stamp enrollment also dropped by
(15:35):
around twenty five percent between twenty ten and twenty thirteen.
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 IUD program. And money wise, do you understand
(15:59):
the impact back onto taxpayers. Each dollar a state health
department spends on long acting birth control IUDs or implants
translates to five dollars and eighty five cents of Medicaid savings,
and Medicaid covers seventy five percent of teen berths. And
(16:21):
these are a lot of percentages and numbers that have
all tossed out, but TLDR, these IUDs literally changed these
young women's lives because the highest teen pregnancy rates were
in the lowest income communities, as is often the case,
not just in Colorado but across the United States. And
(16:43):
the New York Times talked to one woman in particular,
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 due too being able to set
and forget this contraception, it allowed her to really set
(17:05):
up the life that she wanted for herself, you know,
coming out of very disenfranchised circumstances. So Colorado has been
a standout example of the power of these long acting
reversible contraceptives because by the way, that forty percent drop
in teen pregnancy rate is far and away faster than
(17:28):
any other states drop in teen pregnancies. Sounds great.
Speaker 3 (17:33):
I mean, how could anyone not support this?
Speaker 1 (17:37):
Because people get squeamish when it comes to young women
and the government subsidizing birth control, Republicans often aren't fans
of it.
Speaker 3 (17:52):
So yeah, and so this is according to an article
about this from Colorado's in PR station. 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
(18:12):
were able to push through two point five million dollars
in the state budget for it.
Speaker 1 (18:18):
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. But again, this is just a real
world example of how these things can really work and
(18:38):
not just work for you know, college educated, employed, middle
class white ladies like you and me, Caroline. But y'all,
it's not all candy and roses. I don't actually know
that any of it is candy and roses. Although you
your IUD doesn't get you roses, no, just carnations. But
(19:03):
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
iud's and implants because every body is different, and we're
going to get into some of those not so fun
facts when we come right back from a quick break.
Speaker 3 (19:37):
Yeah, okay, so you might imagine that when you are
inserting something, inserting birth control into your body, whether it
is an IUD 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,
but we've got to get you the rundown right of
(19:59):
what 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.
And the insertion, though, is generally faster and anecdotally a
(20:22):
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. And it's not that IUD insertion and
removal is not straightforward. There's just several more steps when
it comes to an IUD.
Speaker 1 (20:38):
Yeah, because instead of putting it in your arm, you
gotta get all the way up to your ute. So,
and yes, ute is my preferred term for uterus, because
why not. So the way that IUDs get inside of
us is Unfortunately, it wouldn't be cool if we could
like swallow them and they're just like, no, no, no, I'm
(20:59):
in your uterus. Nope, that's not how our bodies work.
So gynecologists, well, first you gotta go. You gotta get
in the stirrups, all right, So you're in the stirrups.
Speaker 3 (21:08):
You're on a horse.
Speaker 1 (21:09):
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. And they describe the
(21:29):
discomfort with this as a pinch. Yeah, Caroline's laughing, because
it is quite a pinch. Okay, it's it's quite a pinch.
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 your cervical canal, they do something called
(21:53):
sounding the uterus, which is a term brand new now
to Caroline and me, and sounding the ute is our
new battle cry.
Speaker 3 (22:04):
Yeah, imagine me with a conk shell, but it's actually
a uterus.
Speaker 1 (22:08):
Whenever you want to gather nasty women everywhere, you 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
(22:28):
the right sized iu D and the right place to
put it so it stays in place, et cetera, et cetera.
So so that's how sounding the uterus works. Not to
be confused with our battle cry of sounding the ute.
Speaker 3 (22:41):
Oh okay, well, uh so then your doctor will remove
the measuring rod and pop in another rod that actually
contains the IUD. Christens making a face, girl, I know,
and it's because of.
Speaker 1 (22:53):
Pop in I think, just popping it in.
