By Elizabeth Nahstoll
The purpose of this podcast is to discuss the history of the IUD and compare it to the present. The history will focus on the Dalkon Shield court case and the present will center around current controversy surrounding IUDs. The comparison between the past and present will work to highlight the mistreatment of women’s health both in the past and today.
Transcript
From infertility to death, women have been through it all with the IUD by their side. The history of the intrauterine device (an IUD) reflects the rise in interest and demand for changes in women’s health while still highlighting the continual mistreatment women face. This podcast dives into the history of the IUD as well as today’s controversy surrounding the device and it all starts in 1909.
In 1909 the first model of the IUD was made by Dr Richard Richter using a ring made out of the gut of a silkworm.1 This remained the standard model throughout the 1920s and 30s with the pregnancy rate of the early IUDs ranging from 1.1 to 3 percent.2 A large issue that arose during the development of the IUD was being able to tell whether or not the IUD was still in the uterus and then the process of removing it. Models of the IUD were then produced with the end of the IUD protruding out of the uterus to address this. The most popular model to fix this issue was developed by Dr Jack Lippes called the Lippes Loop and it had a double S shape and a nylon string that allowed for its easy detection and removal3. The addition of this string will become especially relevant soon. While extremely popular, the Lippes Loop got complaints of cramping and bleeding resulting in the production of an IUD in a T shape, the shape it is in today, as Dr Howard Tatum thought it was the size of the IUD that was causing these complaints. While the complaints did decrease, this shape also increased the pregnancy rate to 18%4. The T shape was then combined with copper to decrease the pregnancy rate and this resulted in the IUD model the Copper-T 200.
Now, this brings us to the year of 1971 and the start of quite a memorable era for the IUD. This was the year that A.H. Robins Company put a new IUD on the market called the Dalkon Shield5. This IUD remained on the market for 3 years before being pulled off due to the infections women were getting since the removal string wasn’t sealed on either end. This meant that the removal string was funneling bacteria into the uterus. Due to this women experienced Pelvic Inflammatory Disease, sepsis, infertility, miscarriages, and death.6 By 1985 at least 21 women died and 13,000 were either sterile or infertile due to the device.7 Loretta Ross, a renowned advocate for reproductive justice as well as a key contributor in creating the theory of reproductive justice and visiting professor at Smith College, was one of the women affected by the Dalkon Shield. During her oral history with the Smith College Voices of Feminism Oral Histories, she recounts her experience with the device.
“Finally, one night — back then I was working for the NFL Players Association — but finally one night, I’m laying in bed, my boyfriend, another boyfriend, had just left, and my stomach just explodes in pain. I mean, like, I’m having the world’s worst — worse than labor, and not much is worse than labor. This was worse than labor. And so I called an ambulance but I passed out before the ambulance gets there. Fortunately, once I called the ambulance, I unlocked my door so they could get in. They take me to the hospital, I wake up post-op [to find] that they have done a total hysterectomy on me, actually a subtotal, because they didn’t take the cervix until later, but a subtotal hysterectomy on me and the doctor tells me that was the only way they could think of to save my life, that I was in acute peritonitis, whatever that is, and that I had this Dalkon Shield and they, you know, that my fallopian tubes, both of them, had ruptured. Apparently that’s not something that happens overnight, it had been going on for six months. Um, and they had to do this hysterectomy.”8
Loretta Ross’s experience was unfortunately not a unique one, in fact she was one of 300,000 lawsuit cases filed against A.H. Robins for the Dalkon Shield.9
Following this court case there was a decrease in IUD use and an increase in IUD mistrust. A 1991 survey found that only 16% of US women had a positive opinion on IUDs.10
However, in more recent years that number has increased. According to data from 2017-2019 about 10.4% of women are currently using a long-acting reversible contraceptive such as the IUD.11 This number is likely higher now, increasing even more with the recent election. The first time that President Trump was elected into office there was a 21.6% increase in demand for a long-acting reversible contraceptive in the first 30 days following the election.12 With the current work on banning abortions and implementing stricter abortion laws in many states, access to IUDs as well as other forms of birth control are decreasing while the demand for them increases. The offices where women are able to access a contraceptive are often the same offices that provide abortion care and that are being shut down. Given the decrease in access to birth control, long-acting reversible contraceptives like IUDs provide a great option. By getting an IUD you are guaranteed it for up to 8 years, working around the potential decrease in access.
