She trembled slightly. For a moment, I thought of what she might have been like at six, 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 home town not far from this family planning clinic. She had gone to the library every day after school, she said. She loved the librarian like family and still grieves her early death.
Since 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 (LARC) 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. She wants to be an electrician and she knows she can learn this skill while she serves her country and maybe later she’ll attend college. She’s leaving for basic training soon. She’s nervous about that, too. She was a good athlete in high school - softball and track - but basic training will be physically challenging, and she’ll be away from home for the first time.
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 non-profit I work for 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 likes the idea that she is part of an experiment. That’s why she agreed to let me watch.
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 what she wants.
As someone who has no daughters of her own, but who has taught adolescent women for years, this is a rare moment.
The nurse practitioner numbs her arm and I joke that I’m inclined to close my eyes even though I’ve driven across the state to watch this procedure which I talk about in speeches concerning the work of the Iowa Initiative. That would, of course, defeat the original purpose of my visit, but my presence in the room has become more about the decision than the device or the procedure.
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 matchstick.
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.