How do you do, Justice Kavanaugh? I’d like you to meet my IUD.
What was your latest healthcare decision?
I’ll give you an example. I had some routine blood tests, and my doctor noticed that the hormone that talks to my thyroid gland was getting too high, while my thyroxine, which the thyroid gland makes, was falling below normal. That meant my body was working overtime and still not producing enough thyroxine.
See, up there is about two years of my thyroid stimulating hormone (TSH). The green line in the middle shows a high value that would still be within normal range, and the blue line is where my TSH actually was. See how it dropped suddenly into a normal range?
The dropping blue line is because my doctor wrote a prescription for a pill that is an artificial replacement for the thyroxine my body is lousy at making. I take one first thing every morning, because hypothyroidism can cause symptoms like depression, joint pain and swelling, and even heart problems.
How would you feel if someone who wasn’t an M.D. looked at this graph and then made the decision about this prescription for you? Like whether or not you could have the medicine, or maybe whether you could have it only at certain times, or that you couldn’t have it in your home state, and would just have to live with the symptoms of hypothyroidism, even if they were dangerous.
Yay for levothyroxine! Yay for good decisions between me and my doctor!
This is worth talking about, because the newest member of the Supreme Court (and his colleagues in congress and the presidency) could take a decision like this into his own hands.
Different news outlets quibble about this, but Judge Brett Kavanaugh’s testimony at his initial confirmation hearing seemed to point to a misunderstanding on his part about the difference between contraception and abortion. There was also a high volume of extremely credible testimony, in subsequent hearings, that Kavanaugh is a perpetrator of sexual assault. As a Supreme Court Justice with lifetime power to rule on cases that determine whether women can have legal and affordable access to basic medical care including contraception and abortion, he should, at the very least, demonstrate clear understanding of the medical facts involved—as well as be free of credible accusations of assault against women.
For a long time, I didn’t know much more about contraception and consent than Kavanaugh seems to. When I was a teenager, my “health” classes in Christian high school (the closest thing I ever got to sex ed) didn’t include much information on consent, sexual decision-making, or contraception. But the teacher did show us large photographic slides of advanced syphilis chancres on women’s vulvas and bloody tissue from aborted fetuses.
All we needed to know about sex was that it was dangerous.
Somewhere along the way, I also learned that intrauterine devices (IUDs) work by causing an early abortion. An egg gets fertilized, and then the embryo goes down your fallopian tube and tries to implant in your uterus to grow, but it can’t, because the IUD sitting in your uterus won’t let it. And you bleed the embryo away. It happens so quickly that nobody can tell you were pregnant.
I was an adult for many years before I knew better. An egg (ovum) or sperm cell is called a gamete. A fertilized ovum that hasn’t begun dividing yet is a zygote. For a couple weeks after fertilization, while the cells start dividing, travel down the fallopian tube, and implant in the uterus, those cells are called a blastocyst. The blastocyst develops into an embryo, which becomes a fetus, which finally comes out of your vagina (or, sometimes, the wall of your stomach) if a pregnancy runs full term. Medically speaking, despite our habit of referring to “unborn babies,” the length of your pregnancy determines whether you have a zygote, blastocyst, embryo, or fetus inside of you.
I learned more about IUDs, too. There are actually two main kinds of IUDs: copper or hormonal ones. Copper ones are pretty simple. Sperm hates copper. Your chance of getting pregnant with a piece of copper in your uterus is almost nonexistent. Hormonal IUDs work with different combinations and levels of hormones to keep sperm out a different way: they change the mucus on your cervix so no sperm can get in there. In many women, hormonal IUDs also work to prevent ovulation (when an egg is ready to be fertilized), which means that even if sperm were to get in there, there’s nothing to do. Your chances of getting pregnant are almost nonexistent.
The important thing here is that neither IUD works by allowing your body to get pregnant and then quickly getting rid of the blastocyst.
Maybe all this seems silly to you because you already know it, but I’m mentioning it because, in my experience, a ton of people (myself included for a long time) don’t really understand this stuff. Over the last few years, I have literally explained what ovulation and menstruation are to multiple male partners—people who are otherwise smart, well-educated, and interested in women, but don’t actually know what a menstrual cycle is besides a couple of days when blood comes out of a person’s vagina.
IUDs, despite being an extremely effective and safe method of birth control, are another common field of ignorance. Recently, a woman told me she didn’t want to get an IUD because she wants children in the future. Maybe she didn’t understand that an IUD is reversible—it works only as long as it’s in there. Take it out (an easy procedure), and you can try getting pregnant almost right away.
Beyond Roe v. Wade
So what does all this have to do with Kavanaugh, or my medical decisions?
Nationwide efforts to limit or curtail abortion access are constantly at work on the state level, like putting ridiculous and unnecessary hospital-like requirements on the clinics of responsible and legal abortion care providers. Republican legislators, including in my home state, are constantly working to shorten the legal window of time that a woman can obtain an abortion for almost any reason, including a fatal fetal defect. In some cases, they want to outlaw abortion so soon after conception that many women might not even know they are pregnant by the time their legal window to get an abortion is passed.
