Margaret Atwood has an eerie prediction about the outcome of abortionrestrictions, one that bears an uncanny resemblance to the dystopian future depicted in her hyper-relevant novel, The Handmaid’s Tale.
Speaking at New York City’s Book Con on Saturday, Atwood argued that when states obligate women into childbearing, they institute “a form of slavery,” Insider reported. State-mandated reproduction has two outcomes, she said: That women die, and that orphanages fill up.
Atwood referred specifically to Texas, where Gov. Greg Abbott is poised to sign Senate Bill 8. The legislation not only requires abortion providers to bury or cremate fetal remains, but also bans the most common second trimester abortion procedure — dilation and evacuation — as well as dilation and extraction, the typical procedure for late-term abortions. Dilation and extraction abortions are, generally speaking, only performedwhen the mother’s life or health is in danger.
“I’m waiting for the first lawsuit,” Atwood said, explaining that she expected families of women who died to sue the state. “I’m also waiting for a lawsuit that says if you force me to have children I cannot afford, you should pay for the process,” she added.
Author Margaret Atwood speaks after being introduced for the Ivan Sandrof Lifetime Achievement Award at the National Book Critics Circle awards ceremony on Thursday, March 16, 2017.
Texas’ long-fought war on abortion access correlates with two trends that bear out Atwood’s theory: Since the Lone Star State began purposefully funneling federal money away from abortion providers in 2011, both maternal mortality rates and birth rates have spiked, mostly among women who rely on government funds to get medical care.
The reality of Texas’ abortion restrictions, Atwood said, is state-mandated reproduction without a safety net — and that’s a problem:
They [Texas] should pay for my [a woman’s] prenatal care. They should pay for my, otherwise, very expensive delivery, you should pay for my health insurance, you should pay for the upkeep of this child after it is born. That’s where the concern seems to cut off with these people. Once you take your first breath, [it’s] out the window with you. And, it is really a form of slavery to force women to have children that they cannot afford and then to say that they have to raise them.
Her assessment looks a lot like the picture painted in Atwood’s 1985 novel, The Handmaid’s Tale. It’s currently experiencing a surge in popularity thanks to a Hulu show and a political climate in which abortion is demonized. Critics have drawn parallels between real life attacks on reproductive rights and female existence in the book’s fictional society, Gilead, where fertile women are conscripted as sex servants in the houses of powerful men. Their sole purpose is bearing children.
The difference between women in Gilead and women in Texas, though, is that the former are provided for. Atwood thinks Texas should, at the very least, do that.
“If you’re drafted into the army, the other situation in which the state seizes control of your body, at least you get three meals a day, clothing, and a place to sleep,” she said. “So, if you’re going to do that to women, pay up.”
If Roe falls, women may not face the same kinds of physical dangers from seeking abortion as in previous decades. Instead, however, I predict there will be far more criminal prosecutions of those involved in illegal abortion.63512
In fact, even as Roe remains the law of the land, women are in jail for attempting self-induced abortions.
Lauryn Gutierrez / Rewire
Evidence provided to Congress by state attorneys general and health departments proves that abortion is both extremely safe and highly regulated. Searchable by state.
The prospect of the overturn of Roe v. Wade—which the U.S. Supreme Court confirmation struggle over Judge Neil Gorsuch is highlighting—is terrifying to many, especially to those who remember the notorious pre-Roe days. It is also a real possibility, should President Donald Trump have the opportunity for another nomination, one that would replace a liberal judge with a “pro-life” one, as he pledged to do during the campaign. But if Roe falls, women may not face the same kinds of physical dangers from seeking abortion as in previous decades. Instead, however, I predict there will be far more criminal prosecutions of those involved in illegal abortion.
If Roe is overturned, the most likely immediate consequence would be that individual state legislatures would decide whether or not to allow abortions. According to legal analysts at the Center for Reproductive Rights, some 34 states are at risk of banning abortions, largely in the Midwest and South. About 40 million women live in those states. Predictably, many women seeking abortions will have to travel, paying not only for the procedure, but for transportation, lodging, and babysitters (nearly 60 percent of abortion patients already have children). These travelers, of course, may also lose wages for the time spent away from their jobs. One can safely assume that many won’t be able to afford an out-of-state option, as abortion patients are disproportionately among the poorest women in society.
Therefore, there will likely be a considerable increase in self-induced abortion. (In fact, such an increase is already occurring in the United States, as access to abortion is so difficult in many areas due to restrictive legislation and clinics being closed.)
What might we expect then? Will the abortion landscape resemble the pre-Roe days, when some scholars estimate that approximately 5,000 women per year died from illegal abortion in the 1960s, and tens of thousands more were injured?