Speaker 3 (22:56):
Hey, hey, guys, just popping in there. Just popping in
with I'm Skyla good In Metscha or Kylina. You can't
talk right now, okay, okay, no, because I'm screaming. 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 IUD in it, and
(23:16):
the doc positions it in your cervix, sticks it in there,
and it's hanging out like the kitten in the hang
in there poster in the bottom of your uterus, right
at your cervix.
Speaker 1 (23:31):
Just but it does not feel like claws or inside
inside of you. You don't once it's in there.
Speaker 3 (23:37):
No, yeah, no, no, and and it does it does
hurt there. There is a lucky minority for whom this
procedure feels like nothing more than a perhap smear followed
by some minstrel cramps. Uh. My friend Samantha is one.
Speaker 1 (23:52):
Of those people.
Speaker 3 (23:53):
She uh literally went running the same day, went back
to work. Yeah, A Christen's making a face.
Speaker 1 (23:59):
Do I know?
Speaker 3 (24:01):
Samantha has 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. For the middle group of people, it's
(24:24):
a moderately painful, yeah, not really painful process.
Speaker 1 (24:27):
That's most of us. For most people, it's going to
be moderately painful.
Speaker 3 (24:30):
For the rest of us, including your friend Caroline Irvine here,
it is severely painful. 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 iud's are incredibly effective,
as we have already laid out for you. That being said,
(24:50):
I was not one of the lucky ones who had
low to moderate pain. I was one of the ones
who literally tasted color. I developed apparently circumstantial sinis desia
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 tile in all,
(25:12):
and it was a nightmare. But the thing is, like
they give you the night before you take a medicine
that dilates your cervix so that your cervix is open
so they can more easily stick the ID in. Then
ideally you will take some type of pain medication, and
if you are highly, highly anxious or scared, they might
prescribe you like a low dose of valume or something
(25:33):
along those lines. 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 removed so that I could get my morina,
the removal felt like nothing.
Speaker 1 (25:55):
I mean it did.
Speaker 3 (25:56):
It felt like a pap smear. It was uncomfortable, but
not bad. And the insertion of the marina was a
little bit more uncomfortable than a perhaps mirror, but I
wasn't I didn't taste color. We'll just say that it was.
It was 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, or if maybe my tail and
(26:20):
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 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
(26:41):
Caroline throughout the first time.
Speaker 1 (26:44):
Yeah, 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, definitely take the they're
gonna prescribe you probably regardless, like the horsepill, ibuprofen. Yeah,
so just take that. And even if you don't have
someone who can drive you, I survive both times driving myself,
(27:07):
so we can do it. Because also the great thing
is it is discomfort for I mean in the rest
of the day you're crampy, But then you have birth
control for five years if you have the marina, which.
Speaker 3 (27:20):
Is a presidential term plus a year.
Speaker 1 (27:23):
Yes, which is good, which is good to know. I
think my marina right now, I'm on my second one
and it should last me right up through the end
of Trump. So happy for that. We also don't need
to talk about possible side effects after you get this
(27:44):
thing implanted, whether it's the IUD or the implant. And
this info is coming from Planned Parenthood Vox and again
the American College of Obstetricians and Gynecologists. So typically with
iud's the main side effects you're going to have are
some unpredictable menstrual spotting and bleeding. At first, I experienced this.
(28:09):
I'll just leave it at that. You may also experience headaches, nausea, depression,
and breast tenderness. Speaking to the depression aspects, IUDs were
implicated in a recent study that went viral about birth
control and female mental health, and it was particularly like
(28:33):
strongly correlated to women getting IUDs and then later getting
on antidepressants. Again, there's some correlation causation issue there, but
just something to keep in mind if you struggle with
mental health that it's just something again to just talk
to your doctor about. Right.
Speaker 3 (28:50):
And again, personal experience. Obviously my experience is not everyone's.
