The casualties of contraceptive care

Getting my IUD was dehumanizing, but so is Canada’s entire medical system.

This article briefly mentions sexual assault and describes an IUD insertion procedure in detail. It may be triggering for some readers. If you require support, resources will be listed at the bottom of the article.

A few weeks ago, I threw on an episode of Seinfeld in an attempt to forget what I had to do later that day. I was a couple of hours away from getting my second Intrauterine Device (IUD) insertion, and the first procedure sixth months prior had been complicated and painful.

As a white, middle-class, cisgender person living in a Canadian city, I have incredible access to healthcare relative to so many others. My experience with reproductive health is essentially the best-case scenario, but as a woman in a heteropatriarchal, colonial, capitalist country, my best-case scenario for reproductive healthcare can still be traumatizing.

The Seinfeld episode I’d chosen did nothing to distract me from the topic of reproductive systems. One of the central storylines followed Kramer spinning out about whether his tight underwear was decreasing his sperm count.

I spent the rest of the time before my appointment obsessing over why contraception is so focused on cis women. Why aren’t there super-tight pairs of underwear cis men have to ask their doctor to prescribe and must then sheepishly pick up at the pharmacy counter for $35? Where are the contraceptive regimens for cis men?

I didn’t want to go to the appointment to be touched by another stranger. I wanted there to be another option.

Western medicine is not an infallible, objective system based on technological advancements. It reflects our society, and in Canada, that means our medical system often reflects the interests of racism, sexism, and colonialism.

An integral feature of colonial capitalism is the way it alienates our labour and further, alienates us from each other and ourselves. Through the modern medical system more specifically, we are alienated from our bodies.

Modern healthcare is an industry. I often have to walk into a five-minute-long appointment with a medical professional I just met and defer to their snapshot assessments when making major decisions about my wellbeing and my body.

When I went into my first IUD appointment at a Planned Parenthood in Saskatchewan last August, the nurse asked if I would be alright with a male student performing my insertion. Because I enter medical situations prepped to submit to a professional’s knowledge, I said yes before I could even think no.

As I was being led to the room, all I could think was no.

I was left alone in the examination room with the medical student as he nervously explained the risk of a perforated uterus and I stared blankly at his forehead trying to skip forward an hour.

The nurse came back to coach him through the procedure.

An IUD is a small, metal, T-shaped device that is inserted into the uterus, and will stay there for years preventing pregnancy as long as it stays in place. The insertion process generally involves a speculum that opens your cervix with a dull ache, a pinch when the person performing the procedure grasps your uterus with another device, a cramp when your uterus is measured, and another cramp when the IUD is inserted.

The student had to attempt the insertion twice and there was a lot more general fumbling than usual. This meant my cervix sat forced open by the speculum for much longer and I had a second cramp as the device was reinserted.

The nurse instructed him calmly and they discussed various aspects of the procedure while I lay staring at them, feeling like I wasn’t there.

As the student pulled the speculum out, the resulting feeling was too similar to penetrative sex and I began to shut down. When he wiped the blood off of my labia with a paper towel, my body had enough.

My physical and psychological response was similar to previous instances of sexual assault.

My mother is a doula who helps pregnant people through the medical system, and she is vehement about making sure the birthing person doesn’t feel like a patient—that they retain control.

That’s how I make sense of my reaction to the IUD insertion now—I felt like a patient. I felt no ownership over my person and that feeling echoed much deeper because the procedure involved my vagina, an unexpected man, my feet up in stirrups, and my knees laying open.

It felt like trauma.

I had asked to be there, and the clinic staff was providing a service that I had fully consented to, but still, the dehumanized feeling remained.

What is consent when it is given under the sense of having no other options?

I feel self-conscious about writing that question, about claiming I didn’t have other options, because I am someone with so many resources compared to others.

But I know this is not just a “me” thing, and it’s not about my individual experience of having prior trauma be triggered. I’m not alone in this.

20th-century poet Muriel Rukeyser once wrote, “what would happen if one woman told the truth about her life? The world would split open.”

Many of my friends have had traumatic experiences in the various branches of our healthcare system. We tell only each other, then we go back to our appointments and try again. What else is there?

I often talk with those same friends about the impossibility of democracy with truly informed voters in a country as large as Canada. I feel the same way about many cases of informed consent under our present medical system. So many people I know feel like passive bystanders to their own care. In modern cities, the exhausted employees in our overwhelmed healthcare system care more about getting us back out the door than informing us or even healing us.

I don’t feel as though the tender parts of my body were built to withstand that amount of strange, impersonal efficiency.

I don’t want to have to enter tenuous situations in which I am intimately touched by someone I don’t know in order to avoid pregnancy.

Mine is just one example of what day-to-day interactions with our current medical system look like for people with uteruses seeking to avoid pregnancy.

Dr. Lisa Campo-Engelstein, a bioethicist at the University of Texas, captures the emotionally exhausting larger picture in her scholarly article for the AMA Journal of Ethics, titled “Contraceptive Justice: Why We Need a Male Pill.”

“Beyond the health-related and financial considerations, there are also nontrivial inconveniences and burdens associated with contraceptive use,” she writes. She lists them in succession, a heavy block of text worth reading on your own.

Among those burdens is “dealing with the medicalization of one’s reproductive health.” This is no small thing. This is perhaps the thing that makes all the other inconveniences feel so large.

I don’t want cis men to have to endure similarly invasive procedures—I don’t want revenge. I want accessible, socialized healthcare that isn’t based on laziness, propped up against the idea that females must bear the burden of fertility and reproductive pain.

