ESSAYS ON THE TRANSMISSION OF SCIENTIFIC KNOWLEDGE SURROUNDING INTRAUTERINE DEVICES

Abstract

Long-acting reversible contraception (LARC) use has increased dramatically in recent years, with a nearly 5-fold increase between 2002 and 2012. One form of LARC, levonorgestrel intrauterine devices (IUDs), is quickly becoming the favored choice among health care providers across the U.S. and internationally. Many providers see IUDs as unequivocally beneficial devices, highlighting benefits such as a low side-effect profile due to local administration of hormones and high efficacy due to their long-acting design. Yet patients and reproductive justice activists raise counternarratives of IUDs as coercive and limiting patient autonomy. They underscore the fact that IUDs are more likely to be prescribed to low-income women and women of color and that many women report feeling pressured to select this method of contraception or to keep the device in when they no longer wish to use it. Through a multi-pronged, mixed-methods approach, including interviews with physicians and patients, ethnographic observations of digital and clinical settings, and primary document analysis, this project explores medical and lay narratives surrounding intrauterine devices (IUDs). Drawing on intersectional theory, this research analyzes the epistemic world of key groups of actors involved in the provision and consumption of intrauterine devices, including physicians, patients, and medical organizations. I delineate the epistemic logic of these groups and investigate what happens when these logics come into conflict, such as during clinical encounters between doctors and patients. I explore how broader power structures such as gender and race shape the resolution of these conflicts and the implications this has for women’s bodies.