If there is a second large wave of illegal abortion, a similar kind of danger is questionable. This is because of changes in abortion technology that have occurred since legalization. Pre-Roe, many women attempted to self-induce abortion by drinking dangerous substances such as turpentine and lye, and inserting various objects into their cervixes, including the infamous coat hangers. When they went to others—whether a medical provider or layperson—one of the main methods used was dilation and curettage, or the scraping of the uterus. In untrained hands, this was very risky.
Today, however, there is another method of pregnancy termination: “medication abortion,” which is in wide use in the United States and elsewhere. This method actually involves two drugs: mifepristone, formerly known as “RU-486,” which causes a fetus to stop growing, and misoprostol, a drug with several medical uses, which causes the cervix to open and the uterus to contract. Medication abortion is used both legally and extra-legally: Both mifepristone and misoprostol can be obtained over the internet, and misoprostol is available over the counter in many pharmacies in Latin America (and in flea markets in the United States).
To be sure, these drugs are not always 100 percent effective in ending a pregnancy. When they are ordered over the internet, the products are not always authentic or reliable, and misoprostol, often used alone because it is easier to get, is not quite as effective as the two-drug regimen. But even when ineffective, they are not usually dangerous. Some tragedies will inevitably happen with a large-scale return of illegal abortion, particularly among the young and most desperate, and among those who discover their pregnancies too late to use the medication abortion regime, which is largely recommended for use only through 10 weeks of pregnancy. Overall, though, women will not face the same kinds of death and injury as occurred before the Roe decision.
What will likely be different, however, is the degree of criminalization facing both women who attempt illegal abortions, and any providers or advocates who try to help them. Given the number of illegal abortions that took place before Roe (slightly more than 1 million per year in some estimates), it is striking in retrospect how relatively few prosecutions and jail sentences there were. This is not to suggest, however, that women who sought abortions and doctors and others who provided them were not terrified of being caught, as there was always the possibility of jail time, the loss of medical licenses for doctors, and public shame for both.
Today, though, anyone involved in illegal abortion would face a very different legal and political environment. In fact, even as Roe remains the law of the land, women have recently been jailed for attempting self-induced abortions. The Self-induced Abortion Legal Team has identified 17 known arrests or convictions in connection with alleged self-induced abortion since 2005.
There is already intense scrutiny and sometimes criminalization of pregnant women in the United States—and not only of those seeking abortions. This surveillance is made shockingly evident in a 2013 reportby researchers from the National Advocates for Pregnant Women and Fordham University, which tabulated hundreds of cases of pregnant women arrested since Roe for various reasons. In a particularly bizarre 2010 case, an Iowa woman who accidentally fell down a flight of stairs and sought help at a hospital was reported to police and arrested for “attempted fetal homicide.”
The main reason for this predicted difference in punishment before and after Roe is that in the earlier era, there was not in place anything resembling the national anti-choice movement of today. Prosecution before Roe was very idiosyncratic, dependent on local factors. But if Roe falls, criminal justice officials, from the virulently anti-choice Attorney General Jeff Sessions on down to local police and district attorneys in many jurisdictions, can be expected to avidly pursue those who break the law.
When Donald Trump, shortly after his election, was asked by a journalist about what the possible overturning of Roe would mean for American women who sought abortions, he casually answered, “Well … they’ll have to go to another state.” Yes, Mr. President, some will go to other states, but many others might go to jail.
What’s alarming about the administration’s plan – and how women should prepare
Contraception access advocates in front of the Supreme Court in 2014. Alex Brandon/AP
On Wednesday, Vox published a leaked draft of the regulation the Trump administration plans to use to gut the Obamacare contraception mandate – that is, the rule currently ensuring that most women’s insurance covers contraception without a copay.
Put simply, the Trump administration is planning to make it more difficult for women to use the insurance they earn and pay for to afford birth control pills, IUDs and other forms of contraception. In 2017. In America.
The administration’s plans fly in the face of public opinion, not to mention common sense and decency. The Obamacare mandate is supported by 71 percent of Americans, has caused out-of-pocket costs for contraception to plummet and has coincided with an acceleration in the decline in the abortion rate.
Still, contraception opponents who claim the rule infringes on their religious freedom have fought it for years, and the Obama administration bent over backwards to try to appease them. But what Trump’s leaked rule shows is that opponents’ ultimate goal was never to win exemptions from the law for religious groups – it was to block the government from expanding access to contraception altogether by freeing all corporations, no matter how secular, from requirements to provide equitable health coverage to women.
The long, often mind-boggling, battle over the Obamacare mandate is worth revisiting, to illustrate how we ended up here.
The first version of the rule exempted houses of worship from providing health plans that cover contraception. This was based on a “church autonomy” rationale – the idea being that someone who works for a church likely shares its beliefs and has consented to religious governance, voluntarily forgoing the protections employees enjoy under generally applicable law.
