Effective Contraception Should be a Priority, Not an Afterthought, for HUHS

I shifted my phone to my other ear as the soothingly bland, vaguely jazzy ‘hold’ music restarted. I was on hold with Harvard University Health Services, trying to schedule an appointment with a physician in the Obstetrics & Gynecology department, which handles women’s reproductive health.

I wanted to get an IUD, a long-term reversible birth control option. Finally taking me off of hold, the person on the other end informed me that the office was not booking IUD procedures until April. At that time, it was still February, almost two months away.

‘Have you considered Planned Parenthood?’ the receptionist asked. ‘Other patients have had better luck going through them.’ I was surprised that my university’s health service, mandated to serve a demographic comprised of many sexually active young women, was so ill-equipped to provide contraceptive counseling and access to the full range of contraceptive methods. Trump’s public threats to defund Planned Parenthood and dismantle the Affordable Care Act have thrown America’s contraceptive access into question; it is unacceptable for health services like Harvard’s to put the university’s own provision of contraceptive care on hold.

IUDs, T-shaped devices that are smaller than a tea bag, are among the most effective and best-tolerated forms of long-term birth control available. Studies have shown that with "usual" (rather than "perfect") use, about 17 percent of women using condoms alone and 9 percent of people on a birth control pill or patch will get pregnant in a year. Less than 1 percent of people with a hormone-containing or copper IUD, though, will get pregnant. While we still need condoms to prevent against sexually transmitted infections, IUDs are a much better choice for preventing pregnancy.

Hormone-containing IUDs work by delivering very low-dose progesterone directly to the uterus, which thins its lining and makes it an inhospitable environment for sperm and implantation (the upside: absent or lighter periods). Relative to birth control pills, IUDs contain lower hormone doses, which means women experience fewer hormonal side effects like acne, weight gain, and mood changes. Non-hormonal IUDs are made of copper, which is toxic to sperm, and may be preferable for women who feel uncomfortable about hormones (the downside: heavier periods and more cramping).

In a five-minute, office-based procedure, a gynecologist or primary care doctor inserts an IUD into a woman's uterus where it can stay for 3-5 years (hormone-containing) or 10 years (non-hormonal). IUDs can be removed at any time, and fertility returns to normal, typically within a single cycle.

HUHS should be making every effort to provide information about, and access to, effective female contraception on demand and without a substantial wait. True, contraception is now much more readily available to students than it once was. Dispensers providing free condoms have sprung up in laundry rooms. Even so, it is worth pausing for a moment over this tendentious connection between condom boxes and our communal 'dirty laundry.' The message, however unconscious, seems to be that contraceptive use is still a private matter whose public exposure brings distress and embarrassment.

Furthermore, it is a pernicious idea that condoms and the pill together represent the sine qua non of protected sex. Condom use is, at best, a mutual initiative, discussed and implemented on a case-by-case basis. At worst, it is a male prerogative. The pill, which appears to supply a necessary corrective, is more available but has proven less effective and often comes with unpleasant side effects. IUDs, on the other hand, give women agency over their bodies with a lower risk of side effects. As Harvard discusses consent and sexual empowerment, access to effective contraception, like IUDs, should be inserted into the greater campus conversation about consent.

Silence around female contraception seems symptomatic of a lingering culture of shame that continues to surround women’s bodies. Somehow, it is still easier to talk openly and without embarrassment about the various dressings-up of the male penis, than it is to discuss penetrative procedures involving the female vagina. We want to see posters explaining IUDs next to flyers for plays, sporting events, and workshops at the Bureau of Study Council. When students took on the stigma of mental health on campus and called for the expansion of mental health services, HUHS listened and expanded access. We should do the same for contraception, especially since contraception is a primary health care need for sexually active, university-aged women.

We should ask each other and our doctors more questions about our bodies and our contraceptive options. We should ask HUHS to hire more gynecologists. We should ask our HUHS primary care physicians (not just our gynecologists) to become trained in how to insert IUDs. We can call on Harvard to make education about and access to female contraception a priority, not an afterthought.

With insurance coverage for contraception under threat due to the proposed repeal of the Affordable Care Act and reduction of funding for Planned Parenthood, it is of particular importance for universities to take a strong stand for contraception access. IUDs are a matter of private choice. But access to them needs to be very public.

Emmy Waldman is a Ph.D. candidate in Harvard’s English Department. Helen Jack is a third year medical student at Harvard Medical School and a tutor in Adams House.


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