The day after the 2016 presidential election, I called my doctor and made an appointment to get an IUD. I was seven years into a ten-year ParaGard, not due for replacement until 2019, but imagining what women’s health care would look like in 2019 made me want to set myself on fire.
My memory of that day is blurry at best. I’d left the election party in my living room—what started as a celebration and ended frozen and furious watching the returns—and curled around my small, sleeping son as if my body could still protect him. In the morning, I searched for age-appropriate words to explain. In the afternoon, I went to my creative nonfiction class and tried to teach. We read Toni Morrison. We talked about what we could do: write, read, donate, march, listen, dialogue, and then one of my students raised her hand and said, “We should hoard birth control.” We laughed. It felt good to laugh. And then, very quickly, it wasn’t funny anymore.
I went to my office and made the call.
The birth control mandate under the Affordable Care Act makes insurance plans provide women with contraception at no additional charge, which means we pay a couple hundred dollars out of pocket for an IUD instead of a couple thousand. I am a person who, at this stage in my game, can afford a couple hundred. I have not always been that person, which is why I give to Planned Parenthood every month. I’ve never been a person who can afford a couple thousand, and I’m far from the only one : Planned Parenthood reported a 900 percent increase in requests for IUDs after the ninth of November. For commercially-insured patients like me, IUD-related visits went up 19 percent, and many women are stockpiling the morning-after pill. “But don’t worry,” we were told as we scrambled to protect ourselves, our bodies, our futures. “Nothing will happen overnight.” It didn’t. It happened in six months. It’s happening right now.
*
I know they’re not for everyone—our bodies are as varied as the flowers in a greenhouse—but me? IUD, all the way. I don’t have to think about it. It eased my gut-punch of a period, and god, what a gift, to walk through the world without pain. It lasts up to ten years and is 99.9 percent effective. The kind I have is wrapped in copper, which makes the body produce fluids that are toxic to sperm. Per Cosmopolitan : “ To get an IUD is to immediately join a thriving coven of women who have taken a commonplace but metal-as-fuck measure to prevent pregnancy.”
A tiny plastic T is inserted into the uterus in a one-time procedure that takes two minutes. Best of all, it’s easily reversible for people who don’t want a baby, or in my case, another baby, at least not yet. Maybe we’re still thinking about it. Maybe we’re planning, saving, working. Maybe we’re scared to bring a child into this beautiful mess of a world. Whatever the reason: We want to be sure that motherhood is right for us and, if so, that now’s the right time. How did being thoughtful become a point of political contention?
*
This is, of course, America. There was, of course, a catch.
I could have a new IUD, my doctor explained, sitting in her office a week after the election. However— she gave a clipped sigh, letting me know exactly what she thought about this however —she could not perform the procedure. She was listed as a family practitioner, and even though she’d been taking care of my body for years, even though I could hop on her table right there and be done in a few short minutes— for my insurance to cover the expense, I would have to see a specialist.
She gave me a list of ten clinics in network and I went home to make calls, panic buzzing in the back of my head. This needed to happen now; before the end of the year, at least. I’m not sure why I locked on that particular time frame. The world would not run out of IUDs. Insurance companies couldn’t bill us retroactively. We’d have the ACA through 2017. Right?
I could afford out-of-pocket insurance, at least for the time being. I have geographical access to reproductive care. I am able-bodied—“temporarily-abled,” my friend Maria reminds me—and the disability community will be the hardest hit. I am white—in study after study, racial and ethnic minorities receive poorer quality care in this country —and cisgender—health care discrimination is one of the many ways that transgender Americans are marginalized. I thought about sick kids threatened by lifetime limits and cuts to Medicaid. I thought about how more women die from childbirth in the United States than any other developed country. I thought about how taking care of our bodies is a privilege when it should be a right.
Nine out of the ten clinics I called were booked through the end of the year, but the last one could fit me in at the end of the week, if I was open to seeing a male doctor.
*
A memory I carry not in my head, but my bones: I was nineteen years old, on a year-long study-abroad program in Italy, and the pregnancy test was positive. A teacher helped me find a gynecologist and I showed up at the address, unsure what to expect. Could I ask for an abortion? Could I ask for birth control? I looked up the word pregnant in my Italian/English dictionary and the verb conjugation for do not want.
A man opened the door and it took me a moment to understand that he was the doctor. I’d never had a male doctor. The office was less office and more private home: love seats, drapes, a stained-glass lamp. There was a table spread with clean paper, and I was instructed to undress. These instructions came in Italian and mine was choppy at best. Maybe I misunderstood? I asked for a paper robe, but maybe I said it wrong. He told me again to undress and patted the table, like sit here. He watched while I took off my clothes. I’d modeled naked for a few art classes to make extra money, so I pretended that’s what was happening.