But the exemption for churches wasn’t good enough for contraception opponents. They insisted religiously affiliated groups like universities and hospitals shouldalsobe exempt. The problem with that idea is obvious: Accepting a job at a university, hospital or social service organization is not at all like joining a church. Despite the prevalent stereotyping of religiously affiliated institutions as places where one should expect bishops or other religious authorities to make the rules, they are in fact able to recruit employees and receive government funding precisely because they present themselves as largely secular institutions that are welcoming to people of all or no faiths.
So there’s no church autonomy rationale when it comes to these institutions, but the Obama administration came up with an accommodation to try and make them happy anyway – while still ensuring that women’s health care services would be covered, as men’s are. The workaround allows such institutions to opt out of providing contraceptive coverage by sending a two-page form to their health insurers self-certifying that they have a religious objection to insurance that covers birth control. The third-party insurer is then obligated to provide separate coverage to the employee, for which it is reimbursed by the government. Women get their birth control but not through the health plans of the religiously affiliated non-profits they work for. Everybody wins, right?
Nope. The Obama administration made the mistake of thinking the objectors were negotiating in good faith for a religious accommodation – when their realgoal was to torpedo expanded access to contraception altogether. The attempts to appease the objectors came back to bite the administration in an unprecedented litigation campaign led by right-wing Christian legal groups like the Alliance Defending Freedom and the Beckett Fund that involved more than 100 lawsuits. Secular for-profit corporations like Hobby Lobby sued to be given the same accommodation as religiously affiliated non-profits, and won at the Supreme Court. The non-profits also sued, claiming that filling out the form to get the accommodation – literally just filling out a form – violated their rights under the Religious Freedom Restoration Act since their employees would still end up getting contraceptive coverage in the end.
The Supreme Court wasn’t willing to go so far as to allow employers to block their employees from getting coverage from a third party through the government’s workaround. But the administration that Trump has filled with some of the nation’s premiere anti-contraception zealots is poised to give the objectors what the courts wouldn’t. When the coverage rule was first proposed, Cardinal Timothy Dolan explained the only outcome he would accept: “All Washington has to do is say, ‘Any entity that finds these mandates morally objectionable is not coerced to do them,’ and leave it there.”
Laws do not generally work this way – you don’t get to only follow the ones you agree with. But that’s precisely what Trump’s contraceptive regulation would do. Any employer that decides it has a religious or moral objection would be able to prevent its employees from obtaining contraceptive coverage – even employees currently receiving it through a third party. It’s an exemption that swallows the whole rule.
This is an example of a larger strategy by right-wing religious groups to attack legal protections that should be applied generally under the guise of “religious exemption.” For example, they’ve claimed that laws protecting the rights of LGBTQ people to adopt children violate religious organizations’ rights, only to admit they’re really objecting to any kind of organization having to abide by anti-discrimination laws.
These religious warriors against anti-discrimination laws will surely be emboldened if Trump implements the new regulation as written. However, women should not assume they are no longer entitled to contraceptive coverage. Despite the Hobby Lobby decision, most women – including those who work for religiously affiliated institutions – are currently entitled to birth control without a copay via the workaround. So this is a good time to get one’s birth control situation sorted out, before the Trump administration issues the new rule or otherwise dismantles Obamacare. In particular, women interested in long-acting removable birth control (like an IUD), which is more effective – and more expensive – than birth control pills, should take action pronto.
But even if the new rule goes into effect, don’t assume coverage is gone. Obamacare has strengthened the norms around birth control coverage, and we can expect most plans to voluntarily continue covering it. Furthermore, there is reason to believe the Trump rule won’t survive court review. It doesn’t comply with procedural requirements for issuing new rules – and, worse, it’s discriminatory. So as with many of Trump’s legallydubiouspolicies, expect it to be tied up in court for a long time.
Adding to the plentiful criticism of his controversial 2018 proposed budget, President Donald Trump’s proposed budget also allots millions to abstinence-only education programs — $227 million to be exact. While it’s unfortunately not an unheard of move for a Republican administration to support these sort of programs, investing in education policies that seek to shame and discourage sexual activity rather than providing information that allows young people to protect themselves remains deeply unsettling and insulting.
As concluded by countless studies over the last 25 years alone, these sorts of programs — which vehemently oppose promoting or even mentioning forms of contraception while discouraging all sexual contact “until marriage” — are considered aggressively ineffective. Research also shows that the states that rely on “wait until marriage” philosophies and policies actually have higher rates of teen pregnancy and sexually transmitted diseases. And it makes complete sense when you consider the fact that they’re straight-up refusing to tell young people about the tools available to prevent those things. But, more anecdotally, students who encountered these programs (and the few stray parents who sit in on lessons) report that the culture of shame surrounding sex adds yet another layer of insult to the injury of state-sanctioned ignorance.
