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

3. From the “Masses” to the “Moms”: Governing Contraceptive Risks

3 From the “Masses” to the “Moms”: Governing Contraceptive Risks I was looking forward to getting an IUD when I phoned the doctor at a local Planned Parenthood office in April 2002. So I was momentarily taken aback by the way she responded to my request for an IUD insertion. She immediately asked me whether I was married, and when I said no, she followed up with more questions: “Are you and your partner faithful to each other?” “How long have you been with this man?” “Are you and your partner committed to a long-term relationship?” and on and on. Why was she asking me such personal questions? I did not want her to refuse to give me my contraceptive method of choice. Fortunately, I recalled reading about screening out young promiscuous women because they were believed to be at a higher risk of contracting pelvic inflammatory disease (PID). Gathering my thoughts quickly, I volunteered some information: I was in my late thirties, had one child, and did not plan to have another one anytime soon. I added that even if I were to try to conceive in the future and experienced difficulties, I would not know if my advanced age or the IUD were to be blamed. With this assurance, the doctor agreed to insert an IUD in me.1 In retrospect, I was fortunate to find a willing doctor. In 2002, many physicians still believed IUD insertions were risky, and the number of prescriptions was low.2 My exchange with this doctor exemplifies the kind of scrutiny over sexual relationships, age, number of children, and willingness to consent to risk that women still receive as a prerequisite to IUD insertions in the United States. IUD developers were initially reluctant to necessitate user screening, viewing it as counterproductive to their goal of population control. The contrast between the indiscriminate insertions of the 1960s and this current climate of careful identification of a user that the doctor deems appropriate is remarkable. Of course, 74 Chapter 3 forty years had passed by the time I was calling Planned Parenthood, and the geographical and social contexts were vastly different. Nevertheless, I note this contrast because it highlights how different women’s bodies are managed differently for divergent reasons. The historical process that transformed the ideal users from the masses to the moms involved the reshaping and multiplication of biopolitical subjects, or kinds of bodies regulated by the IUD, in accordance with the transnational political economy. This chapter charts how IUD researchers have engaged the issue of risk associated with contraceptive use since the 1960s. It illustrates how ideas about risk are co-constitutive with different implicated users, bodies, and modes of governance—or biopolitical scripts—that have emerged around this contraceptive method over the past five decades. As IUDs reached middle-class users in the mid-1960s, its developers were compelled to revise the concept of IUD users as a homogeneous mass because the U.S. social context introduced new concerns around contraceptive use that were not considered when IUD supporters were focusing on women in the global South. Departing from the view of users as uniformly underprivileged, undereducated , and excessively fertile women, or targets of population control , researchers on the device began to take into account differences in women in terms of their race, class, nationality, age, marital status, childbearing history, and sexual activity. IUD developers, who had once assumed that health risks associated with the device were negligible, also began to reconceptualize bodily and other risks in accordance with the shifting social and geographical contexts. Changing situations gave rise to concerns such as teen pregnancies, infections or other health complications, and lawsuits against medical practitioners and device manufacturers, while they produced different meanings of “risk” with various profiles of “risky” users. At the same time, certain “safe” bodies were differentiated from dangerous ones and presented as appropriate users of the device, which its researchers considered to be an inherently safe technology. Different modes of governance, or a range of strategies to discipline diverse female bodies to avoid risk, were formulated within the IUD discourse. I begin with a story that is familiar to many readers in the United States: the Dalkon Shield fallout that began in the early 1970s and its aftermath that continued through the 1980s. The shield was created and distributed independent of the Population Council’s efforts to establish the IUD as an From...