A Former Abortion Doula Explains Why an IUD Might Be Right For You

Illustration by Jim Cooke.
Illustration by Jim Cooke.

By noon on the day after the election, Google searches for IUDs were spiking—one of the most popular search terms overnight was, “Get an IUD now.” What’s long been an unpopular form of birth control suddenly took on a newfound appeal for one major reason: it’ll last longer than a Trump presidency. It’s a devastating trend, but it’s also a smart one.


I didn’t think the IUD was for me until I began working as an abortion doula and saw doctors recommend the contraceptive day after day to all sorts of patients as an extremely effective, long-lasting but easily reversible, no-regular-maintenance-required option. Since it seemed too good to be true, I figured there must be something wrong with it, otherwise I would have gotten one ages ago. Instead, when I asked my doctor about birth control options when I was 16, she didn’t even mention it.

The IUD was introduced to the American public alongside the birth control pill in the sixties and garnered immediate popularity. In the early seventies, over just a few years, an IUD called the Dalkon Shield led to 17 deaths, widespread incidences of Pelvic Inflammatory Disease, and a massive class action lawsuit in the seventies. Unsurprisingly, the IUD quickly fell out of favor.

In Europe, where the Dalkon Shield was less common, women continued using IUDs. They remain significantly more popular in most European countries than in the U.S., even as modern iterations have eliminated earlier problems. But today, many doctors still aren’t trained in implantation, insist that IUDs are only for women who’ve already had children (despite evidence to the contrary), and often fail to suggest it to those who’d most benefit, like teenage girls.

So, I picked birth control pills at 16 and worried constantly about missing a dose, waited in terror for my period to appear each month, and experienced a few less-than-pleasant side effects. It was hard to keep up with and I didn’t always trust that I’d been methodical enough. When I went to get plan B without my ID—thankfully I was by then eighteen—the (male) pharmacist refused to hand it over. “Come back with an ID,” he said, looking over my shoulder before adding, “Next!” I didn’t move right away. “You want me to have a baby?” I snapped, furiously. “I’ll bring you one in nine fucking months and put it right here on the counter for you to take care of!” I stomped out and later got Plan B from another Duane Reade once I’d found my driver’s permit. Of course, my big statement was marred when, three weeks later, I had to show up at his counter and wait while he refilled my birth control.

It became routine to leave a series of increasingly desperate voicemails for my doctor, begging her to write a script even though I hadn’t gotten a physical in ages. In fact, it was complaining about that exact situation that resulted in my IUD implantation. I was between shifts as an abortion doula, hanging out with my boss in her office. “I have one pill left and my doctor hasn’t returned my calls for days,” I said, playing with a mini-speculum she kept on her desk. “Maybe it’s time for you to finally get an IUD,” she said, “Ask Doctor W., she’ll put it in for you.”

I’d been toying with the possibility of getting one for months, but the idea of suddenly having the problem of birth control solved for five years made me jittery with excitement. So, eight years after becoming sexually active, I picked the Mirena, a hormonal option most often recommended by the doctors I worked with. It was supposed to last for five years; the copper IUD lasts twice as long and is hormone free, but it can result in heavier or more painful periods. When I asked one doctor if she’d implant one after our shift together, she told me to meet her in the exam room with my insurance card at 6:00. I was honestly a bit terrified. I took two Advil, spread my legs and tried to take measured deep breathes. “It hurts a lot, but then it’s over,” she said, “tell me when you want to begin.”


In Jezebel, Jenna Sauers wrote that getting her IUD felt like “someone throwing darts at my cervix.” I’ve yet to find a better description than that. After the pretty painful insertion, I treated myself to a cab home and rode uptown with my jeans undone in the backseat. For a couple of days I felt a vauge stabbing feeling in my uterus, then I didn’t really feel much. My period disappeared for a few months, when it came back it was lighter and less cramp-y.


The most lasting side effect writer Kat Stoeffel observed was the “quasi-religious fervor” of women who get them. I’m definitely one of Stoeffel’s “IUD evangelicals;” I’ve converted a handful of friends and am hoping my twin cousins will both get one before they start college next year.

