The Global Biopolitics of the IUD: How Science Constructs Contraceptive Users and Women's Bodies

1. Turning the Gaze on Modern Contraceptive Research: An Introduction

1 Turning the Gaze on Modern Contraceptive Research: An Introduction It has been a half-century since the contraceptive pill and the modern intrauterine device (IUD) were introduced. These inventions were remarkable because birth control methods before the 1960s had a number of drawbacks . Surgical sterilization prevented pregnancy with high reliability, but was invasive and not reversible. Barrier methods such as condoms, diaphragms , cervical caps, and sponges had high failure rates and required action at the time of sexual intercourse. The new contraceptives, prescribed by doctors, were coitus independent, were reversible, and had low pregnancy rates. At a time when abortion was illegal in the United States, these medical methods were saviors for women who dreaded unplanned pregnancies . Population control advocates, who sought to decrease fertility rates in the global South, also eagerly received these new contraceptives. They welcomed the IUD in particular as a one-time-intervention method that would prevent pregnancy for a number of years after the device was inserted. In the past few decades, new birth control methods have been added. The female condom is a valuable addition to the barrier methods that simultaneously prevents sexually transmitted diseases (STD). Hormonal methods, which have been dominant, now include injections, implants, vaginal rings, patches, and the emergency contraception pill. The original oral contraceptive consisting of a high-dose combination of estrogen and progestin has been reformulated into safer lower-dose pills and progestinonly pills. Birth control pills that suppress menstruation are on the market as well. IUDs have been reformulated both materially and discursively, as this book discusses in detail. The “fit-them-and-forget-them” population control method has now become a “hassle-free contraceptive” for appreciative consumers. Research on male methods and contraceptive microbicides 2 Chapter 1 against HIV transmissions have also been underway, although their commercialization has been slow.1 Despite these new products, women around the world still face impediments to safe and autonomous control of their reproduction. Modern birth control technologies have simultaneously been a boon and a bane for women. Long-acting provider-controlled methods such as the IUD, injections, and implants are, as Adele Clarke labeled them, “imposable ”: they can be forced on women to contracept for a long period of time without allowing them to discontinue use at their own will.2 Coercion in using these methods has been a serious violation of the autonomy of underprivileged women. Furthermore, all medical methods introduce the possibility of health impairment, which can range from minor physical discomfort to debilitating side effects, serious illnesses, and even threats to life. For many women, protection from pregnancy has come with a cost. Women in some societies who contracept against the wishes of their husbands or in-laws take considerable personal risks since angering them could lead to domestic violence and divorce. Without doubt, contraceptives have played an enormous role in enhancing women’s lives by providing them with means to control their fertility. Yet medical contraceptives have also presented significant challenges to women’s well-being. Further complicating the significance of contraceptives, various groups—including the state, pharmaceutical industries, religious organizations , and feminist activists that are invested in the act of contraception for different ideological reasons—have assigned disparate meanings to this form of technological intervention in the body. For governments that regard overpopulation as a primary concern for the future of the state, contraceptives are the technological solution to a national problem. In economically developed regions where birth control is viewed as the responsibility or choice of the individual, government interventions are mostly limited to laws and policies guiding reproductive health care services. In these countries, the pharmaceutical industry and the market, social and religious values, and personal aspirations often have larger roles in shaping reproductive behaviors of their citizens. While curbing the birthrate of the poor and improving maternal health provide the framework for family planning in the global South, an entirely different set of concerns, such as profitability, liability, and health risks, determines the conditions of contraceptive use in the global North. Turning the Gaze on Modern Contraceptive Research 3 In both the global North and South, women’s access to contraception undermines the traditional gender roles prized by religious conservatives and the political Right. These groups regard contraceptives as threatening technologies and actively try to discredit them as well as keep women from accessing them. Feminists have been struggling against the encroachment of antichoice movements on women’s rights...