For a moment, I thought of what she might have been like at 6, sitting on the edge of the paper-covered table in the doctor’s office waiting for the needle prick. She laughed nervously and tossed her shoulder-length mane of tight curls. Trying to distract her, I asked where she lived. I told her I’d visited the library in her hometown, within driving distance of the Planned Parenthood in Cedar Rapids.
Because she had agreed to let me observe the nurse practitioner insert an Implanon in her upper arm, I asked how she heard about the new, long-acting, reversible contraceptive and why she decided to get one.
She works at Wal-Mart in a minimum wage job. At 21, she lives with her grandparents, but she grew up the oldest in a family with three much younger siblings. She’s tired of not making enough money to afford to live on her own. Her family can’t afford college. She wants something more, so she enlisted in the Navy.
The nurse practitioner arrives and in her low-key manner gathers information and explains the procedure. Is she sexually active now? (Yes.) What kind of birth control is she using? (Only condoms.) She knows that’s not enough. She’s heard about free Implanon from a television ad. She wouldn’t have been able to afford the $500 fee.
I explain that the nonprofit I work for, the Iowa Initiative to Reduce Unintended Pregnancies, makes free, long-acting reversible contraceptives available to every woman in the state who wants one, that this is part of a research program to see how we can reduce the number of unintended pregnancies among women her age in Iowa first and then across the country.
She jiggles her arms, like she might before placing her feet in the blocks and taking her runner’s stance. The cliché a “bundle of nerves” comes to mind. But there is nothing trite about this young woman or the decision she’s making. She exudes strength and vulnerability at the same time. She is poised on the verge of womanhood. I’m witnessing her personal history. She is leaving home and everything familiar; she is making an adult decision to be responsible for her own well-being and health. She has come to the realization that her future is in her control and that having a baby right now isn’t in her best interest.
The nurse practitioner numbs her arm. She closes her eyes. I watch. In seconds, the nurse practitioner announces she’s done. We’re both surprised at how easy it is. The device, which dispenses hormones much like the birth-control pill, is not visible but it feels like a small, tubular pasta.
She laughs again, relieved. The nurse tells her she can take some ibuprofen if it’s tender, and in a few days, she can remove the Band-Aid. She cautions her to continue to use a condom to protect from sexually transmitted infections; her Implanon will protect her from pregnancy for up to three years, long enough to give her a good start with the Navy. Anchors Aweigh.
Christie Vilsack is a former first lady of Iowa and the executive director of the Iowa Initiative to Reduce Unintended Pregnancies. For more information about unintended pregnancies, visit www.iowainitiative.org.