IUD counseling and the gynecological gaze: the biopolitics of clinical shared decision-making in the US

Abstract

The intrauterine device (IUD) as a long-acting reversible contraceptive technology is increasingly being marketed to younger women for whom hormonal therapies are deemed problematic. Focusing on the American College of Obstetricians and Gynecologists (ACOG) training materials for clinicians, we examine the biopolitics of reproductive counseling for the IUD among this population. Specifically, we interrogate how American clinicians are trained to engage young patients in the coproduction of reproductive biographies to determine their suitability for the IUD. Ostensibly recognizing the importance women’s autonomy to reproductive justice, ACOG stresses the importance of ‘shared decision-making’. However, we argue that ACOG’s approach to shared decision-making still enrolls patients in processes that delineate forms to reproductive differences to be controlled. Specifically, obstetricians and gynecologists are instructed to categorize certain reproductive bodies as risky, differentiating them from those classified as timely and responsible. These categories, underpinned by constructions of normative readiness, reproduce forms of ‘colorblind’ difference under the rubric of reproductive risk. Our findings suggest clinicians are still trained to employ a gynecological gaze that differentiates patient populations based on perceived reproductive responsibility. Thus, we argue that beneath the surface of collaborative reproductive counseling, the gynecological gaze continues to differentiate treatment for those bodies classified as irresponsible. Our analysis highlights the enduring power relations that link the production of reproductive health knowledge and deeply gendered and implicitly racialized systems of categorizing populations.

Keywords:

• Colorblind racism
• geographies of the clinic
• IUD
• reproductive counselling
• untimely bodies

Acknowledgements

We are grateful to Sandy Wong, Mabel Gergan, and the members of the Critical Geography Lab at Florida State University for their advice and comments on previous versions of this manuscript. We would also like to thank the three anonymous reviewers for their generous feedback.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Madeline Levey

Madeline Levey-Brower is a doctoral student in the Department of Sociology at Florida State University. Madeline holds a Bachelor’s of Science and a Master’s of Science in Geography from Florida State University. Her past research used feminist theory to examine the politics of contraceptive technologies and the gendered corporeal body. Her doctoral research builds upon this foundation, interrogating the relationship between the pregnant body, reproductive technologies, and big data.

Tyler McCreary

Dr. Tyler McCreary is an assistant professor in the Department of Geography at Florida State University and an adjunct professor in the Department of First Nations Studies at the University of Northern British Columbia. He has published over two-dozen articles, including pieces in Annals of the American Association of Geographers, Antipode, Children’s Geographies, Environment and Planning C, and Geoforum. He has also published two books, the most recent being the co-edited collection Settler City Limits. His research examines how racial capitalism and settler colonialism inflect the sociotechnical governance of human life and environmental relations.