But I had been on the pill specifically yaz or
Yasmin for you years, about a decade before I went
on an IUD, and I never had never, never had
PMS with the pill, and I now on an ID,
I do get PMS, and that's again that's not going
(29:12):
to be the same for everyone. But I noticed that
that was something that changed for me. So things on
an IUD versus the pill versus no birth control whatsoever,
they're not necessarily going to be the same.
Speaker 1 (29:23):
And with implants, the major side effects sited 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, nausea, sore breasts, weight gain. I mean, honestly,
(29:43):
these are side effects that you see with a lot
of hormonal birth controls. And there 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 IUD expulsion. And this is probably the
most common scary story that you hear when you're, you know,
(30:07):
talking two friends about iud's because for about three to
five percent of people who get them in the first year,
your uterus might be like ha, now girl, Kylie, go
back to to Cabo. You know, they don't live in Cabo.
Calabases calabases. I know that, and I'm ashamed of that,
(30:30):
but that's likely because the gynecologists didn't insert it correctly.
If you're concerned about this though, watch out for cramping
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. Your IUD can actually puncture
(30:53):
your uterine wall, which could potentially harm your bladder and
intestine and if left untreated, lead to hemorrhaging and sepsis.
But that sounds awful, it is awful, Take heart, It
is very very very rare. It is about zero point
one percent expulsion rate chance with.
Speaker 3 (31:13):
That, and these are just more even more reason to
make 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. Another worst case scenario involves
(31:36):
a slightly elevated risk of pelvic inflammatory disease in the
first twenty days after you get your IUD inserted, and
when it comes to implants, incorrect insertion can cause discomfort
and ineffectiveness, and in the very very very super rare
case of pregnancy with one of these long acting reversible contraceptives,
(31:59):
you do have an element 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, their concerns,
we did have one listener who said, yes, I was
one of those people who had to endure an ectopic pregnancy.
So the risk is there, and again it is very small.
Speaker 1 (32:21):
Now in terms of who shouldn't get one of these,
especially for iud's people with untreated STIs, no, because insertion
can promote pelvic infection. Also, a good gynecologist is probably
going to make sure that you're tested before going anywhere
near insertion. Speaking of pelvic infection, not surprisingly if you
(32:45):
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 STIs, it is worth
emphasizing that even though it these these wonderful things dramatically
(33:08):
reduce our chances of getting pregnant, they do nothing to
reduce your chance of contracting st I. So you know,
don't throw away your condoms folks. And we should also
mention when it comes to having sex with IUDs that
at the bottom of these little T shaped devices there
are some strings that hang down, just a little tiny strings,
(33:30):
And if your sexual partner is like I think I
can feel the string, that's probably okay. It's it's not
terribly surprising, especially for digital penetration. But you might also
want to monitor your string because if you can't feel
them at all, because you can actually yourself reach up
(33:55):
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 expelled. I've
actually called my doctor before because a partner way back
when was concerned about feeling the strings, and it was fine.
(34:17):
It was totally fine. You know, just always pick up
the 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
to get into the more fascinating story of how they
(34:38):
came to be. And we're going to do that when
we come right back from a quick.
Speaker 3 (34:42):
Break and as we get into this history of the IUD, specifically,
we want to go ahead and give a shout out
(35:03):
to Chikako Takashida, whose dissertation Negotiating Acceptability of the IUD,
Contraceptive Technology, Women's Bodies and Reproductive Politics is a major source.
It's a very well, as you might imagine, it's a
very in depth dissertation. Does that even need to be said?
It's full of Chuck's chock full of great information.
Speaker 1 (35:22):
Good job.
Speaker 3 (35:24):
But basically, iud'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 overseas in Europe
than it is here, and a lot of that has
to do with some horror stories that we have and
(35:48):
some terrible things that we endured in the nineteen seventies
thanks to this thing called the Dalkon shield. You also
have issues in the way, hurdles like in shurance not
covering this device, which can be four hundred dollars or more,
and just general lack of awareness. I mean, I spoke
with some friends after I got my IUD inserted who
(36:09):
were still under the impression that IUDs 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 IUD memory lane first.