“Women are born with pain built-in. It’s our physical destiny,” Fleabag character Belinda, played by Kristin Scott Thomas, monologues in a standout second season episode.

“Period pains, sore boobs, childbirth, you know. We carry it within ourselves throughout our lives. Men don’t.”

That idea—that pain is inherent to possessing a uterus—allows medical researchers and doctors to dismiss and excuse a lot. Ask someone with endometriosis about their experience in the healthcare system.

We have pain built into our bodies, so what’s a little more?

Pain is what led me to seek another IUD insertion less than a year after that first August appointment.

Entirely because I suck at regularly taking my prescribed supplements, I’m anemic, which basically amounts to having low iron. For someone who gets periods, iron deficiency can mean that bleeding too much makes interventions like iron supplements generally useless.

My deficiency is pretty severe, and my copper IUD was making me bleed quite a bit. However, I’ve always had heavy periods, so I could have ignored it a bit longer had it not been for the increased cramping pain.

I had chosen a copper IUD in the first place because I wanted to avoid hormones, never feeling stable enough to test how they might impact my mood and interact with my mental illness.

The copper IUD is the only contraceptive besides a condom that does not contain any hormones, but it’s also known to increase period bleeding and cramping for at least the first few months after it’s inserted.

There is another form of IUD that releases hormones and is known to reduce bleeding. In Canada, it’s called the Mirena. I had been avoiding hormonal contraceptives for years because of my concerns surrounding hormonal birth control and mood imbalances.

I mentioned this concern, alongside my anemia, to many different health professionals, including the first nurse who helped me choose a copper IUD over the phone. None of them ever corrected me, not until my family doctor referred me to a gynecologist in the fall of 2020 because I was spending more time bleeding than not bleeding.

The gynecologist told me the Mirena IUD was not known conclusively to affect patient moods. She told me iron-deficient people should not have a copper IUD and that conversely, hormonal IUDs are often used to treat anemia.

After the appointment, I texted my physician sister-in-law and she explained that the hormonal IUD releases much lower amounts of hormones than the pill. Plus, because it is internal instead of oral, the hormones stay more locally in the uterus rather than travelling throughout the rest of the body’s system.

The same gynecologist inserted my IUD and talked me through the process as she did it, never touching me without telling me what she was doing. She even warned me before she wiped away the blood, acknowledging the awkwardness of this form of touch from a relative stranger.

I have had no complications with the Mirena so far, meaning only light bleeding and semi-frequent cramps. I would recommend it to anyone if the device itself wasn’t $400.

Since my second IUD insertion, I did a preliminary Google search on why there are no male contraceptives on the market

The first article I read explained that interfering with testosterone is “tricky,” which has slowed down the search for satisfying hormonal options. I’d argue anyone who uses the hormonal contraceptives presently on the market would certainly characterize them as “tricky” as well.

A BBC article mentioned previous studies into male contraceptives had stopped because men in the trial were experiencing mood disorders. The article also confirmed my suspicion that pharmaceutical companies are a large part of why there isn’t a male contraceptive yet. Apparently, there hasn’t been much interest from overwhelmingly male-led pharmaceutical companies to develop male hormonal contraceptives.

The one beacon of hope for male contraceptives that every article seemed to reference was an American clinical trial led by two female endocrinologists, that was presented for the first time in 2019.

The negative side effects of the daily oral hormonal contraceptives in the trial were small and longer trials are going ahead. One of the co-investigators said that “safe, reversible hormonal male contraception should be available in about 10 years.”

Is 10 years enough time for social opinion to shift on who bears the weight of reproductive responsibility?

It’s hard to imagine men taking it upon themselves to accept possible side effects from hormonal birth control when women have already been conveniently socialized to feel obligated to do it for them.

There is so much more I could say about reproductive health.

My mom would recommend that I end this article with a call to action for those who sleep with cis men to join me in a sex strike. I decided against it.

One of my sisters got pregnant despite having an IUD inserted and now uses her social work degree to help others navigate the healthcare system. My other sister teaches medical students how to give proper pelvic exams, using her own body as an example.

They are the two most important people in my life, and they have dedicated their lives to this issue. One of them was even waiting for me in the car during my first IUD insertion.

I just want us to be able to control what happens to our bodies.

That’s what reproductive justice has always been about—making it understood that having a uterus doesn’t mean you don’t deserve control over your own body.

That feeling of helplessness—of disassociation from full personhood—is everywhere in societies like Canada that are built on colonial capitalism. It is most potent for Indigenous people and other racialized Canadians.

I feel it just as a chemical side effect of my mental illness but also as a side effect of the dehumanizing system that attempts to treat my mental illness.

My meek hope is that I live to see a future where we can stop writing articles that seek to testify to something that has been long proven, and we begin instead to act and respond.

Less time spent on studies calculating exactly how many racialized women die in childbirth, fewer think pieces amounting to, “Gee, maybe Indigenous people had it right,” no more pretending that readers don’t already know, in our bones, what this system does and who it treats as less than human.

Before we get to that point, I’ll most likely have to return to that same Planned Parenthood for a pap smear. When I get back to the car, I’ll tell my sister about it, and her easy understanding will be my source of healing.

If you require resources or assistance surrounding sexual assault, please visit The CRVC for province-specific support. If you are exploring contraceptive options or care, learn how to advocate for yourself in those appointments. Additional crisis lines and 24/7 options can be found at The Lifeline Canada website.

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