He got down between my legs, and I stared at the ceiling and told him I didn’t want to be pregnant. He said I wasn’t. We went back and forth: him frustrated, me confused. I said the stick had turned pink, but maybe I said red. Did it matter? What the hell was happening? I’d spent an excruciating week thinking I was pregnant, telling my boyfriend, making decisions. Eventually I started crying, humiliated and exposed on that fucking table. I wanted my mom. I wanted a woman. I wanted a common language. I’m not talking about English, although that’s true, too. I’m talking about the language of the body, messy and complicated and impossibly tangled with our heads and hearts and fears.
*
My in-network specialist-gynecologist’s office was on the third floor of a nondescript building at the backend of Evanston, Illinois. Think packaging plant, not health care facility. The waiting room was dark purple-red, like a growth. It was the last day of November and there was one holiday decoration: a banner made of tinsel that said MERRY JOLLY JOY.
It had been twenty-one days since the election. Wisconsin was doing a recount and back then I still had hope. Maybe this would be the thing. There had to be a thing, right? Evidence of wrongdoing. Voter fraud. Impeachment. Natural disaster—say, a giant meteor headed toward earth. Space invasion, maybe. Zombies? Zombies are easier to accept than the truth. There have been a thousand things. None of them matter.
In a stunning display of fuck you , at the same time I sat in that waiting room, Trump appointed Tom Price as Secretary of Health and Human Services. This is the man who wants to defund Planned Parenthood, gut Medicaid, and eliminate the birth control mandate. Price dismissed the idea that women struggle to afford contraception. “Bring me one woman who’s been left behind,” he said in 2012 . “Bring me one. ”
The struggle to afford contraception was the reason I was there.
I filled out paperwork. Medical conditions? Medications? What was my reason for coming in today? Confirm pregnancy , maternity care , postpartum care , or problem-oriented visit. I checked the last one, which brought me to the next charmingly worded question: What is your problem?
Here’s what I wanted to write:
I don’t trust the current administration with my body, and yes, I know it’s not medically advisable to remove an IUD early, I already had a consultation with a doctor who is well-acquainted with both my vagina and my neuroses and I’m pissed that I have to pay to explain myself all over again to a dude I don’t know and I’m pissed that this country voted for a man who supports policies so breathtakingly cruel to women and children and poor people and people of color and Muslims and queer people i.e. everyone I know and love and I’m pissed that men keep telling me to calm down about it, that being angry won’t solve anything and don’t use divisive language and be nice and smile and it’s like holy shit, Bob, read a history book.
Here’s what I actually wrote: I want my IUD replaced early.
You know what happens next: nurse, room, undress from the waist down. I’m forty-one years old now and every time I put on the paper robe, I’m back on that table in Italy, naked and humiliated. Memory lives in the body.
The doctor came in. Maybe I’m projecting but whatever—he looked like Tom Price. Like Vice President Mike Pence. Like every photo ever taken of white men in suits congratulating themselves as they legislate us. He sat on a stool between my feet and I laid back on the table. The ceiling was bare. Sometimes doctors put posters up there so you have stuff to look at while they poke around inside you. I felt pressure on the dangly strings at the end of my IUD. I wished he would remove it. It would take two minutes. But I wasn’t there for the procedure. I was there to request the procedure. If he agreed, I’d come back. If he didn’t, I’d find another doctor. Rinse and repeat.
After I got dressed, the nurse took me to his office. I appreciated that. Sometimes you don’t get to put your pants on before you hear the news. He had a ton of books; I appreciated that, too. Maybe this would be okay. Maybe I was being too judgmental. This man was somebody’s grandpa. He was a professional. He wanted the best for me.
Who decides what’s best for me? Him? Me? Thirteen men in a secret room?
He came in and sat at his desk, flipping through a file faxed over by my doctor. “Well,” he said after a minute. “Everything looks good.”
“Good!” I said.
We sat there. We sat there for what felt like a long time.
“Can I have an IUD?” I asked finally.
“The one you have now is fine,” he said. “You’re good for—” he looked back at my file.
“Three years,” I said. “I know.” I kept calm and explained it again, even though I’d explained it on the phone when I made the appointment, and to the nurse before he came in the examination room, and to my own doctor, so it should be in that file he was holding, and the intake paperwork. I want my IUD replaced early.
He seemed utterly confused as to why I would make such a request. I was utterly confused at his confusion. How could he not know? I cited recent news stories—women scrambling for birth control that would outlast a presidency. Jesus, typing that sentence makes me want to throw my laptop out the window. Can we all sit quietly and consider what people are doing to protect their bodies from the government?
“But why? ” he kept asking.
“I’m scared I won’t be able to get one in the future.”
He responded to my emotions, not my intellect. “You don’t have to be scared,” he said kindly. “They’ll never get rid of IUDs. They make too much money.” And then: “They’re a total cash cow.”
