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.