I had a phone call with the local Planned Parenthood office this week. I called to schedule my annual gyne exam. I also requested that at that visit they remove the Paraguard IUD I’ve had for the last eight years.
Here’s where it gets interesting… you, dear reader, know what I do for a living. Therefore, I have massive amount of information stored in my brain about all things pregnancy related. I will never begrudge a care provider telling me things I already know, because it means they are doing their job with regards to ensuring informed consent.
That’s a good thing. That level of explanation should happen every visit, every time.
What I do bite back on is what the staff member said to me on the phone. It started off reasonably well and went downhill from there.
The staff member said that if I take the IUD out, I should use other birth control, and so on. Which, for most people makes sense. I also understand that she was doing her job and trying to provide me with informed consent before scheduling the procedure. I respect that.
I let her know my intention was to try to get pregnant and therefore other methods of birth control were irrelevant and implied that she didn’t need to continue in that vein.
She didn’t listen. So, I repeated myself, “I want to have a baby and therefore I need my IUD to be removed.”
Again, she repeated her script on needing additional birth control.
I was beginning to get annoyed.
Active listening, as a care provider, is paramount to being able to treat a patient appropriately. If you don’t listen, you can’t hear what the problem is and you will possibly make assumptions that could cause harm.
Then, she said something that raised my ire. She said the provider would need to have a discussion with me about whether the removal of my IUD was appropriate.
She went on to say that the provider could refuse to take my IUD out based on medical reasons, social reasons or financial reasons.
That stopped me in my tracks.
What she’s really saying is that I don’t have autonomy over my own body to make these decisions and that I need to cede my power to a provider.
I was appalled and angry. Bodily autonomy is a human right according the United Nations, The World Health Organization and Amnesty International.
~ The World Health Organization
In examining the reasons the staff member gave me as to why the provider might refuse to remove my IUD, I find no supporting cause.
Medical reasons – In my research, the only reason I can find to refuse to remove the IUD is if at that visit it is, or embedded, in the uterus and a surgical removal is needed. So, that’s not a refusal, that’s an “it’s more complicated, let’s schedule the procedure later.” There may be an active vaginal infection that needs to be treated first. Again, that’s a delay not a refusal. If any readers know of any other medical reasons to refuse removal, do let me know, I’ll add them here.
Social reasons – Ummm….. no. This is my choice to try to have a baby, regardless of what you think of my personal life. No one else gets to decide that for me. This is a conversation between me and my partner only. While I appreciate the concern of my provider to ensure I’ve explored all avenues and rationales, ultimately the decision is mine whether or not to remove the IUD and when.
Financial reasons – There’s two possible perspectives we can explore.
The first is based on personal finances, or “Can you afford the procedure to remove it?”. That one doesn’t hold water for me. If you have health insurance, the removal would be covered in part or full. Planned Parenthood offers sliding scale fees for those without insurance or for those whose insurance is insufficient. So, it’s unlikely that’s to what she referred.
My assumption is that she meant, “can you afford to have a baby?” This goes back to social reasons. How can someone other than me and my partner determine if a baby is financially a good choice (they never are really, kids are expensive!). How can they make an accurate assessment about my income, my partner’s income and our lifestyles in a brief office visit? The bigger question is, why does it matter?
It is my body and my life. My autonomy.
The bizarre irony is that this is Planned Parenthood. “My body, my choice!”
Choice to have a baby or not. The statement made by the staff member belies Planned Parenthood’s mission.
“Planned Parenthood believes in the fundamental right of each individual, throughout the world, to manage his or her fertility, regardless of the individual’s income, marital status, race, ethnicity, sexual orientation, age, national origin, or residence.”
*Deep breath*
As a childbirth educator and doula, this topic, bodily autonomy, I choose to discuss with every client. With the autonomy conversation, comes the right of informed consent and informed refusal.
Bodily autonomy sits firmly in the seat of power and control.
Who controls my body? When a care provider dictates a patient must have a medical test, procedure or medication and does not give her full information, which includes her right to say, “no thank you”, that provider strips the patient of her autonomy and her power.
This also applies if the provider refuses a medical test, procedure or medication that is appropriate for that woman and her current medical condition.
Granted, the relationship between provider and patient must be one of mutual trust and openness. If a woman doesn’t trust her provider, she should find a new one. If the provider’s methodology and course of treatment isn’t suitable for this patient, the provider has the right of refusal of service. This should be after a long, informed and compassionate conversation with the patient.
However, in my opinion, this provider right of refusal must be tempered by circumstance. If this provider is the only provider in a particular geographic area, their right of refusal should be reduced. If their refusal is based solely on their personal or religious beliefs and those beliefs interfere with their ability to serve their patients appropriately, their right of refusal should be eliminated. This is the case with those who refuse birth control, etc. If their refusal will cause harm to the patient, thus violating the Hippocratic oath, their refusal should be restricted.
Key points:
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Patients have the right of informed consent and informed refusal.
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Patients have the right to change providers (assuming another provider is available in their area).
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Providers have the right of refusal of service for really any reason.
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Good, respectful communication between provider and patient is imperative.
This refusal to treat a patient is a huge issue. Look back to the Hobby Lobby case or pharmacists who refuse birth control or the morning after pill. Providers can refuse to treat LBGTQ, transgender, women who’ve had past abortions, etc. This has a massive impact and snowballs quickly.
What we see is a clash of personal values, rather than respect for the patient’s autonomy. This is highly concerning to me.
My hope, with regards to the woman on the phone at Planned Parenthood, is that she is the outlier and that the provider with whom I have my appointment will be as respectful of my autonomy as I am of theirs. I hope we will have open communication and a mutual understanding.
I’m also curious to see what they say when I tell them I want to take my IUD home for my collection. Heck, I did pay $750 out of pocket for the thing, pre-Affordable Care Act. It is mine after all.
How far does my autonomy really go?
Have you had an issue with your provider regarding patient rights or your own autonomy? Let me know about it in the comments below.
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I hope you reported this person to the clinic manager. She sounds either very naive or very misguided, hopefully she’s new, and can be corrected. I’m a nurse midwife and insert and remove IUDs and Nexplanons. It’s what the patient wants. If they want it out because of side effects early on, we do communicate and encourage them to wait a bit longer for them to resolve. But not when you clearly state you want it out, and you want to have a baby! You can also pull your own our by grasping the strings and pulling (not always possible, however).
I did speak to the manager and I will speak to the physician at my appointment as well. So, no worries there.
Waiting to see if side effects resolve is wise, but that’s a wait, not a refusal. It’s the refusal comment that was inappropriate.
I thought about DIY removal but my strings are very short. I can’t effective grasp them!
sounds like a misguided individual rather than a formal PP position.
I do believe you are correct on that. However, since she’s front line reception for the office, that means she’s giving misguided information to many people, not just me.