Cervical Violence: Tigrayan Genocide, IUDs, and the Imperative for Gentle Care
Content Note: This post discusses medical procedures (and their potential to be traumatic), sexual violence, and uses women-centered language in quotes from others. In my own writing, I seek to use gender-inclusive and -expansive language as frequently as possible to honor my own voice as a trans person and recognize the experiences of other trans, non-binary, and gender non-conforming people.
Anytime we enter someone’s body, the potential for violence, infection, and harm is tremendous. When considering health—public health, global health, medicine—this violence emerges in myriad ways, sometimes more graphic, more obvious perhaps, and other instances more subtle, unintentional even, but nonetheless harmful.
In a recent Breakfast Club interview with Millete Birhanemaskel & Andom Ghebreghiorgis, they discuss conflict, violence, and genocide in Tigray, a northern region of Ethiopia. Describing this war in her home country, Birhanemaskel states: “This war is being played out on the bodies of women and girls, period. Every genocide has a signature and this one is sexual violence.” She goes on to describe the purposeful destruction of Tigrayan people’s internal reproductive organs by Eritrean soldiers.
It feels important to avoid a binary view of sexual and reproductive violence, critical not to position one experience as “worst” or “not so bad.” As a white person born in the US, I honor the expertise of Birhanemaskel and Ghebreghiorgis and wish to be clear that I’m in no way an expert on the conflict they described. And yet, this idea that wars, genocides have a signature—and that at times this trademark is the targeted destruction of the organs that create, hold, grow, and birth new humans—is striking to me and feels worth exploring here.
SisterSong defines reproductive justice as “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities” and I want to delineate here that sexual and reproductive organs are not inherently valuable because of their reproductive potential. The potential of our bodies, organs, and genetic material not to create pregnancies or have children is just as important as the possibility to do so at will and must be protected and cherished with equal vigor.
That being said, it’s true that many wars (in the broadest sense of the term) have waged their fire on the bodies of birthing people, sometimes under the very guise of reproductive health. In Killing the Black Body, Dorothy Roberts describes how contraception and birth control were tools in the eugenics movement in America and “how critical [individual and collective] political objectives are to determining the nature of reproductive technologies—whether they will be used for emancipation or oppression.”
Intrauterine devices (IUDs), a birth control method born in the early 1900s and popularized as early as the 1950s, are a popular contraceptive option for many people with uteruses and the potential to become pregnant. IUDs are small “T” shaped devices that are inserted into the cervix. Molly Dutton-Kenny, a full spectrum midwife offering care for abortion, miscarriage, pregnancy, and birth recently wrote an Instagram post about “gentle IUD insertion.” She writes: “Cervices aren’t made to have things enter them from the outside (except for some fluids like sperm). Rather things pass from inside out.” She describes the tendency of the cervix to resist pressure from a foreign instrument trying to insert something from the outside as “a healthy, protective response in the body.” Dutton-Kenny goes on to describe how clinical practice is often to force the insertion of the IUD, usually with some numbing, but otherwise strong, quick, and forceful maneuvers. She concludes: “If you’re inserting an instrument through the cervix and meet resistance at the outer or inner OS [the “os” refer to the openings of the cervix, at the top into the uterus and at the bottom into the vagina], respect that. Honour that…when the person is able to relax, the cervix will eventually ‘give’ and the instrument will slide through.”
A few additional moments can make all the difference in whether an IUD insertion or any other genital or pelvic exam or procedure is traumatic for the individual receiving care. Practicing these procedures as a cooperative effort between provider and patient—not a patient yielding to the provider’s acts on their body, but a tandem, communicative effort that allows the person to access the medicine they seek—is vital. Though in many respects worlds away from the sexual violence of the Tigryan genocide described in The Breakfast Club episode mentioned above, this force—particularly when it occurs without consent—that is often used in pelvic and genital procedures can cause harm and should be approached mindfully.
When we—purposefully or inadvertently—destroy, control, hurt or manipulate another person’s body, specifically their sexual and reproductive organs, we strike at an integral and generative part of that individual and their family and community. And so, while preventing war and providing support to those harmed in conflict is essential to healthy and thriving communities, so too is avoiding related harm in the day-to-day operations of our hospitals, clinics, offices. All medical procedures ought to center the consent, comfort, and health of the individual receiving care, and this is especially the case when providers are entrusted with caring for their patient’s sexual and reproductive organs. Whether checking dilation during labor, inserting someone’s first (or fifth, or tenth) contraceptive device, or screening for cancer, these glimpses at and brushes with the cervix and other vulnerable parts of a person’s body have the potential to be incredibly vital and life-enhancing or terribly traumatic and violent.