With nearly 95 percent of Americans engaging in that sweet, sweet premarital sex on the reg, arguments claiming that having sex out of wedlock makes a person lesser remain fundamentally flawed. However, that still hasn’t stopped the steady flow of federal funding to these programs.
El Salvador has one of the worst records on reproductive rights in the world. Since 1998, Article 133 of the Penal Code has made abortion illegal in all circumstances, without exception, punishable by up to eight years in prison. Sentences of up to 30 years have been handed down when a judge determined that “homicide” rather than abortion had occurred. The Alliance for Women’s Health and Life has reported that 147 El Salvadorian women were charged with crimes relating to abortion between 2000 and 2014.
Because our laws are so draconian, so tilted in favor of the rights of fetuses over those of living women, pregnant women experiencing difficulties may not feel safe in El Salvador’s hospitals. We’ve all heard about Maria Teresa Rivera, who was sentenced to 40 years in prison after she miscarried. (She was released after serving four.) We are terrified of having medical problems during pregnancy as there is an underlying presumption of guilt. So women often suffer in silence, which causes further complications.
The U.N. committee stated that the country violates the basic human rights of women and girls, including their right to life, health, nondiscrimination, human dignity and the right over their own bodies.
Those who call for continued restrictions on safe and legal abortion in El Salvador fail to realize that making the procedure illegal does not reduce its prevalence. (The country’s Ministry of Health has estimated that 19,290 abortions took place between 2005 and 2008.) Lack of choice means that women tend to seek out dangerous covert methods, which put their lives at risk. These women are also reluctant to seek post-operative medical care after their abortions have taken place.
El Salvador is not supportive of women’s rights. The power of the Catholic Church and right-wing conservatives here and throughout Latin America has meant that our laws are not secular, but are heavily influenced by subjective interpretations of religion. The Trump administration has further exacerbated the problem by making it illegal for U.S. organizations providing international aid to so much as help women access information about reproductive rights, let alone provide abortions.
El Salvador is one of the most dangerous countries in the world for women. We have the highest rate of femicide in the entire world: A woman is murdered every 15 hours. A 2010 law made femicide a specific criminal category, but most perpetrators still evade arrest. The levels of gang violence and other forms of civil unrest are extremely high, and women bear the brunt of it both inside and outside our homes.
If Kansas state lawmakers have their way, women seeking an abortion in the state will first have to receive a detailed professional history of the doctor performing the procedure — and it must be in black, 12-point Times New Roman font on white paper.
The bill, believed to be the first of its kind in the country, would require abortion clinics to provide patients with printed information detailing doctors’ educational history, disciplinary and malpractice record, and when they started working at the clinic.
Doctors would also have to disclose whether they have malpractice insurance and admitting privileges at a local hospital, and if they are Kansas residents. Critics argue that such admitting privileges — which many states have sought to mandate — are not only difficult to obtain but medically unnecessary, as abortion clinic patients rarely have to go to a hospital. And due to a number of factors, including a lack of trained and willing local doctors, abortion providers often live far from their clinics or even out of state.
“I think this is a bill that will help women make the right choice or an informed decision,” Republican Sen. Rob Olson told the Kansas City Star.
Republican state Sen. Mary Pilcher-Cook added, “Women don’t leave abortion clinics whistling and jumping up and down…. They are in a very vulnerable state because the nature of abortion is ugly and is evil because it kills a human being.”
But other lawmakers condemned the bill as “simply harassment” and “discriminatory,” arguing that doctors who perform other medical procedures doctors are not held to the same standard. And Democratic state Sen. Marci Francisco pointed out that the state legislature routinely uses 10-point font on its bills.
“We should not ask to have someone provide something in a larger font than we provide the information to ourselves and our constituents on bills that are very important,” Francisco told the Associated Press.
The bill is still awaiting the signature of Republican Gov. Sam Brownback, who has signed every abortion restriction that has crossed his desk since he took office in 2011.
According to the Guttmacher Institute, a nonprofit that researches and supports abortion rights, Kansas already has a number of abortion restrictions on the books, including:
Women must wait 24 hours after getting counseling that describes the details and risks — a requirement critics argue is meant to discourage abortion — before they can receive an abortion.
Women must also receive ultrasounds of their fetuses, and the provider must offer to show them the ultrasound image.
Except in medical emergencies, abortion is prohibited at 22 or more weeks after a woman’s last period. Supporters say this is because fetuses can feel pain at this point in their development, a statement that is not backed up by medical research. According to the American College of Obstetricians and Gynecologists, fetuses generally become viable at 24 weeks.