Speaker 1 (36:23):
Yeah, so 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 pessories, we
have used cervical caps, we have used all sorts of
(36:47):
things similar to iud's with a similar kind of strategy
in mind of really blocking the sperm from reaching dim eggs.
But in the late nineteen twenties, even though a doctor
in Japan tenray Ota was doing the exact same kind
(37:07):
of research and development at the exact same time, German
Ernst Grafenberg, he of g spot fame.
Speaker 3 (37:14):
Yeah, I always forget that, even though we talked about
him extensively in our Clitteracy episode.
Speaker 1 (37:18):
Oll Ernst. So doctor Ernst is a doctor g cited
as the inventor of the modern IUD, and his was
a small ring made of silkworm gut and coiled silver
that was inserted into the uterus and the cultural climate
in Germany was perfect for Graefenberg to get his proto
(37:46):
IUD on the map because a sex reform movement was afoot,
and he presented as a male doctor his device as
scientific hashtag credibility.
Speaker 3 (38:03):
But they weren't very effective and they cause a lot
of infections. Turns out silkworm gut not perfect. And once
we get into the nineteen sixties, interest in iud's is
reignited thanks to the Population Council, which had been established
in nineteen fifty two, and they do remain the number
(38:26):
one developer of IUD and Lark technology. They were actually
initially looking for a pregnancy vaccine and considered the pill
too expensive and user dependent, but there are layers there
to that idea of it being too user dependent.
Speaker 1 (38:45):
Yeah, so essentially what's happening are mostly a lot of
white dudes making a lot of classist and racist assumptions
about how poor women, especially women of color, both in
the United States and in developing countries, simply not be
trusted with their own reproductive health. So they are more
(39:05):
fans of the set it and forget it type of contraception.
And I didn't do much deep digging on the population Council.
But in general they I mean, their name kind of
says it all. Really they are, I want to say,
an NGO still around whose mission is population control, you know,
(39:30):
and especially focusing in on developing countries and low income areas.
This does start to intersect, especially around this time, with
eugenicis philosophy, and again just a lot of classism and racism.
But nonetheless they were the pioneers, the scientific pioneers of
(39:52):
the IUD, and in nineteen sixty two they hosted the
first international conference on the IUD.
Speaker 3 (40:00):
I bet they had great swag, all the goodie bags
full of silkworm gut. How do I get through all
what's at the bottom.
Speaker 1 (40:09):
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 my brain of you know,
what what is what is really? What is really the intent?
(40:29):
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.
Speaker 3 (40:37):
Yeah, but a question mark was one was not one
of the shapes of early IUDs, but there were several others.
Early iu d's were rings, bows, loops, coils. All of
these different shapes were patented. And you even had this
crazy straw looking thing, this loop, that became the go to.
Speaker 1 (40:58):
Yeah, the lip is became what they thought was going
to be the key to population control in developing nations
in particular. And listeners, imagine your head. How the IUD
today is very small, It's t shaped. The lip is
(41:20):
loop is just this zigzag back and forth and back
and forth.
Speaker 3 (41:25):
That looks it's really there to confuse the sperm more
than anything.
Speaker 1 (41:29):
You think, So it just it looks incredibly painful. But
and I'm so glad that it is not the current design.
In nineteen sixty nine, though, Population Council affiliated Chilean scientist
Jack Zipper, who has the best name of this podcast
so far, Jack the Zipper, Jack the Zipper Hold. Jack
(41:51):
the Zipper discovers the anti fertility effects of copper. He
was doing some research on fertility in rabbits and realizes, hmm,
this copper is a really effective contraceptive. Hello, proto parreguard
copper IUD.
Speaker 3 (42:08):
Woom, that's the force field again.
Speaker 1 (42:10):
The sperm forest field.
