Art by Claire Osborn 

Samantha Garzillo didn’t know what to wear on the day she would get her intrauterine device, otherwise known as an IUD. The Pennsylvania-native was about to be scrutinized by not only the physicians at a Planned Parenthood in Washington, D.C., but also her 695 Facebook friends.

Garzillo decided to post a series of Facebook livestream videos throughout the day of her IUD procedure. She didn’t film during the actual appointment, though.  

“What the heck do you wear to have someone stick an IUD in you?” Garzillo, 22, said during her livestream. “So I felt like being cute, and I’m wearing a little lemon romper.”

Wearing her lemon-printed romper, white sneakers and peachy-red lipstick, Garzillo signed off from her first livestream video of the day and headed to Planned Parenthood. She carried her virtual world inside her purse.

In the end, Garzillo decided not to get an IUD after she experienced too much pain during the procedure. Still, Garzillo is part of a growing number of women and others who have uteruses in the United States who want to get — or already have — IUDs as their form of birth control. The surge in women getting IUDs is part of the larger conversation of women’s demand for autonomy, and the precariousness of affordable access to birth control. As Republican and GOP leaders push to restrict access to birth control and abortions, many women are seeking contraception that can outlast a presidency. And for some, the best option for that is the IUD.

“I think the more recent obsession with IUDs is stemming from realizing the fragility of access to birth control,” Garzillo said. “Unless somebody forcefully takes it out of you because they know you have it, it’s yours. Nobody can take it away from you. People explicitly said that’s part of the reason they got theirs in the past couple of months.”

The IUD is a small, T-shaped plastic device that is inserted into the uterus to prevent pregnancy. Hormonal IUDs last between three to six years, and nonhormonal copper IUDs can last up to 12 years. Both are over 99 percent effective.

More studies, like one from the Journal of Obstetrics & Gynecology, show that the IUD is a safe contraceptive even for teenagers.

“For the overwhelming majority of women, once it’s inserted they really don’t even have to think about it,” Faith Barash, a board certified OB-GYN, said. “It frees people up because it’s not a daily concern.”

The birth control pill is still the most popular contraceptive in the country. But, the number of women getting IUDs has been on the rise since the early 2000s. IUD usage increased nearly five-fold in the last decade, according to the U.S. Centers for Disease Control and Prevention, with 7.2 percent of women aged 15 to 44 getting the device.

And that number soared during the election season. IUD prescriptions and procedures increased 19 percent between October and December of last year, according to data compiled for AthenaHealth.

“Right now it’s a choice, whereas a week from now it might not be a choice,” said Aimee Richardson, a women’s health professor at American University. “So it’s making the choice of what I think is best for my body right now so that I don’t have to pay the consequences later because the rules might change.”

And the rules have already started to change. In October of this year, the Trump administration rolled back the Affordable Care Act’s birth control mandate.

But worries over access to birth control grew even after the election, and more people became interested in the IUD. In November of 2016, once it was clear that Donald Trump was the president-elect, Google searches for “IUD” skyrocketed, with terms like “IUD options” and “should I get an IUD” increasing by 800 percent and 200 percent, according to Vice. In May of 2017, the same month the House passed the American Health Care Act, the number of Google searches for “IUD” spiked to an all-time high.

Planned Parenthood reported a 900 percent increase in the amount of women trying to get an IUD, the organization’s president, Cecile Richards, told CNN in January of this year.

And on social media, women urged others to quickly get long-acting reversible contraceptives and, like Garzillo, opened up about their own experiences with such devices.

“There’s no other subjects where the government makes decisions about our bodies,” Richardson said. “When it comes to reproductive health for women — birth control, abortion — there’s no other situation where the government makes a decision that you’re like ‘oh crap, I need to make sure that I get what I need.’”  

The buzz around IUDs also helped the device seem less scary and more personable, making it a more viable option for women seeking an alternative to birth control pills. Garzillo and her friend Gabbi Hill, who also made a video sharing her IUD experience, are two voices in the ongoing conversation of long-acting reversible contraceptives and women’s sexuality.

“I think that as a result of more people talking about it, I’ve noticed more and more women getting comfortable with it,” Hill said.

Hill is a second year pharmacy student at the University of Pittsburgh. In January of this year, she posted a video to Facebook where she talked about her experience getting an IUD and gave some basic information about the device. In the video she wears a nose ring and often flashes a wide, welcoming smile. She made the video to break down stigmas, she said.