A proposal in the U.K. Parliament would change a 19th-century criminal law that allows prosecution of people who end their own pregnancies. And in New York state, a bill moving through the legislature would remove abortion, including self-induced abortion, from the penal code.
The experiences of people seeking abortions from the U.K. to New York teach us that access to affordable clinic-based abortion is critical, but is not enough to ensure that no one goes to jail for ending their own pregnancy. Shutterstock
Abortion is among the safest medical procedures in the United States. Yet, myths about its safety abound. False Witnesses reveals the individuals behind these lies.
No one should face jail or arrest for having an abortion, especially in places where abortion is legal and generally accessible. That is exactly the scenario that politicians in the United Kingdom are trying to address by moving antiquated criminal abortion laws off the books. Legislators in the United States should follow.
Abortion is legally available in the United Kingdom, with the exception of Northern Ireland (where the procedure is only allowed when the pregnant person’s life is in danger). But even under the 1967 Abortion Act that is in effect in England, Wales, and Scotland, two doctors must agree that a woman’s continued pregnancy poses a greater risk than ending that pregnancy. Though doctors typically interpret the law liberally so that getting the signatures does not significantly delay most abortions, the law also requires that abortions much take place in a hospital or other clinical premises that have government permission to perform the procedure. That means family doctors cannot supply medication and women cannot use it at home, even when it is legally prescribed.
The result: Women who use abortion pills without doctors’ permission can face jail terms—which criminalizes patients in a way that doesn’t apply to any other health care procedure.
In March, U.K. Member of Parliament Diana Johnson introduced a bill that took the first steps toward decriminalizing abortions in the first two trimesters in England and Wales. Under the proposal, abortion would be regulated in the same way as other clinical procedures and women would not face jail for inducing their own abortions.
“There is no other medical procedure in this country governed by legislation this old, this out of step with medical developments and public attitudes,” she said.
Johnson was referring to the U.K.’s 1861 Offences Against the Person Act, which she proposes amending. This law made ending one’s own pregnancy a crime punishable by life imprisonment throughout the U.K., with the same penalty applying to anyone who assists. The 1967 Act did not overturn this 1861 law; rather, it created exemptions to prosecution for women and their doctors when certain criteria were met.
But both the Offences Against the Person Act and the 1967 exemptions were drafted at a time when no one could imagine safely and effectively ending a pregnancy with pills.
Medication abortion is increasingly preferred by women in the U.K.—and in Northern Ireland, where only 16 legal abortions were performed in 2015-2016. And women are increasingly obtaining pills online. While the choice for women in Northern Ireland used to be starkly positioned between finding the funds for travel to England for abortion care or having a baby, today women can find a safe solution on the internet.
But while Irish women who have used mail-order medications from organizations such as Women on Web report relief and satisfaction with the process, they face a serious danger that’s not medical in nature: punishment by the state.
In the last two years, women have been dragged through the courts in Northern Ireland, and police in Belfast raided activists’ homes looking for pills while they attended International Women’s Day rallies in March. In Northern Ireland’s two-tiered system where abortion is punishable under criminal law, some people seek abortion care under the looming threat of jail time.
And even where the Abortion Act does apply and lawful abortion is accessible, any U.K. woman who uses abortion medication purchased online could be sent to prison for life under the same 1861 Act used against women in Northern Ireland. For women with work and child-care commitments, the fact that lawful medical abortion can require multiple appointments and that pills cannot be taken at home at the time that best suits them makes unlawful online supply attractive.
Those of us in the United States, where Roe v. Wade remains the law of the land, might wonder: How is it possible that a legally protected medical procedure can be a crime? We need look no further than New York for an answer.
New York has long been a leader in ensuring reproductive rights, liberalizing its abortion laws in 1970—three years before Roe. But, as in the U.K., change came in the form of exceptions to a criminal law. To this day, even though abortion is generally accessible in urban areas and may be covered by Medicaid, abortion remains in the state’s penal law. In fact, any attempt to end one’s own pregnancy–even if it is unsuccessful, and even if the person isn’t actually pregnant–may be prosecuted as criminal self-abortion, which can carry a sentence of up to a year in jail.
Having such an outdated law lingering on the books is no idle threat: A handful of New Yorkers believed to have ended their own pregnancies have been arrested, most recently in 2011. Even if they weren’t convicted, the women were invasively interrogated about their sexual and reproductive lives, separated from their families, and shamed in the media. These prosecutions follow the usual pattern of criminalization in the United States, falling disproportionately on women of color and low-income women who are most likely to come under scrutiny of law enforcement or social services agencies.