Speaker 3 (42:12):
Yeah, but when you hit the nineteen seventies and eighties,
there's a bit of a drop off because of the
nightmare that was the Dalkon Shield disaster. So this scary
looking thing which can look like a cartoon eye with eyelashes.
It can also look like a bacterium or some kind
(42:35):
of fishing lure, depending on which way you hold it.
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 infertility, and
fifteen women died.
Speaker 1 (42:56):
Fifteen women died in the process of miscarriage because of
this Dalkon shield. And the thing is I had known
about the Dalcon 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 Dalcon Shield d A
L K O N because how ugh it It just
(43:20):
looks 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. But surprisingly, it
wasn't this frightening looking evil eye design that caused all
the problems, but likelier, the thread that served as just
(43:42):
a bacterial infection canal, instigating all of these pelvic infections
that led to so many problems as a result, especially
in the eighties, as the company that released the Dalcon
shield was just flooded with lawsuits and Sheer company is
just moonwalk away. They're like, nope, we are out of
(44:04):
the IUD game. But that's the US.
Speaker 3 (44:09):
Yeah, 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 were being pushed
were like, hey, you've had one child, go with an IUD.
Oh hey, you've had to be sterilized.
Speaker 1 (44:29):
So that's that right. But there was, you know, as
all of this Dalkon shield nightmare was happening in the US,
China was definitely on the forefront of developing the IUD,
which in nineteen seventy nine, when the program was kicked off,
they had gone to the Population Council and had been like, hey,
(44:51):
what are y'all working on? We need something? Oh yeah,
this IUD thing. So it was fascinating to see how
all of this globally is starting to weave together back
to the United States. In nineteen eighty eight, after a
couple years where IUDs were nowhere to be found in
the US, the Paraguard the copper IUD was made available
(45:14):
to American uteruses once again, and in the nineties the
Marina which Caroline and I have was developed in Europe
and became super popular quite quickly. Twenty three percent of
French women on birth control today, for instance, use IUDs.
Twenty seven percent of Norwegian women on birth control use IUDs.
(45:37):
All of this to say that IUD use in the
US at what ten eleven percent right now is still
so much lower than use abroad.
Speaker 3 (45:48):
Well, yeah, and I mean the FDA was watching for
about a decade what was happening in Europe, essentially making
sure that there was not going to be another Delcon
shield nightmare of death and injury and unexpected regnancy. And
so I was actually ignorant of that fact that the
Marina and it's like weren't even available until the new millennium.
(46:13):
I kind of just had thought that they had been
around for and they have been around for longer, but
I mean available especially with insurance.
Speaker 1 (46:21):
Yeah, I mean, and for a while too, even when
they were made available again, most doctors wouldn't allow women
who had been pregnant before to use them. They were
all sorts of concerns, understandably, you know, because fifteen women
died hello, But there were a lot of concerns around
whether they were truly safe. And it turns out yes
(46:43):
they are. 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 time to take a pill every day,
you're busy with your kids.
Speaker 3 (46:59):
Well 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 this birth control to single women
and have people just willing nilly ditch condoms, for instance,
(47:20):
or think that they can just have unproductive sex forever.
Speaker 1 (47:23):
Unproductive sex. Unproductive sex, yeah, as in not having kids sex.
But that's the case today, I mean, thankfully, Like are
people are all about id's and I wonder if that
is at all correlated to like the growing population of
female obgyns, just just a thought. If anyone knows, let
(47:46):
me know. So, what's not to love about all of
this technology? Well, there are some feminist scholars who have
interpreted their development and use, particularly as it relates to
the Population Council and their implementation in developing countries and
(48:07):
promotion among poor women in particular, as coercive and even violent.
Speaker 3 (48:14):
Yeah, we read a lot in the dissertation about sort
of this history of forcing 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. In a lot
(48:36):
of countries, regions like Indonesia or India, it's viewed more
as almost punishment, as a way to control women.
