Gendered Subjects, Gendered Objects

Representations of Agency in Medical Contraceptive Training

By Bethan Holt

International Planned Parenthood Federation – Contraceptive Training Films: Intrauterine Devices (1989)

‘The intrauterine device, commonly called the IUD, is one of the most widely used methods of reversible contraception. It has many advantages…’ (00:33).[1]

Figure 1: Screen capture from Intrauterine Devices (IPPF, 1989).

This 1989 film, produced by North South Productions for International Planned Parenthood Federation (IPPF), was made to inform medical practitioners and providers of contraception about intrauterine devices (IUDs). The twenty-five minute video informs viewers about different types of IUDs, and where, when and how they should be used.

The film is significant because it offers some insight into the approaches to contraception and family planning of professional medicine, and those of IPPF, a mainstream international family planning organisation. In this short review, I will focus on what the film reveals about the attitude of these groups – professional medicine and IPPF –  towards women’s agency in birth control.

In the 1980s, the IUD had a mixed reputation. Although feminists and women’s health activists initially welcomed the IUD (concerns over the safety of the oral hormonal contraceptive pill rose in the late 1960s), by the mid-1970s, significant health problems had arisen as a result of IUD use. One particular kind of IUD, the Dalkon Shield, had caused thousands of women to experience infections, of whom at least fifteen died.[2] Chikako Takeshita, a feminist scholar of science and technology studies, described the IUD in the 1980s as ‘a symbol of health disaster for women.’[3]

Furthermore, some contemporary feminist critics were concerned about the coercive capacity of the IUD. Notably, Andrea Tone’s 1999 article noted the ways population control advocates envisioned the IUD as a device that could be used on poor and uneducated women to prevent them from reproducing.[4] The IUD could also be used by force in contexts where governments sought tight control over reproduction. One of the most stark examples of this was during China’s one-child policy in the 1980s. After giving birth to their first child, every woman was required to be inserted with a tamper-resistant IUD.[5]

These are clear and perhaps even shocking examples of how IUDs could be enforced in ways which denied or undermined women’s agency over their bodies and fertility. The IPPF film offers an example of more subtle ways women were not given full control over their fertility choices.

The film emphasises the importance of women being given information about the IUD alongside information about other contraceptive methods in order for them to make an ‘informed’ and ‘free’ choice (07:22). At the same time, the film clearly constructs a profile for the ideal IUD user. In one depiction of an interaction between a doctor and patient (fig. 2), the age and parental status of the potential IUD user are shown to be important factors when determining whether the woman is an appropriate candidate for the IUD. Likewise, being in a monogamous sexual relationship, most likely indicated by marriage, is considered an important factor for the ideal candidate for IUD use. As such, the ideal candidate for an IUD is constructed as a married woman with children.

Figure 2: Screen capture from Intrauterine Devices (IPPF, 1989)

            The film states that women who have not had children are not suitable candidates for the IUD there is a risk it may cause infertility. This approach to the IUD reveals the assumptions made by medical professionals and birth control providers about risk. For women without children, the risk of infertility outweighs the need to prevent conception. For women with children, the risk of an unplanned pregnancy is more severe than that of infertility. Writing in the same decade this film was produced, Hilary Thomas’ work on the medicalisation and professionalisation of contraception noted that the need to maintain fertility is usually assumed by medical professionals rather than discussed with the patient.[6] The possibility that some women may never want to become pregnant is therefore not considered, restricting childless women’s reproductive choices to those that preserve their fertility.

Thomas’ critique of the ways the medical profession approached birth control highlighted a contradiction. At the same time as asserting the importance of all methods of contraception being clearly explained to the patient in order for them to choose the method (as we see in the film), medical discourses construct ideal types of patients, matching them with appropriate methods.[7] What is considered appropriate is not only based on physiological or medical factors – for instance the film states that a woman with an existing pelvic infection should not have the IUD inserted – but also social and cultural factors.[8] In this case, the claim that childless women are not suitable for using the IUD because of the risk of infertility is based on a socially/culturally constructed expectation that all women must one day have children.

The way the film deals with women’s pain is also telling.  In cases where an IUD user is unhappy with their IUD, the film informs viewers of the ‘fine balance between reassuring her and suggesting she should give the device more time, and removing the IUD’ (22:57). At face value this seems a fairly innocuous statement. However if we consider feminist critiques of Western medical practices, this statement takes on different meanings. Underlying these issues is a fundamental lack of regard given to women’s self-reporting of pain. Considering this, the statement in the film can be understood as subtly urging medical professionals to encourage women to keep their IUDs despite any pain or discomfort they may feel. This brings into question the extent to which patients can consent to having an IUD inserted if the reversible nature of consent is denied, or at least discouraged.

The IPPF film expresses ambivalence towards women’s agency when making reproductive decisions. Analysing it with the question of agency in mind reminds us of the importance of thinking critically about the ways professional medical discourses can affirm gendered social and cultural gender expectations, setting out structures within which people can make reproductive decisions.

[1] Time stamps and images throughout are from: ‘Contraceptive Training Films: Intrauterine Devices’ (1989) <> [accessed 10 February 2020].

[2] Chikako Takeshita, The Global Biopolitics of the IUD: How Science Constructs Contraceptive Users and Women’s Bodies (Cambridge and London: The MIT Press, 2012), p.6.

[3] Takeshita, Global Biopolitics of the IUD, p.6.

[4] Takeshita, Global Biopolitics of the IUD, p.6; Andrea Tone, ‘Violence by Design: Contraceptive Technology and the Invasion of the Female Body’, in Michael Bellesiles ed., Lethal Imagination: Violence and Brutality in American History (New York University Press, 1999).

[5] Takeshita, Global Biopolitics of the IUD, p.70.

[6] Hilary Thomas, ‘The Medical Construction of the Contraceptive Career’, in Hilary Homans (ed.) The Sexual Politics of Reproduction (Gower Publishing Company, 1985), p.54.

[7] Thomas, ‘Medical Construction’, p.62.

[8] Thomas, ‘Medical Construction’, p.63.