“One of the things that I think is still stigmatized is the discussion of feminine products, periods, birth control and safety when it comes to sex education,” Hill said over the phone. “My goal stemmed from the fact that I had a lot of questions going into it, and I’m an older sister and I know a lot of friends who also were kind of unsure, so I made the decision to put out all the answers.”

Both Garzillo and Hill received positive feedback on their videos. Garzillo says she still receives private messages from people asking about the IUD.  Hill even got messages from 30-year-old women after her post. Both videos gave their Facebook friends a platform to open up, bringing positive experiences of the IUD even further into the mainstream.

“What was really interesting about the comments [section] is people were like ‘this was the most painful thing I’ve experienced, I had to be heavily medicated with ibuprofen everyday for three months,’” Garzillo said. “And they were like ‘and I would redo it again in a heartbeat.’”

While the IUD is widely regarded as a safe form of birth control, the device didn’t always have such a positive reputation in the United States.

In the 1970s, the IUD picked up among American women, with almost 10 percent choosing the device as their contraception, according to the Guttmacher Institute. But then a new IUD called the Dalkon Shield was linked to extreme complications, and everything changed.

The Dalkon Shield, which was actually shaped like a shield, was shown to cause pelvic inflammatory disease, septic abortions, infertility and, in some cases, death. In the United States, 18 users died, 15 of those were from septic miscarriages or stillbirths occurring around the second trimester of pregnancy, according to a Planned Parenthood report.

“It was associated with a lot of cases of pelvic inflammatory disease — so really bad pelvic infections that could result in infertility,” Barash said. “So it got a really, really bad reputation after that and a lot of women were really, really afraid of using it.”

From that point on, the IUD was plagued with stigma and suspicion. By 1974, the Dalkon Shield manufacturer suspended sales. The “Dalkon Shield Disaster,” as Planned Parenthood calls it, cast such a large shadow that IUD usage stalled in the United States.

The IUD’s stigma and rumors can still be seen today.

“If you enter this part of the Internet when you’re looking up birth control, it’s all these scare-tactic articles that are like ‘you’re going to die,’” Garzillo said.

Even though it’s still marred by its past, the IUD is becoming more popular as time passes and more studies show it’s a safe form of contraception.  

“In the 1990s, I definitely did have some patients getting IUDs,” Barash said over the phone. “I think there’s been a little bit more awareness of IUD as a safe and very, very effective method of contraception.”

Infections from an IUD, while still possible, are very rare, according to Planned Parenthood.

“More studies have come out showing that they are safe and very effective at preventing pregnancy for all women,” Lizzie Kitue, a midwife in Massachusetts said.“There has also been a rise in the number of IUDs on the market so that women have more choices when it comes to getting an IUD.”

Even though there are more choices than before, the United States is still behind in how many IUDs are available on the market. There are currently only five types of IUDs in the United States, all with the same T-shape. In Britain, there are 22 different kinds of IUDs, according to The Atlantic.

While progress is slow, the IUD is benefitting from younger generations’ changing attitudes and word of mouth.

“With every new generation of birth control users comes different needs,” Richardson said. “And if you look at the needs of Millennials — instant gratification, and STIs aren’t as terrifying as they were 15-20 years ago. You are used to having things versus taking a pill everyday. So then throw in the fear that something won’t be available the way it is now, then IUD becomes a more viable option.”

Even though Garzillo chose not to proceed with an IUD, she instead got the implant, another form of long-acting reversible birth control. The implant is a small rod that is inserted under the skin in the upper arm. Similar to the IUD, the implant lasts up to 4 years and once it’s inserted, the woman doesn’t have to deal with it. Garzillo made another Facebook video after this procedure, too.

Garzillo’s videos are part of a larger grassroots movement of women speaking for their reproductive autonomy during a time when the government seeks to stifle those rights.

“Beyond breaking the stigma, what was nice about [Hill’s] video and then what I also tried to do in my video was that she wasn’t just talking about herself,” Garzillo said. “She was trying to inform others. Even people who would never go on birth control because it isn’t their anatomy. Wanting to put that education out through your own research, that was really nice.”

As the IUD slowly makes progress, so too does the fight for bodily autonomy.

“I believe that it’s becoming less of a radical idea that women are in charge of their own bodies,” Hill said. “I mean we’ve been fighting this fight for many, many years. I don’t think it will ever really be over but it’s definitely a slow progress. You can’t look at today versus yesterday.”