“Whose cash?” I yelled, surprising us both. “Women will pay 1.4 billion dollars! To start . ”
He had not considered this. Or he didn’t think it was a big deal. Or he wanted me to calm down. I don’t know. I was so angry I could’ve exploded that clinic with the sheer force of my brain. He would fly backward through the air, into the sky and far, far away.
Except I needed him. I needed a fucking IUD.
*
At a routine postpartum checkup after the birth of my son, my doctor found a cyst that had swallowed one of my ovaries. When she said the word swallowed she held up her hand and wrapped her fingers around the empty air. I would have emergency surgery the next day and there was a chance—she slid a box of Kleenex across the table—that I’d lose the ovary.
I was thirty-one years old. I had a tiny, brand-new baby and was so in love I thought I’d die. The winter was horrible and I was scared to take him outside. I wasn’t healing right from the episiotomy. Nobody was sleeping. Breastfeeding was hard as fuck. “What happens with one ovary?” I asked my doctor. Hormones dripped out of my nose. “Can I have another baby? Do I want another baby? How do I feed another baby? I can’t feed the baby I already have.”
It was 2008, the lead-up to the housing market crash and our mortgage had spiked. I was a part-time college teacher—no paid maternity leave—and my husband took a second job. We were in a paper fight with our insurance company, trying to get them to cover a $250 per hour lactation consultant named Jane. She came to my condo every day to help us as milk squirted over the walls and I tried not to jump off the balcony.
I felt so far away from everything, myself, my husband. I wanted to get back in my body. I wanted to have sex. I don’t think that’s a radical confession, something to be whispered or ashamed of. I like having sex. I like having sex with my husband. I liked having sex with him before he was my husband. I liked having sex with other people before I met him. How and with whom we’re having sex should not be a factor in our access to safe, affordable birth control.
“You don’t have to decide anything now,” my doctor said. She saved my ovary. She helped me through postpartum depression. She gave me my first IUD.
*
My friend Jeff drove me to the appointment. We caught an early showing of Doctor Strange beforehand, a movie that I now associate with pain. There’s a joke to be made about Benedict Cumberbatch, but I’ll leave it alone.
Recently, I asked what he remembered about that day. He talked about the building: communist-era, a concrete box. “The elevator was a death trap,” Jeff said. “Everything was . . . mauve.” He said mauve like leprosy or locusts . “I was trying to distract you, rambling on about any old thing like when I gave you away—” he gave me away at my wedding, walking in the sunset through the sand—“except then you were nervous. This wasn’t nervous. This was—”
“Scared?” I said. “Was I scared?”
“You were pissed ,” he said. “I’ve never seen you so angry.”
I was already in the paper robe when the doctor came in. By then I pretty much hated him. Rational or not, it’s easier with someone to blame. The last thing I’d said that day in his office was, “Will you do it or not?” He nodded and I left, making the appointment on the way out. Now I lay back on the table and tried to unclench. “You’ll feel a pinch,” he said, and I knew I could kill him with my brain.
The nurse’s name was Eleanor. She was nice to me. Thank you, Eleanor. Thank you, nurses. Thank you for holding our hands when it hurts.
I don’t remember how it felt when my first IUD was inserted. I’d just had a baby. I’d just had surgery. My body was shredded, sewn shut. All I cared about was my son: eating, gaining, growing. I wasn’t paying attention to myself. It was my doctor who reminded me: You matter, you are worthy of care.
I dug my nails into Eleanor. I looked at her face and knew she knew. A common language.
*
A month later, I got the bill. It came—wait for it—on the same day as my period. You’ve got to laugh. If we don’t laugh we’ll jump off the roof.
I hadn’t had a period in seven years. It had all but disappeared with my first IUD. Apparently the new one had to adapt to my body and in the meantime Jesus God it hurt. I wondered if I was dying. I wondered if the doctor had screwed up, maybe on purpose, to get back at me because I yelled at him, I don’t know, I was out of my mind. I wondered if this was what periods always felt like and I’d forgotten, like how after I had my son a sip of wine knocked me on my ass because I hadn’t had a drink in nine months. I wondered how women do this every goddamn day.
The consultation, removal, reinsertion, and IUD itself cost me $250 out of pocket. For some, that’s a drop in a bucket. For others, an impossibility—the choice between protecting your body and paying rent, tuition, feeding your kids. I called the billing department and gave the woman my credit card number, pacing my apartment because years ago my grandma told me that women walk it off. “Anything else?” she asked.
“Yes,” I said. “How much would this have cost without insurance?”
She did some math and said, “Twenty-five hundred.”
“Twenty-five hundred,” I repeated. “Twenty-five hundred. ”
I wanted to weep with relief; one zero, not two. I wanted to invest in an IUD factory and give them away worldwide for free. I wanted to run for public office and draft legislation that protects our body autonomy. I wanted to go to med school. You matter, I’d say. You are worthy of care. I wanted to burn this bullshit to the ground. We can hold all these things at once. We do it every goddamn day.
