When Dr. Evelyn Figueroa became a doctor in 1999, very few women were opting for IUDs, the little T-shaped birth control devices inserted into the uterus to prevent pregnancy.
The University of Illinois family medicine physician placed, she guesses, just eight of them in the span of three years. Now that IUDs are the hot, not-so-new thing—fueled by personal essays and advocates—she inserts about 12 every month, and has worked with thousands of patients who have them. Her Chicago clinic speaks to the national trend: The rate of IUDs has doubled in the last decade.
And that new frontier has its own new frontier: new science might give the average woman more power than ever to insert and remove IUDs.
Just two months ago, a group of public health researchers in India teamed up with Stanford University to pilot test a device that would make inserting an IUD a simpler process. They tested it on postpartum women with health providers who had no former experience inserting IUDs. (This process was closely monitored.) They concluded that no only was it safe, but that the device might even reduce risk of infection compared to normal techniques.
This could mean extended access to millions of women who can't get to licensed gynecologists or family doctors for contraception, or pay for their services.
"If there isn't access, people are going to make their own access," said Figueroa, who was not involved with the study.
She said the risks of inserting IUDs are not high. One in 1000 women are at risk for a perforated uterus during the procedure, when it's done by a trained medical provider. And that risk decreases with experience, so a controlled medical setting is usually the safest.
But in areas where women don't have access to contraception, Figueroa said IUD placement would still be much safer than an unwanted pregnancy and its consequences.
Meanwhile, women are already removing their IUDs at home without a doctor's help. There are tutorials on YouTube and multiple threads on parenting forums of women who have removed their own device or had a partner pull it out for them. The reasons they do it vary — from people who think they gained weight, to parents who are ready for a new child.
Dr. Figueroa said her own patients have removed their own IUDs usually by accident, if they've become partially dislodged or if they mistook the IUD strings for tampon strings. But she said self-removal is largely safe—and a sign that more women want to be in control of their reproductive health.
"People who are able to have autonomy in their birth control and not have the doctor regulate them is key."