In my high school’s women’s health class, students learned about every birth control method out there, but there was one option that received notably less attention than the others: the humble IUD. We learned the basics about these tiny devices—what they are and how they work—but the teacher was quick to point out that very few of us would ever use one. “They’re just not very popular,” she said.
That was in the late 1990s, and she was right, because at the time, IUDs (intrauterine devices)—small, T-shaped devices that are placed in a woman’s uterus and prevent pregnancy by stopping implantation of a fertilized egg—were not often used or recommended. Although they were all the rage in the 1970s, they then fell out of favor; women commonly believed that IUDs were dangerous because they caused infertility or even death, and many gynecologists had barely any experience in inserting them. Even though IUD usage has begun to rise since 2002 (from 2 percent of all birth control users to 6 percent), women’s stubborn misperceptions about the device persist and represent the biggest uphill battle in IUDs’ resurrection.
The Dalkon Disaster
The popular sentiment against IUDs can be traced back to a single model that was prescribed for a few years in the early ’70s: the Dalkon Shield. The nickel-size Shield hit the American market in 1971, despite huge safety concerns and conflicts of interest, which the company successfully hid from the FDA and consumers. As evidence later showed, the only study on the Shield’s effectiveness at preventing pregnancy was deeply flawed and conducted by a company shareholder—someone who stood to make a huge profit by getting the Shield approved at any cost. Furthermore, intracompany memos proved that the A.H. Robins Company, maker of the Shield, was well aware of a serious design flaw that left women especially vulnerable to devastating pelvic infections, yet the company suppressed that information in order to get the product to market.
Between 1971 and 1974, millions of women used the Shield, until the fatal design flaw, which involved porous fibers that allowed harmful bacteria to make their way from the vagina to the uterus, began causing hundreds of thousands of cases of pelvic inflammatory disease, infertility, ectopic pregnancies, and miscarriages. The number of injury lawsuits filed against the makers of the Dalkon Shield reached into the hundreds of thousands, making it the largest liability case since asbestos litigation, and judges awarded billions of dollars’ worth of settlements to women who had been injured. The corporate malfeasance and publicity surrounding the case convinced the FDA to start regulating medical devices just like it regulated drugs. The Dalkon Shield incident—and the grieving infertile women who pulled at the public’s heartstrings—turned women off to IUDs altogether, but it was ultimately an isolated case of one bad product. Other IUD models remained just as safe and effective as they ever were, and have been used by a small but happy minority of women ever since. Perceiving all IUDs as inherently unsafe or dangerous is a bit like assuming all cars are death traps just because the Corvair was poorly designed.
Devices inserted into the uterus to prevent pregnancy date back to ancient times; Bedouins even used thin tubes to implant stones into the wombs of their camels to prevent pregnancy during long desert journeys. With the exception of the Shield, no other model of IUD has ever been shown to be hazardous to women’s health. That’s why doctors in recent years have been enthusiastically recommending and prescribing the devices—for women who fit a certain profile, they are excellent reversible birth control options. According to the American Academy of Family Physicians, IUDs are the most common form of reversible birth control worldwide, used by eighty-five million to one hundred million women.
This time around, in addition to having corrected the Dalkon Shield’s design flaw, doctors are more selective about the patients to whom they recommend IUDs. Because of the inherent risk involved in placing any foreign object inside the body, the most important criterion for determining good candidates for IUDs is that they be extremely unlikely to contract an STD, since IUDs can facilitate the transmission of bacteria into the uterus. That’s why married monogamous women make up the vast majority of IUD customers. Also, IUDs are most comfortable and least likely to slip out of place in women who have already had at least one child, since their uteruses are a bit more elastic than those of women who haven’t.
A gynecologist inserts the IUD, and it usually becomes effective immediately. Depending on the model, a single device can last up to ten years, and once it’s in place, it’s 99 percent effective at preventing pregnancy without the user’s having to do anything at all. Once it’s removed, the user immediately becomes fertile again. In the United States, there are currently two IUDs approved for use: ParaGard, which releases small amounts of copper ions to kill sperm in the uterus, and Mirena, which releases progestin and has the added benefit of reducing menstrual cramps and lightening heavy periods.
Although the legacy of the Dalkon Shield is a tragedy for those women who lost their fertility because of it, its greatest and most disastrous effects were to poison a generation of American woman against a form of contraception that has been shown overwhelmingly to be safe and effective. IUDs may not be as widespread as they once were, but after a long time out of the spotlight, they’re being recognized as an easy, effective, and painless way for a woman to plan her family. Some women may still choose to be leery of them, but having all the facts enables them to make the best possible choice.