But, like U.K. lawmakers, New York legislators have an opportunity to make a long-overdue change to the law. Propelled by concerns about federal rollbacks of abortion rights, New York lawmakers have proposed the Reproductive Health Act (AB 1748/SB 2796), currently awaiting consideration by the state senate after having been approved by the assembly months ago. This proposal would repeal abortion and self-abortion from the penal law, finally making good on Roe’s promise of decriminalization of abortion.
The experiences of people seeking abortions from the U.K. to New York teach us that access to affordable clinic-based abortion is critical, but is not enough to ensure that no one goes to jail for ending their own pregnancy. Nowadays, people may be pushed toward self-directed care by clinic closures and unnecessary restrictions, or pulled toward it by the private and personalized experience promised by abortion with pills.
At a time when aggressive, regressive anti-abortion forces are on the rise, it is tempting to batten down the hatches, defend the gains we have made, and make the best of the laws we do have. But it is also not enough that the law insulate certain types of people with certain types of abortions from criminalization. It should not create a threat in the first place.
“IUDs are making a serious comeback.” I say to a girlfriend over a Sunday morning walk.
“I thought IUDs were a new thing. Didn’t you just get one?” she asks me. It suddenly occurs to be that IUDs do feel new; this once retro form of birth control was relatively unknown when I was a teenager. I didn’t even hear of this option until I was at my first job at 23.
I caught myself pretending I knew everything about these devices when chatting with my friend, but my knowledge was relatively limited … and I have an IUD. Why is that? Why now? Women everywhere are in a rush to get IUDs, due to the uncertain political climate. I was among them. I got an IUD in January, just before Trump took office and documented my experience.
“Even before the Trump disaster, an IUD has been for many women the best method of contraception in terms of safety, reversibility, and efficacy,” Dr. Lauren F. Streicher, MD, Clinical Associate Professor of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern Memorial Hospital, tells Bustle. “By getting an IUD now, they will be protected for 3-10 years depending on which one they choose. Possible defunding of Planned Parenthood will make access even more limited. If Roe is overturned, not only will abortion become illegal, but many types of birth control as well (such as IUD’s) since far right extremists such as Mike Pence put their own personal beliefs above science.”
I stepped into the OB/GYN ready to have this implant inserted through my cervix and into my uterus without even doing that much research on the effects. I just assumed everything was going to be fine. Having an IUD is hip now — it’s cool.
According to a 2013 survey from Planned Parenthood, IUDs are the #1 choice of OB/GYNs for birth control. “I think the best candidate for the IUD are women who do not want to get pregnant for at least the next two years,” Dr. Fahimeh Sasan, Consultant Medical Doctor at Progyny and OBGYN at Mount Sinai tells Bustle. “It’s a great form of contraception because it doesn’t require you to do anything—once the doctor places the IUD you are all set.”
The recovery process from my procedure was arduous and painful. I didn’t feel OK for over two weeks. Even though I’m fine now, I still have questions about the IUD and why everyone’s so obsessed with it.
Due to my own neurosis, I’ve become hell bent on knowing everything there is about the intrauterine device … including its history. In case you too want to know, here is a brief history of the accidental winding road that lead to modern day IUDs — and our recent interest in getting implanted.
IUDs Date Back To The Victorian Era
When I think of birth control, I don’t think of the Victorian Era, but the history of birth control does go back further than you might think. IUDs were first invented in 1862 and the diaphragm in 1882.
The early invention of the IUD was not intentionally feminist. They were not originally designed to prevent pregnancy, but were meant to treat vaginal infections and injury such as prolapse, pregnancy prevention was somewhat of a happy accident (for us ladies, anyway). According to the Sexual Health Charity in the UK, “These were small button/cap shapes attached to stems, made of a number of different materials, which extended into the cervix.”
In the 1930s, smaller and safer IUDs (Ota rings) were introduced. These silver rings were far more effective than their predecessors at preventing unwanted pregnancy.
During the Sexual Revolution of the 1960s, IUDs were recognized as medically safe forms of birth control, and the copper IUDs we still use today hit the scene in 1962. See, you really are vintage after all.
IUDs Become Infamous
IUDs lost popularity as hormonal birth control pills hit the market in the ’60s. As Vouge points out, the pill was easier to get than an implant — making it the preferred form of birth control into the early 2000s.
IUDs became truly controversial thanks to, the Dalkon Shield in the ’70s. This notorious IUD allowed bacteria to enter the uterus and was allegedly the cause of death of 18 women do to infection. Nothing like 300,000 lawsuits and claims of death to deter someone from using an IUD, amiright?!
IUDs were only used by 6.4 percent of women in 2013. Up until then, they were out of fashion (er, to put it lightly) — right around when myself and my girlfriends became aware of them. From 2010-2013, IUDs saw a 33 percent spike.
