Graduation Year

2026

Document Type

Campus Only Senior Thesis

Degree Name

Bachelor of Arts

Department

Biology

Reader 1

Marion Preest, Ph.D.

Reader 2

Gabriela Morales, Ph.D.

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Rights Information

© YYYY Sophie C Claisse

Abstract

Intrauterine devices (IUDs) are highly effective, long-acting, reversible contraceptives. Yet pain during the insertion process remains a major barrier to uptake. This concern is shaped by an extensive history of gynecologic pain dismissal and inequitable care for historically underserved racial, ethnic, and lower socioeconomic status groups. Despite clear clinical evidence and updated CDC guidelines supporting evidence-based pain management methods, implementation remains inconsistent. Many patients report feeling under-medicated and underprepared. This project frames inadequate IUD pain relief not only as a clinical gap but as a form of obstetric and gynecological violence that undermines bodily autonomy.

This research proposal outlines a quantitative cross-sectional study across six Bay Area clinics that vary across resource levels. The research will examine provider practices as well as perceived quality of provider-patient interactions. This study will recruit approximately 180 individuals, comprising 90 clinicians and 90 patients. A purposive, stratified sampling strategy will be implemented to ensure representation across all groups. Data will be collected on pain management practices, clinic protocols, and custom subscales, which include the following: Communication and Informed Consent Score, Perceived Empathy and Respect Score, Normalization/Minimization Score, Patient Empowerment/Advocacy Support, and Intersectional Treatment Fairness. The outcomes will be analyzed using descriptive statistics and multilevel models that account for patient, provider, and clinic characteristics.

Based on previous literature, I predict that evidence-based pain management will be systematically underutilized. I further anticipate that Black, Indigenous, and other people of color, individuals from lower SES backgrounds, and those with trauma history will report higher levels of pain, lower satisfaction with their care, and more frequent experiences of pain normalization and minimization when compared with white individuals, those from higher SES backgrounds, and individuals without trauma history. Additionally, I anticipate that lower-resource clinics will display greater implementation gaps than higher-resource settings. Lastly, clinicians are expected to report training gaps and a lack of standardized protocols as barriers to consistent pain management practices.

My study will illustrate how systemic inequities across race/ethnicity, SES, and trauma history manifest in IUD insertion pain management. These results will underscore the need for trauma-informed, person-centered, and equity-focused care that incorporates individualized pain management protocols. It is crucial that clinicians and healthcare institutions implement shared decision-making, explicit bias-minimization strategies, and pain management protocols as standard care to ensure that bodily autonomy is central to reproductive healthcare.

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