Ever since the 2016 election, Republican legislators have been working to undermine the Obama-era policies that give people like me, a self-employed woman with chronic illness, access to healthcare. They want to remove rules that prevent insurers from charging me more because I’m a woman, remove my access to birth control as a covered benefit (abortion care is already not covered under my PA Affordable Care Act policy, as per state law), and deny affordable health insurance to people with pre-existing conditions (with a previous pregnancy or birth being pre-existing conditions).
This is all pretty hair-raising. Is Kavanaugh a man who doesn’t quite understand what contraception is, a man who doesn’t believe I should be able to access it, a man who believes I should be forced to give birth if I become pregnant, and a man who believes, or once believed, that bodies like mine are available for him to violate at will?
As I’ve explained before, I don’t want children: I’m not financially, emotionally, practically, or physically able to undertake pregnancy and parenthood, and I like my child-free life. So especially with Kavanaugh’s Supreme Court confirmation, it’s a perfect storm for me: it seems possible that I’d be unable to get affordable birth control (or any healthcare) in the near future, AND it could soon be much, much harder to get an abortion. If Kavanaugh and his colleagues decide to overturn legal access to abortion in all 50 states, that doesn’t mean abortion will suddenly be outlawed all over the country. But it does mean American women will be scrambling in a patchwork system state by state, increasingly under siege from more and more cruel and nonsensical legislation.
This is how you make a medical decision because of the government
Last summer, about five months into the current presidential administration, way before I ever heard Kavanaugh’s name, I was scared. If I have hypothyroidism, my doctor can treat it. But if I want to avoid getting pregnant, or if I need an abortion, soon my doctor might not be able to help me. That’s because the people in Congress and on the Supreme Court—people who may not understand how pregnancy and birth control work, and may not even believe it matters whether women consent to sexual contact in the first place—don’t want me and my doctor to be in charge of healthcare for my female body. They want to be in charge of it, no matter what happens to me.
So I weighed my options, while I still had them.
I went to see a couple gynecologists (because my health problems are complicated). The doctors sadly agreed that I was right to be concerned about my future healthcare options, reproductive or otherwise. We decided that given my uncertain access to healthcare (in general) and reproductive care (in particular) in the near future, I would try an IUD.
That way, even if I can’t afford healthcare in the future, at least I can make sure to have up to 10 years of birth control that no-one can take away from me, because it’s literally inside of me. I can get as close as possible to knowing that I won’t need an abortion, while I’m still able to use my health insurance to prevent one.
So I put on a hospital gown. A nurse brought a big dose of ibuprofen and some crackers for me to eat along with it. Then the doctor did an ultrasound, with the help of a tech. She put my feet up in the stirrups and the chilly speculum stretched my vagina. Then she filled a syringe with lidocaine, cautiously maneuvered the needle up my vagina in the space of the speculum, and then poked the needle into my cervix.
The fiery invisible pinches were so bad that I yelled. Tears came into my eyes. Then the lidocaine started to work and I felt a kind of warm numbness. And pain again as the doctor carefully wrenched my cervix open.
It was over within a few minutes, and the doctor did another ultrasound to make sure the IUD was in the right place. I wanted to sit up, but I felt woozy.
“You’ve just had a real procedure,” someone said. “Rest for a minute, ok?”
After a few minutes, I sat up. Then I wanted to get on my feet, but a nurse asked me to wait. I did, for about ten minutes, on my own on the exam table, and then stood up. There was blood on the paper cover where I’d been sitting. I went into the adjoining bathroom and there was more blood. I unwrapped a pad from the stack by the sink. Painful cramps squeezed and I felt more blood leaking.
It took me awhile to get out of the office. The bleeding scared me and the pain got worse. But I made it home.
I went back a couple weeks later because the bleeding didn’t quite stop. The practitioners did another ultrasound and everything looked fine. Minor bleeding continued, on and off, for more than six months—a common side effect.
I still occasionally get spotting and cramps. My periods have changed a lot. (There are some rare and possibly dangerous complications with IUDs that you can talk to your doctor about.) But not worrying about pregnancy in the years ahead, when I may lose my healthcare, is a lifesaving cushion of relief. I am 100 percent sure I did the right thing.
Wouldn’t it be bizarre if I had decided to go on levothyroxine because of the people in charge of the government? But because of those same people, I decided to have one of my internal organs forced open from the outside so a medical device could be placed inside me that made me bleed for months. And I’m relieved that I did it before Kavanaugh got to the bench, and sick with worry for the women who may not have access to a similar choice before it’s too late.
Does that sound right to you?
If you’re a person who’s upset about Kavanaugh’s confirmation because of your principles, I appreciate your concern. I also humbly and sincerely ask you how you’d feel if, in direct relation to an event like Kavanaugh’s confirmation, you underwent a painful, bloody medical procedure that significantly altered your body’s natural function—and felt grateful you could do it, before someone who is supposed to represent your interests forced you to go through something worse.