By now, most organs have their own biography. Writers have advocated with visceral passion for their chosen body part, each structure apparently overlooked and undervalued. During Covid, a spate of non-fiction was published on lungs and breathing. While the UK is thigh-deep in controversy about what it means to be a woman, the uterus is having a moment. “For a very, very long time, western medicine has not given a shit about the womb apart from it being a container for the next male heir,” a doula tells Leah Hazard. But now, this pear-shaped muscle nestled in the bellies of half the population, has become a “clenched fist” on the frontline of the culture wars.
Hazard, a practising NHS midwife in Scotland, praised for her 2019 memoir, Hard Pushed, is here to speak – eloquently and vigorously – for this “most vital” organ. She is tired of the uterus being treated as a deviation from the male anatomical norm and sick of gynaecology’s routine excuse that “more research is needed” to understand it. Stitching together patient, academic and clinical testimonies, Hazard is herself “a celebrant” and “devout believer in the power and wisdom of birthing bodies”.
The womb’s timing is a marvel. We ask a lot of it: obedient to a monthly cycle, starting and ending in step with our peers, shushed by a daily pill or indwelling device and jump-started when a baby is no longer dreaded but craved. In labour, to avoid medical intervention, the uterus must perform “Goldilocks” contractions, neither too early, too late, too fast or too slow. The rest of uterine life is silence. A baby girl’s womb is ignored, an unsavoury harbinger of puberty and sex, imagined only as a flattened carton, sealed and sterile.
Hazard upends these untruths. Far from barren, a girl’s uterus – like her gut – is teaming with microbial life. Different bacterial signatures may hold clues about why many women’s uteruses won’t keep pace with society’s punishing schedule, because of infertility or disease. Just as the intestinal microbiome seems to influence our moods, new research suggests that a “womb-brain relationship” sways our thoughts and feelings. Hazard also debunks the uterus’s passive reputation in conception. The cervix is in fact a bouncer, restraining sperm in thousands of tiny crypts, letting through only the most presentable. The womb’s walls actively contract during orgasm to “upsuck” these male gametes towards the egg. In the same vein, Hazard is scathing about misogynistic terminology in medicine, such as “irritable uteruses”, “incompetent cervixes” and the “living decay” of the menopause, which inappropriately blames and shames women for challenges in their reproductive lives.
Meanwhile, the surgeon’s scalpel is never far away. In the US, one third of women have a hysterectomy by the age of 60. While most are consensual and medically indicated, these operations, along with forced abortions, sterilisations and surgical births, have also been deployed with oppressive and racist intent. In another context, surgery can be a deliverance. We meet Ryan, a trans man who loathed his body and his period. A hysterectomy offered a way to be himself. Looking to the future, it is a matter of when rather than if transplanted as well as synthetic wombs become widely available. Dystopian to some, for “same-sex couples, single parents, women whose health precludes a pregnancy” and trans women, uterine technologies will open new paths to family life. By exploring the risks and rewards of these possibilities, Hazard demonstrates how a uterus is neither necessary nor sufficient to define a woman. The politicisation of such cases distorts the truth of biological and social diversity. “This is not some kind of virtue-signalling wokery on my part,” she writes when discussing men with wombs and women without them. “This is fact, borne out by scientific and sociological evidence.”
Central to Womb are the visions of freedom that medicine, social media and business sell to women: the freedom to follow one’s natural cycles with interest and celebration, versus a freedom from the agony and hassle of menstruation. Where the Victorians touted leeches, tinctures and boric acid pessaries, modern women are advertised apps, supplements and vulval steaming to make their bodies behave. As the uterus becomes a marketplace, “femtech” is cashing in. The #periodsoptional movement claims that bleeding is a handicap and caring parents who want their teens to succeed in a competitive culture should start them on continuous oestrogen and progesterone. Regulation around such promises is minimal, studies are selective and reputable sources are muddied. For each new product described as a liberation, there’s someone warning it’s “taking patriarchy, wrapping it up in a pink bow and saying it’s feminism”. Everyone seems to know, and disagree, what a “good” uterus looks like.
I’m curious about Hazard’s aversion to hormonal treatments for herself and the book’s minimal mention of intrauterine devices (better known as coils, which can be life-changing), as well as her criticism of C-section rates and disbelief that “major abdominal surgery is more appealing to some would-be mothers than the perils of the labour ward”. In the shadow of recent maternity scandals, fearing vaginal birth seems quite reasonable to me. From my medical training and position of privilege, prescribed medicines and surgery feel familiar, controlled and safe. But not so for millions of others. Unique constellations of anecdotes from our mothers and friends, bodily idiosyncrasies, life experience and discrimination shape our assessment of risk. Everyone aims to feel “maximally at home in her own body”, says Hazard, but arriving there is different each time. In lieu of a map, Womb is an excellent guide. Turning its final pages, I was reminded of Amy Poehler’s mantra of tolerance: “Good for her! Not for me.” Womb invites us to wish others well, defend their rights to make informed choices and refuse to apologise for our own.
Kate Womersley is a doctor and academic specialising in psychiatry. Her work at Imperial College London focuses on sex and gender equity in biomedical research