While the use of IUDs increases, so do concerns over the pain they cause. The insertion of the IUD is a procedure that causes cramps and bleeding that can last mere minutes or continue on over the course of a few days. In a 2013 study, 17% of women who have never had children and 11% of mothers shared that they experienced enough pain during the procedure that pain management was required.13 The procedure has been described by patients as feeling there were “shards of glass in their vagina” or “hell on earth”, not necessarily encouraging reviews.14 Despite the painful process reflected in the experience of many women, there is no standard of care for the pain management during or after the procedure. Not only is there no standard of care, it is often recommended that patients take ibuprofen before or after the insertion as a form of pain management; however, research shows that over-the-counter pain relievers are often ineffective in treating the pain. Furthermore, a 2013 study found that patients would on average rate their pain level during the procedure a 64.8/100 while providers rated what they perceived the pain to be as a 35.3/100, that’s quite a big gap.15 While lidocaine, an anesthetic, can be used for these procedures, it is often only used upon request and most women don’t know that it is an option.
However, just this year the CDC updated their guidelines for IUD insertions which placed an emphasis on use of topical lidocaine and paracervical blocks to help with the pain along with comprehensive procedure and pain counseling.16 This will help address both the pain women are experiencing but also complaints that the patients aren’t given an accurate portrayal of how painful the procedure is. Hopefully these recent changes will help with the pain management, however, time will have to tell.
The history of the IUD continues to highlight the mistreatment of women’s health both in the past and now. While important strides have been made, these changes will need to continue to help ensure that women are receiving the healthcare they deserve. And that’s all on the deadly history of the IUD.
- Megan Corbett and Brandy Bautista, “A History: The IUD,” Reproductive Health Access Project, March 20, 2024 https://www.reproductiveaccess.org/2024/03/a-history-the-iud/#:~:text=Three%20years%20later%2C%20it%20was,infertility%2C%20miscarriage%2C%20and%20death. ↩︎
- Corbett and Bautista, “A History: The IUD” ↩︎
- Corbett and Bautista, “A History: The IUD” ↩︎
- Corbett and Bautista, “A History: The IUD” ↩︎
- Rainey Horwitz, “The Dalkon Shield,” Arizona State University, January 10, 2018 https://embryo.asu.edu/pages/dalkon-shield ↩︎
- Corbett and Bautista, “A History: The IUD” ↩︎
- René Kladzyk, “The Troubled History of the IUD,” adyn, June 12, 2023 https://adyn.com/blog/iud-history/?srsltid=AfmBOopkrXmvdeF4fcqzKUVYP-A36Pggxt4luPUjj-8GOifK3oR78P7W ↩︎
- Ross, Loretta, interview by Joyce Follet, Voices of Feminism Oral History Project,Sophia Smith Collection, Nov. 3-5, 2004, Dec. 1-3, 2004, Feb. 4, 2005. ↩︎
- Corbett and Bautista, “A History: The IUD” ↩︎
- Kladzyk, “The Troubled History of the IUD” ↩︎
- “Contraceptive Use,” National Center for Health Statistics, December 15, 2023 https://www.cdc.gov/nchs/fastats/contraceptive.htm ↩︎
- Kladzyk, “The Troubled History of the IUD” ↩︎
- Deanna Hartog and Madeline Morcelle, “Reproductive Health Care Pain Points: Raising the Standard of Care for Managing Pain From IUD Insertion and Removal,” National Health Law Program, December 12, 2023 https://healthlaw.org/reproductive-health-care-pain-points-raising-the-standard-of-care-for-managing-pain-from-iud-insertion-and-removal/ ↩︎
- Hartog and Morcelle, “Reproductive Health Care Pain Points: Raising the Standard of Care for Managing Pain From IUD Insertion and Removal” ↩︎
- Hartog and Morcelle, “Reproductive Health Care Pain Points: Raising the Standard of Care for Managing Pain From IUD Insertion and Removal” ↩︎
- Carrie MacMillan, “What Women Should Know About Intrauterine Devices (IUDs),” Yale Medicine, August 13, 2024 https://www.yalemedicine.org/news/intrauterine-devices-iud ↩︎
Citations
“A Beautiful New World (No Drums)”, Wevideo Audio
Chung, Jamie. Lippes Loop IUD. Photograph. Wired. June 15, 2011 https://www.wired.com/2011/07/ff-iud/
“Contraceptive Use,” National Center for Health Statistics, December 15, 2023 https://www.cdc.gov/nchs/fastats/contraceptive.htm
Corbett, Megan and Bautista, Brandy, “A History: The IUD,” Reproductive Health Access Project, March 20, 2024 https://www.reproductiveaccess.org/2024/03/a-history-the-iud/#:~:text=Three%20years%20later%2C%20it%20was,infertility%2C%20miscarriage%2C%20and%20death.