The IUD’s Comeback
Now that memories of the Dalkon Shield are beginning to fade, and hormonal models like the Mirena and Skyla are down to a science, IUDs are finally making a glorious comeback.
Are We Going Fully Natural In Every Aspect Of Our Lives?
Whenever I ask a friend why she favors an implant, it’s always a similar answer, “I don’t want all of those hormones in my body. It’s not natural.”
Is an IUD just the next phase in our Millennial quest to be fully organic and all natural? Is placing a foreign object inside your uterus the best option? Have we gotten so entrenched in all things vintage or are we just reveling in the upgraded models of the past? There are certainly benefits. For instance, I recently wrote about the impact IUDs have on sex drive. Indeed, having a reliable form of birth control can relieve a lot of stress, but as many experts point out, the best birth control for you ultimately depends on you.
The controversy around contraception, the female body, and what is safe is far from over and as we move into the future, we have to take a dose of history with us so we don’t slip backward.
As for me, if I can have something popped into my uterus that allows me to have control over my reproductive system, I’m in.
Visiting a clinic privately and in peace should be a basic right, Philip Goldstone writes.
Dr Philip Goldstone: Providing safe zones where patients can access sexual and reproductive health services, including abortions, is a public health issue. Photo: supplied
This is not a new concept; Victoria, the ACT and Tasmania have these zones and shortly so, too, will the Northern Territory.
The zones ensure patients can enter a clinic without being harassed by protesters and recorded without their permission. They provide a bubble of safety around a clinic so patients can have their privacy upheld and can access sexual and reproductive health services without being intimidated.
Fortunately, there is a second chance to implement safe access zones with a private member’s bill due to be debated in the NSW legislative council. The bill, introduced by Labor’s Penny Sharpe, is a second chance for women in NSW to have some form of protection when it comes to seeking sexual and reproductive health services.
For me, and many of my colleagues working in sexual and reproductive health clinics across the country, safe access zones are a personal issue.
I am used to being told daily that I am going to hell. I am used to standing up to protesters who block my path when I am entering my workplace. I can handle the criticism spat at me angrily by strangers. I can do this because I strongly believe in providing sexual and reproductive health services to Australians no matter who they are or where they are.
While I am based in NSW, I have the privilege of working in Marie Stopes clinics across the country. There is a marked difference between places that have safe access zones and those that don’t. Since the zones were implemented in Victoria in 2016, the experience of entering our Maroondah clinic has changed. Where once staff and patients were yelled at and had graphic images thrust at them that are designed to misinform and manipulate, they are now able to attend the clinic in peace.
Whenever safe access zones have been implemented, anti-choice activists assert they will stifle freedom of speech and the right to protest. That is simply untrue. There is no evidence that the implementation of these zones limits debate on the issue of abortion.
The reality is that providing safe zones where patients can access sexual and reproductive health services, including abortions, is more a public health issue than a challenge to free speech.
Studies in the United States, most recently in 2013, have found a direct correlation between a patient’s negative emotional state and the presence of anti-choice activists at clinics. A qualitative study of women’s experiences accessing abortion clinics in the US between 2006 and 2009 also revealed patients attending clinics with protesters found the experience negative and, in some cases traumatic.
The decision to have an abortion is not one that is taken lightly, but it is a legitimate medical decision for a woman, her doctor and any other person she wants to bring into that decision. To stand in her way, literally and metaphorically, is not only a danger to her wellbeing, it is discriminatory.
In 1979, the Convention on the Elimination of All Forms of Discrimination against Women was adopted by the United Nations General Assembly. The convention defines discrimination against women as “… any distinction, exclusion or restriction made on the basis of sex which has the effect or purpose of impairing or nullifying the recognition, enjoyment or exercise by women, irrespective of their marital status, on a basis of equality of men and women, of human rights and fundamental freedoms in the political, economic, social, cultural, civil or any other field”.
Australia signed this convention more than 30 years ago, yet still we are debating whether to protect a woman’s right to access a medical procedure without discrimination.
The politicians of NSW have the power to stop the harassment and vilification of women entering clinics. It is the decent thing to do and it is the right thing to do.
Dr Philip Goldstone is the medical director of Marie Stopes Australia.
“California has great public policy regarding abortion access, but great public policy does not always translate to women being able to have greater access to care,” especially in the more rural spaces of the state’s Central Valley.
In California’s breadbasket, the Central Valley, the nearest abortion provider may be an hour’s car ride away or even farther on public transportation.
Evidence provided to Congress by state attorneys general and health departments proves that abortion is both extremely safe and highly regulated. Searchable by state.
Rosalinda Hernandez-Guzman grew up in the same Central Valley town where she is now raising her daughter. Visalia is rich in agriculture—fields of grapes, olives, and citrus ring the city—but it falls behind many other parts of California in access to reproductive health services.
