The IUD: Can Birth Control Be Too Good?

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Photo: Eduardo Luzzatti/Getty Images

A friend and I were chatting about the cute children of Instagram when she sprang it on me suddenly, as if hoping to succeed by sneak attack.

“MOLLY!!!!!” she typed. “HAVE A BABY!!!!!!!!!!” This friend has had children and likes urging others to do the same.

Nope, I replied: “I still have a year left on my IUD.”

There are many reasons for me not to have a baby at the moment, but first among them is: I’ve got a hormone-coated piece of plastic in my uterus, it was totally miserable to get it in there, and there’s not a chance I’m having it popped back out again until I am absolutely sure that I’ve gotten my misery’s worth.

According to the National Center for Health Statistics, use of IUDs (and other contraceptive implants) has nearly doubled in recent years; though they still trail the pill in popularity, they’re the fastest-growing form of birth control, and with good reason. Their failure rate is less than 1 percent. Depending on the model, an IUD can provide as many as 12 years of effortless birth control, and ACA coverage means that it no longer costs hundreds of dollars upfront. Reliability through benign neglect: It’s a combination that has won the IUD devoted evangelists (and a New York City subway ad campaign). “Behind every successful woman is 14 even more successful women texting her ‘Stay strong you're gonna be so glad you got the IUD,’” tweeted Jezebel editor Jia Tolentino, who recounted her IUD journey for the site earlier this year.

In contrast to the pill, IUDs promise simplicity. Yet naturally they come with their own complications — subtler, maybe, than weight gain or weird moods, yet still changing the user’s relationship to her body in unexpected ways. In an age of IUD enthusiasm, I’ve been surprised to find myself with a mild, nagging sense of IUD ambivalence. The problem isn’t that I don’t think it’s great birth control; it’s that I do — and the total control over my life’s shape that an IUD offers turns out to be a daunting prospect. 

But start with the unsubtle fact of what it feels like to have an item, however small and flexible, jammed up your cervix. It feels bad: like your panicked uterus is clenching to repel the intruder, taking period cramps to a place past Advil, where you sweat and see lights and feel nausea, in my experience. “Discomfort” is how the official warnings refer to this, which should remind you that the medical Establishment also uses “comfort care” to refer to morphine.

Of course, it’s not hard to make the case that five to ten years of fail-safe birth control is worth a crummy afternoon at the gynecologist. Somehow, though, the medical valor involved seems to entwine with the evangelism. IUD insertion stories are birth stories for the childless. (To be fair, we are whiny; it takes significantly less cervical drama to freak us out.) What drugs did they give you? Did the doctor seem like she knew what she was doing? How long did it take? Did you pass out? Almost, though, right? The boyfriends who tend to figure into such stories contribute to a sense of rehearsal for future reproductive adventure. Was he kind, clueless, worried, calm? Did he hold your hand, buy you nice snacks, drive you home? By and large these boyfriends comport themselves admirably: They are clearly capable of loving, responsible care-taking behaviors. This is an irony of IUDs — if you’re getting one, you’re probably dating a person whose child you’d at least briefly entertain the idea of having.

In this sense, the 20- and 30-somethings inclined toward IUDs aren’t so different from the “Pullout Generation” Ann Friedman described in 2013 — ensconced in long-term relationships, tired of condoms and pills. But if pulling out means courting the possibility of a baby, allowing fate and your “pregnancy ambivalence” free reign, the IUD means eliminating this possibility pretty much entirely. It creates the slightly cyborg feeling that your fertility is a flippable switch.

With an IUD, pregnancy is not something I can drift toward vaguely or expect to somehow befall me, as has traditionally been possible. Condoms break; pills get skipped; pulling out seems good in theory. An IUD fills in the gaps where chance has always leaked into reproductive life. An IUD allows me to think of having a baby the same way I might think of moving cross-country: not impossible, maybe interesting to imagine (under the right set of hypothetical circumstances), but definitely a non-obvious turn for life to take at this juncture, and one that would require significant action on my part. My IUD ambivalence is, of course, actually baby ambivalence.

If the dominance of the pill created a new timeline for women’s lives (as Vanessa Grigoriadis suggested, on the occasion of its 50th anniversary), then the IUD gives that timeline crisp edges, new units of measurement, an unprecedented sense of certainty and control. In fact, this sense of certainty is probably particularly appealing to the recent 20-something cohort, a group that graduated into a recession and is still saddled with contingent employment and student debt. IUDs suggest foresight, planning, and responsibility, all of which is especially reassuring if you’re not sure how you’ll ever buy a house or save for retirement. The IUD often gets discussed as something you “don’t have to worry about” for years at a time. But that’s because it invents a new biological status quo, a new default setting — not pregnant, not going to be — for the duration. Far from being careless, it’s decisive on an unfamiliar scale.

“Choice” is shorthand for women’s reproductive freedom. Choice is also what leaves consumers paralyzed in the cereal aisle. What do you want? The IUD places this question in abstract, rational terms. It dismisses any fantasy of having decisions made for you, of getting exactly what you didn’t realize you wanted by surprise.

The little card they gave me at my IUD appointment was marked with a removal date five years in the future. I’d be 30! I guessed that meant I wouldn’t wind up a mom in my twenties; I guessed that was fine. What would happen at the end of five years? I still don’t really know: It’s a deadline I barely realized I was setting.