Dalkon Shield. Photograph. Case Western Reserve University. https://artsci.case.edu/dittrick/online-exhibits/history-of-birth-control/contraception-in-america-1950-present-day/intrauterine-device-iud/
Gerlach, Alexendra, “CDC Recommends Use of Lidocaine for IUD Insertion in Updated Guidelines,” Pharmacy Times, August 16, 2024 https://www.pharmacytimes.com/view/cdc-recommends-use-of-lidocaine-for-iud-insertion-in-updated-guidelines#
“For Those Concerned With Pill’s Risk, a Look at the Choices”, File-box 47, Loretta J. Ross Papers, Sophia Smith Collection of Women’s History, Smith College, Northampton, MA
Hartog, Deanna and Morcelle, Madeline, “Reproductive Health Care Pain Points: Raising the Standard of Care for Managing Pain From IUD Insertion and Removal,” National Health Law Program, December 12, 2023 https://healthlaw.org/reproductive-health-care-pain-points-raising-the-standard-of-care-for-managing-pain-from-iud-insertion-and-removal/
Horwitz, Rainey, “The Dalkon Shield,” Arizona State University, January 10, 2018 https://embryo.asu.edu/pages/dalkon-shield
IUD in Uterus. Photograph. Obstetrics and Gynecology of Atlanta. https://www.obgynofatlanta.com/iud
IUDs, Contraceptives, Health Action International, File-Box 47, Loretta J. Ross Papers, Sophia Smith Collection of Women’s History, Smith College, Northampton, MA
Kladzyk, René, The Troubled History of the IUD. Photograph. Adyn. June 12, 2023https://adyn.com/blog/iud-history/
Kladzyk, René, “The Troubled History of the IUD,” adyn, June 12, 2023 https://adyn.com/blog/iud-history/?srsltid=AfmBOopkrXmvdeF4fcqzKUVYP-A36Pggxt4luPUjj-8GOifK3oR78P7W
Loretta Ross Oral interview Conducted by Joyce Follet in Northampton, MA, 11-03-2004, 11-04-2004, 11-05-2004, 12–01-2004, 12-02-2024, 12-03-2004, 2-04-2005” From the Smith College Special Collections, Voices of Feminism Oral History Project, Sophia Smith Collection. Film https://findingaids.smith.edu/repositories/2/archival_objects/89289 (accessed Nov, 24, 2024)
MacMillan, Carrie, “What Women Should Know About Intrauterine Devices (IUDs),” Yale Medicine, August 13, 2024 https://www.yalemedicine.org/news/intrauterine-devices-iud
Pregna Copper T 200B. Photograph. Pregna. https://www.pregna.com/tcu200b_gal.html
“Removal Now urged of ‘Dangerous’ Device,” U.S. Medicine, File-box 47, Loretta J, Ross Papers, Sophie Smith Collection of Women’s History, Smith College, Northampton, MA