Speaker 1 (48:45):
Well China, hellow, I mean that's like state propaganda right there.
I mean they refer to it as state imposed fertility control,
where it's not you know, white women like jumping up
in the air choosing our choice, but rather the government
choosing your choice for you. And again going back to
(49:06):
those you know, classiest 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. So and this
was an area, these these biopolitics, feminist biopolitics, were something
(49:26):
that I hadn't read before, and I'm curious to read
more about also because a lot of that information 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 that iud's are more
(49:49):
common and more affordable in the US in particular, but
there are also still a lot of barriers to use,
especially in developing countries, even though it is recommended by
the World Health Organization because increasing iuduse could be a
major boon to maternal health and of course managed population control. Still,
(50:15):
as of twenty fifteen, according to NPR, sixty one percent
of women in developing nations have unmet family planning.
Speaker 3 (50:23):
Needs right and so many of them, more than fifty percent,
get pregnant 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 to
(50:44):
i guess let their bodies recover essentially, especially if you've
had a traumatic childbirth. But some of the hurdles that
people are up against are things like menstrual taboos and
very real sterilization fears, because we do have this his
street globally of forcing women, particularly women of color, to
(51:05):
be sterilized.
Speaker 1 (51:06):
And Jill Philipovic a couple of years ago wrote a
terrific in depth piece for Cosmopolitan about the situation of,
or the challenge really of getting IUD access to women
in rural India because they tend to opt for the
pill over the paraguard. When it comes to iud's being sent,
(51:31):
you know, through nonprofits and NGOs, it's usually going to
be the copper IUD because it is much cheaper than
the hormonal version, as you might imagine, And in these areas,
the pill is chosen because what the paraguard. Remember that
one of the major side effects is heavier periods, And
(51:53):
if you are in a developing area, you might already
have entrenched menstrual taboos. But I mean, if you're on
your period because of that, 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.
Speaker 3 (52:11):
And you've also got the issue of the difficulty of
insertion even right after childbirth. And you know, another benefit
of course of the paraguard is it can remain in
for so much longer, so there isn't the every three
years or every five years. Even there's that nice ten
to twelve year stretch where you can just I mean,
(52:33):
you can just set it and forget it. Not to
sound globe, but there have been developments. There is this
new easy to use quote unquote IUD insert or developed
by Population Services International, which I feel like these names
need to be improved. Doesn't Population Services International sound like
(52:53):
something out of nineteen eighty four.
Speaker 1 (52:55):
I think they're related to the old school Population Council.
Speaker 3 (52:58):
Well, all right then, but this new inserter could make
IUDs more accessible and on top of that lowered the
chances of getting IUD related infections. The expulsion rates are
still comparable to those in the US right now.
Speaker 1 (53:15):
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 instruments to use, and apparently the existing inserter
(53:36):
that tends to come with a mariner or paraguard is
really flimsy and kind of hard to use if you
don't really know what you're doing.
Speaker 3 (53:42):
Yeah, it's not as long as as would be ideal.
And they mentioned I think this was still from Philipovic's article.
Right she she mentions how right now in the study,
when IUDs are inserted with these these new inserters that
have been developed, the doctors leave the strings long still
(54:02):
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 no, 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
(54:25):
trim those IUD strings.
Speaker 1 (54:26):
And most often that does happen right after childbirth. You know,
they come in to have the baby and like a
lot of women choose to then get a tubal ligation.
For instance, you can then get an IUD inserted. But
here in the US even there's still some mistrust around iud's.
(54:47):
Of course, there are horror stories because of you know,
people we might know or have heard about who have
had to deal with those very painful expulsions or even
rare perforations. And since though the election of Trump and
even more troublingly, former Indiana Governor Mike Pence as Vice president,
(55:13):
IUD searches have skyrocketed, skyrocketed, my friends, I am not
That is not hyperbole. You can see it. You can
see it in the Google 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
IUDs can run you eight hundred dollars. So there have
(55:38):
been a lot of women ever since that happened, ever
since November ninth, who have said get an IUD. Yeah.
