IUDs Won’t Save Us
Embracing Reproductive Justice for Our Collective Liberation
By Della Winters
This piece is a part of our Spark Series Reproductive Justice as a Human Right
In the wake of Dobbs v. Jackson Women’s Health Organization, the mainstream reproductive rights movement has remained silent on the onslaught of legislation restricting the rights of trans people, disabled people, and people of color. National reproductive rights organizations have persisted with their limited imagination of reproductive freedom by continuing to focus exclusively on legal access to abortion and contraceptives. The “victories” of legal protection for reproductive rights continue to exclude the most structurally marginalized people.
Female Empowerment through the IUD
Before organizers and political strategists even had time to process the loss of Roe, far right lawmakers across the United States made statements foreshadowing their support of legislation which challenges the legality of certain forms of contraception, often targeting emergency contraceptives (Plan B, morning-after pills) and long-acting reversible contraceptives (LARCs). Facing an uncertain future of access to contraceptives, patients have demanded access to IUDs. In the 3 weeks following the Dobbs ruling, Planned Parenthood reported a 41% increase in IUD appointments.
LARCs, which include the subdermal implant and intrauterine devices (IUDs), are more than 99% effective in preventing unintended pregnancies. Depending on the device, pregnancy prevention can last from 3–12 years after insertion. Described as “set it and forget it,” LARCs are promoted as effortless forms of multi-year pregnancy prevention for users after insertion.
Over the last 10 years, LARCs have been promoted by LARC manufacturers as devices that empower women. The front page of one IUD website declares “It’s time to make your move. Birth control, on your terms.” A different IUD brand website is more explicit by stating “My music is my baby right now.” Portraying the women in their commercials as smart, driven, and successful, these are women who are choosing to delay or prevent pregnancy because they are prioritizing their education, career, leisure, or parenting an existing child. The message is clear — with an IUD you can pursue your goals and dream without the fear of being derailed by an unwanted pregnancy.
Between 2006 and 2017, IUD usage among people aged 15–44 increased from 6% to 14%. Several factors have contributed to this expansion of IUD use. A new generation of IUDs are being marketed to people outside of the controversies involving Dalkon Shield in the 1970s. The Affordable Care Act expanded mandated, no-charge coverage of contraceptives. The median age of people in the U.S. giving birth increased to 30 as people prioritized education, employment, and financial stability before having a child.
The promotion of IUDs as devices of empowerment has expanded to health care providers as well. Two national organizations — the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) — have recommended the use of LARCs as the most effective reversible contraceptive for most people. These recommendations were based on the findings of the Contraceptive CHOICE Project which found that increasing LARC usage led to a “dramatic” decrease in unintended pregnancies and abortions.
As a result, providers were encouraged to use a tiered effectiveness approach in contraceptive counseling. “LARC-first” counseling recommends the most effective form of reversible contraceptives (LARCs) as the primary strategy to combat unintended pregnancies. LARCs have also been promoted to patients seeking abortion services to “prevent repeat abortions”.
The use of LARCs to reduce unintended pregnancies and abortions have also been embraced by politicians and non-profit organizations as “solutions” for poverty and low educational attainment. A coalition of more than 60 organizations in Colorado claims to have “dramatically reduced unintended pregnancy and abortion rates — empowering women, promoting effective family planning, saving the state millions of dollars and becoming a model of success”. In Tennessee, a non-profit organization provides free LARCs to “improve educational, economic, and health outcomes” for women.
Deciding whether to get pregnant and timing wanted pregnancies are essential to reproductive autonomy. Even before Roe was overturned, many people were already living in a post-Roe world: required in-person consultations with 72 hour waiting periods before an abortion procedure, undocumented people and non-citizens being excluded from public health insurance options, and 6 states having only one abortion clinic. However, the reproductive rights movement has promoted political strategies and organizing efforts around singular “solutions”: people volunteering to fly patients to states where abortion is legal and stockpiling emergency contraceptives and abortion pills. Calls to organize alongside all people who are facing ever encroaching restrictions to bodily autonomy have been non-existent from national organizations. Instead, many are following the lead of those who can already choose, access, and advocate for these forms of contraception continuing the exclusionary practices of white feminism within the reproductive rights movement.
No Unwanted Pregnancies, No Need for Roe
With Roe overturned, 13 states had trigger laws in place to immediately ban first and second trimester abortions. The realization one might not be able to obtain a legal abortion led to individual “solutions” to impending social crises. Reports of people close to the expiration of their current IUD who were seeking to replace the device early and stockpiling emergency contraception emerged within weeks of the ruling.
While everyone is affected by reproductive injustice, the experiences of people of color, disabled people, LGBTQ+ people, criminalized people, and poor people are ignored. In this moment — where our interconnected struggles have never been more visible — abortion has been further enshrined as the foundation of the reproductive rights movement.
By not advocating for more expansive and inclusive rights, Roe was already the floor of reproductive legal protections. The consequences of a singular focus on abortion as a political strategy ignored the historic and continuing reproductive control of LGBTQ+ people, disabled people, and people of color. Just like abortion and contraception bans, legislation criminalizing trans people from receiving gender-affirming care is a denial of bodily autonomy. People of all genders need access to affirming, affordable reproductive health care. People with disabilities already facing discrimination in health care settings are subjected to even more restrictions on their rights to reproductive self-determination. Immigrants and undocumented people face additional cultural barriers and risks of criminalization when trying to access abortion care.
The United States has targeted incarcerated, disabled, impoverished, “promiscuous”, and racially minoritized people for forced sterilization. Black people who were enslaved were subjected to reproductive control through forced relationships with other enslaved people, rape, and criminalization of people who had stillbirths. In the 1930s, the birth control pill was tested on the people of Puerto Rico without their consent or compensation. The fall of Roe represents another opportunity for those within the reproductive rights movement to follow the lead of those who experience the most reproductive oppression as a step into our collective struggle toward liberation.
Embracing Reproductive Justice for Our Collective Liberation
Despite the struggles ahead, reproductive justice provides a clear pathway forward. Combining reproductive rights and social justice, reproductive justice was developed by Black women to lead the national movement toward reproductive liberation by centering the people and communities closest to reproductive control and oppression. Reproductive justice is the right to bodily autonomy, to have children, to not have children (through abstinence, contraception, or abortion), and to raise children in safe and sustainable communities. While the right to safe, legal, and accessible abortions and IUDs is a part of reproductive justice, continuing with an exclusionary framework will not lead to reproductive liberation. Only by following the coalitions led by Black, Indigenous, and other minoritized groups can we move forward in our collective struggle toward reproductive freedom.
Dr. Della J. Winters is an Assistant Professor at California State University Stanislaus, whose research focuses on long-acting reversible contraceptives, surveillance, and reproductive control as expansions of the carceral state in the United States.