But the IUD is about more than convenience. Before getting one, I’d accepted fear as an essential component of sex. It wasn’t until after I had a more than 99% effective form of birth control working away without my doing or forgetting to do anything that I began to finally began to tease those two things apart. Even though I didn’t start having sex until I was on birth control, I immediately learned that the punishment for sex was the fear of possible pregnancy. On the day of my graduation, I remember thinking, Okay, at least I didn’t get pregnant in high school. I wish at 16 my doctor had told me I could have sex without fear of pregnancy and that an IUD was a great way to achieve that.


For a number of women I saw come in and out of the hospital, the biggest appeal of the IUD wasn’t necessarily its effectiveness, but its undetectability. That women undergoing abortions for unplanned pregnancies are forced to prize the ability to secretly use birth control over how effective a given method is speaks to the devastating reality of reproductive coercion.

“Who’s picking you up today?” I would ask women in for abortions to suss out whether a teenage girl could rely on her mom or if the nervous-looking woman had to hide the procedure from her partner. There were other signs too. A woman would ask how soon she could have sex, and when told to wait two or three weeks, would wince. Sex wasn’t a choice for her. A teen girl in for her second abortion would shake her head to condoms, pills, patches, but then raise her eyes from the floor when the doctor said no one would find out she had an IUD. Carrying any confirmation of her sexual activity endangered her life with parents who constantly went through her things. (The IUD strings soften with time, but some women do report that their partners feel them; a doctor can clip them shorter if need be.)


If you’re under 25 or childless, your own doctor may give you a hard time or try to steer you in a different direction, so arm yourself with information. The American College of Obstetrics and Gynecologists have called IUDs the best form of birth control for both women and adolescents. You’ll have a better shot of getting an IUD inserted at a Planned Parenthood or a hospital based clinic than at a small practice of a doctor; they’ll also probably be more experienced inserting them.

A lot of those considering the IUD seem worried that they’ll get it, hate it, and then be stuck dealing with it for years. That’s not the case, but you should still read up on possible side effects. Most doctors recommend trying the IUD for six months before requesting a removal, since any side effects will usually even out by then. But you can get it taken out whenever you want and removal itself is generally less painful than insertion. You cough while the doctor pulls the small strings, the IUD’s arms fold up, and it slips out. Cramping and discomfort is normal.


There’s no way to get around the fact that insertion is painful. But you know what else is unbearable? Waiting in line every single month in the fluorescent-lit basement of Duane Reade for a birth control prescription refill. My insurance wouldn’t allow me to pick up more than a month at a time, and it usually took twenty minutes and most always induced a boiling rage. During the five year lifespan of my IUD, I’m saving 20 hours of facetime at Duane Reade. And, on some insurances, the IUD is completely free.

Another big concern I’ve heard is the fear that a sexual partner will be able to feel it, or, as one patient in for an abortion asked, “Isn’t it going to poke my boyfriend’s dick?” No. The IUD is inside the uterus where dicks and dildos and hands do not go. The only part of the IUD outside of the uterus is the small strings, which are largely undetectable.


Even though IUDs tend to be the most cost effective form of birth control over time, they do have a high upfront cost. Thankfully, they’re currently free with Medicaid. Here’s a breakdown of costs for those with varying levels of insurance. A number of insurance providers don’t cover removal, which is fucked up because it makes women feel entirely stuck in their choice and drives them away from what should be a reversible one. That said, if you’re getting it switched out for a new one or changing to a different form of birth control, it’s possible you won’t be charged for the removal. Prices can vary pretty widely, so call around.

Getting an IUD was a really positive experience for me, but I recognize that considering an IUD because of the current circumstances is less than thrilling. It’s sad to see fear drive a decision that can bring about such a sense of power. And sadder still that terror in being detected controlling reproduction has driven many women to the IUD in the past. Even if panic drives the decision, there’s strength to be found in taking care and control of our bodies.


Alex Ronan is a writer from New York now living in Berlin. Her mom was really proud when she had stuff in the New York Times. She’s also written for a bunch of other outlets on everything from reproductive rights to viral grief to one old guy in Ohio whose work predicted the recent rise of Birkenstocks.



I love my IUD—so, so much.

Here’s one thing that never gets talked about. An IUD is an awesome birth control option for the plus-sized crew (like myself). The Pill and other hormonal options aren’t super-effective if you’re over 175 lbs. So if you’ve got more cushion for the pushin’ or are just a fatty-fatty-sex-haver (like me), GET AN IUD! Tell ‘em AnneAnneAnne sent ya.