Despite California’s progressive bent—there is a Democratic supermajority in both houses of the state legislature—pockets of the state are staunchly conservative, including some in the Central Valley. Even though abortion is legal under federal and state law, women here often have a tough time actually finding abortion providers.
“California has great public policy regarding abortion access, but great public policy does not always translate to women being able to have greater access to care,” said Amy Everitt, state director of NARAL Pro-Choice California.
This was the case for Hernandez-Guzman, now 21. Last summer, when her daughter was 2, Hernandez-Guzman became pregnant but knew immediately that she and her husband couldn’t support another child at the moment. They didn’t have enough money for a car or, at times, cell phone service, and Hernandez-Guzman had plans to go back to college to earn her bachelor’s degree.
“When it comes to diapers and clothes and formula and bottles, it’s overwhelming,” she said. “When you have prior bills and another child in diapers … the financial aspect was a huge part of the decision.”
Her decision made, Hernandez-Guzman needed to find a clinic. “There are zero” abortion services in Visalia’s Tulare County, population 460,000, said Sarah Hutchinson, senior policy coordinator for the nonprofit ACT for Women and Girls in the town. “Even for medication abortion, which is up to about 10 weeks [of pregnancy], women have to go to Fresno to get the pills.” That’s a 47-mile drive each way.
The situations for Hernandez-Guzman and others in similar towns show what could happen state- and nationwide if the Republican-controlled Congress and President Donald Trump limit abortion access and funding. When running for president, then-Republican nominee Donald Trump said that he would nominate anti-choice judges and that if Roe v. Wade were overturned, states would have jurisdiction over abortion access.
That would likely mean fewer resources for all communities, but compounded barriers for already underserved areas. If abortion does go back to the states, economic security and access to health care could even more heavily “depend on your ZIP code,” said Everitt.
Transportation Challenges
If Hernandez-Guzman had not talked with a friend who worked for ACT, she wouldn’t have known where to turn. Like many in the Central Valley, she was raised in a conservative Catholic Latino family and didn’t think she could ask her community for help. In her family,“we don’t talk about abortion,” she said. So Hernandez-Guzman approached her friend, who shared her story of an abortion at age 17, and helped Hernandez-Guzman make an appointment at one of two Fresno abortion-providing clinics.
“But then it was, ‘How am I going to get there?’” Hernandez-Guzman recalled. “It was just a frustrating feeling that I couldn’t just hop on a bus and just go.”
Buses do run between Visalia and Fresno, Hutchinson said. But the trip typically takes about two hours one way, and some routes can take up to four hours. Also, many people live in rural areas of Tulare County with no bus service. A California nonprofit, ACCESS Women’s Health Justice, has a hotline that people in need of transportation to an abortion appointment can call, but few in the Central Valley know about it, Hutchinson said.
Growing distraught, Hernandez-Guzman finally found transportation to the clinic. “It was hard, but luckily I had a good friend that just took me, no questions asked,” she said.
For women who live in more remote areas of the Central Valley, or for those who need later abortions, access is anything but guaranteed.
The Planned Parenthood clinic in Fresno performs abortions up to 17 weeks of pregnancy. But many Californians must generally go to Los Angeles or San Francisco to access a later abortion, Hutchinson said.
Furthermore, options tend to narrow for the 13- to 18-year-olds who are ACT’s clients. Hutchinson told a story of a 17-year-old girl whose mother found out that she had had a birth control implant in her arm and forced her to get it removed at a local clinic. When the girl became pregnant soon after, the physician assistant at the same clinic shamed her and tried to convince her not to have an abortion, Hutchinson said.
“These are a majority farmworker people breaking their backs with no health insurance, and the things that [health-care workers] say resonate with them and those folks believe them,” she said. “That’s what’s really upsetting to me.”
The girl, who was in an abusive relationship, eventually found help through ACT. “She said, ‘I need to not have a kid now—I need to get a college degree because I’m undocumented,’” said Hutchinson.
Hutchinson now is also working on state legislation, Senate Bill 320, which would require public college campuses with student health centers to offer medication abortion. Though the bill, introduced by Sen. Connie M. Leyva (D-Chino), won’t help young teens who need access to reproductive health care or women who aren’t enrolled in college, it would still greatly expand access across California, and particularly in the Central Valley—home to at least nine colleges that would fall under the umbrella of the legislation, Hutchinson said.
The bill passed with a 6-2 vote through the Senate Health Committee in mid-April and now moves to the Education Committee.
Nearly a year after her abortion, Hernandez-Guzman is preparing to enroll in college and working a secretarial job. She’s thankful she was eventually able to access the care. “I feel like, because of the position I was in,” she said, “I was making a mature decision in my life.”
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