Speaker 3 (55:48):
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 get your contraceptives of whatever kind taking of? And
I mean the response was overwhelming from women of all
ages and backgrounds saying I'm on the phone with my doctor.
I'm calling I'm going to planned parenthood. One woman literally
(56:10):
responded from her doctor's waiting room saying that she was
getting it taken care of.
Speaker 1 (56:15):
Yeah. So, I mean, this conversation is more relevant than
ever before, and even though we were only able to
offer just a tiny snapshot of a more global perspective,
it does go to show how again, reproductive rights are
very intersectional issue and affect different people in such different ways,
(56:41):
in the same way as birth control does. So perspectives
that you can share insights, questions, send them to us.
Mom staff at HowStuffWorks dot com is our email address.
You can tweet us at mom Stuff Podcasts. You can
directly tweet and follow me at Kristin Conger.
Speaker 3 (57:04):
And me Caroline Irvin at the Caroline IRV.
Speaker 1 (57:08):
And we've got a couple of messages to share with
you right now.
Speaker 3 (57:14):
Per well, actually, to be honest, we just have one
letter to read and it's from Allison. So. Allison saw
on social media that Kristin and I were gearing up
to do an episode on iud's and she, a fellow
IUD evangelist, had to write in. She says, I'm not
(57:35):
a medical professional or IUD salesperson. However, I am the
owner of one set of lady parts, my Lady Parts.
Alison writes. When I started college, I was prescribed the
pill for irregular MINSI 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, moodswingsh
(58:00):
and debilitating cramps. 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 eschewed hormonal birth control altogether because my side effects
(58:21):
were so bad. But I met an Englishman in two
thousand and nine and I needed to get birth control
stat After talking to my amazing lady obgyn who sets
my heart alight, and doing a little research, I told
her I wanted to try the IUD even though I
am nella Paris. I wanted to try the IUD for
a variety of reasons, but most importantly, I wanted something effective,
(58:43):
easy to use, and easy to reverse. Oh that, and
it was covered by my insurance one hundred percent. Only
my regular appointment COPE would apply. This was before the
legislation for covering birth control was passed, so my doctor
and I talked about it, and because I had a
bad reaction to hormonal birth control, she recommended doing the
paraguard the copper id. We giggled when she said that
(59:05):
she liked that one because she likes to 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 alight 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 anytime, just come in. When I've
told friends about the insertion process, I've described it like
(59:26):
sticking a straw in your huha then shooting a dart
into your uterus. But it didn't really hurt. I did
have cramping and a tinge of regret that I only
took four hundred milligrams of ibuprofen. 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 IUD to my best girlfriend after she had two
(59:47):
children fourteen months apart her she and her husband decided
their family was complete, at least for now. She wanted
to know about my experience, and she talked to her
obgyn and decided the marina was for her. I will
pretty much talk to anyone about my ID if they ask,
and have called out IUD deniers for just being lying
liars like those who say it's an abortifacient. Anyway, Englishman
(01:00:09):
and I got hitched in twenty fourteen, and I have
four more years of effective, safe 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 paraguard
because she's just in their chill and popping the heads
off sperm. Thank you so much for listening to my
story time. I've listened to you both for a few
(01:00:30):
years and appreciate so much your candor and the important
topics you discuss. Please let me know if you have
any questions I can answer. And Alison signs her letter
unicorns and empowerment and what a fabulous way to end
a letter. Thank you so much, Alison.
Speaker 1 (01:00:47):
And thanks to everyone who's written into us moms stuff
at HowStuffWorks dot com is our email address. And speaking
of email, y'all, in light of the post 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
(01:01:10):
Digest and you can subscribe at tiny letter dot com.
Slash Kristen, which is c R I S T E
n everlinks 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
(01:01:31):
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, visit houstuffworks dot
com
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