Menus Subscribe Search

Follow us


Sperm approaching egg

(Kannanimages/Shutterstock)

What to Expect When You’re Not Expecting

• May 30, 2012 • 5:00 AM

(Kannanimages/Shutterstock)

IUDs are 20 times more effective at stopping unintended pregnancies than the pill. Why do so few American women use them?

The technology was not new, but it was still disruptive: a small, cheap piece of plastic, wrapped in copper wire, that could prevent pregnancy with a near-zero failure rate. Once in place, it would last for years.

The Dalkon Shield appeared in American drug stores in 1971; it wasn’t the first intrauterine device, but it was popular. The pill was now a decade old, and while still revolutionary, IUDs promised convenience that oral contraception couldn’t. The drug companies knew it. By the early ’70s, the Shield was one brand among dozens, and the head of family planning at Columbia was calling IUDs “the ideal” form of birth control. So simple you forgot they were there.

Two million women were using the Shield when, in 1974, the problems became too big to ignore. Stories were splashed across two columns in the New York Times: more than a dozen deaths and 200 infected abortions. Manufacturer A.H. Robbins pulled finally recalled the Shield in 1975. Fifteen years later, the company paid out a $2.5 billion settlement to thousands of women.

IUDs went from being the fastest growing form of birth control in the United States to being untouchable—a toxic product and an impossible sell.

Long overdue, then, is a study in this week’s New England Journal of Medicine confirming what physicians have argued since the Dalkon Shield scare: in addition to being safe, IUDs are radically more effective at preventing unintended pregnancies than pills, patches, or rings—particularly in young women.

Among developed nations, the United States has an unusually high level of unintended pregnancies: roughly half of the six million women who conceive each year do so by accident, often from improper or inconsistent contraceptive use. More than one million abortions result, incurring real costs (dollars), social costs (lost education, missed work), and, importantly, emotional ones.

Not surprisingly, the most commonly used form of birth control, the pill, is less effective “as used” than “as directed.” Owing to the varied hassles of having to pop a pill at the same time every day—what if you decide to stay at his place? What if that pastel case is contraband in your parents’ house?—according to the recent NEJM study’s authors, the real-world failure rate hovers at 10 percent. For teenage girls and high-risk populations, it’s worse.

IUDs have a failure rate of less than 1 percent, rivaling sterilization. So why does just one American woman in 20 use them? Abroad, IUDs are hardly so novel. A 2011 study from the World Health Organization reports that, in China, a full third of married Chinese women use so-called “long acting” devices. In Scandinavia, nearly 20 percent do. The highest users? Vietnamese and Egyptian women, at around 35 percent. Only in sub-Saharan Africa are IUDs less popular than in the Americas.

When American women were offered a choice of free contraception, though, as part of the recent NEJM study, 77 percent of them chose to have an IUD implanted—an indication that up-front cost may play a deciding role in how women manage their reproductive health.

Led by senior author Jeffrey Peipert of the Washington University School of Medicine in St. Louis, the researchers followed a diverse group of 7,500 Missouri women for four years. Participants, between the ages of 14 and 45, had to be sexually active and express a desire not to become pregnant in the next 12 months. The authors read aloud a standard script, stating that IUDs were proven to be the most effective type of birth control, but provided in-depth counseling on the risks and benefits on pills, patches, and rings as well. Women would be allowed to switch methods any time they desired, but those using only condoms or “natural planning” were excluded from the analysis. In the end, more than 5,700 women chose IUDs.

The results were striking: women using pills, patches, or rings “had a risk of contraceptive failure that was 20 times as high as the risk” among those using IUDs.” And, much as the authors had hypothesized, women younger than 21 who chose to use a pill, patch, or ring—rather than an IUD—were twice as likely to become accidentally pregnant than older women.

The authors also note that, by the third year of the study, nearly one in 10 women relying on pills, patches, or rings had had a “contraceptive failure.” And with each passing year, the rate climbed.

The study’s conclusion runs a single, unequivocal sentence: the effectiveness of IUDs is simply superior to other contraceptives.

“If there were a drug for cancer, heart disease, or diabetes that was 20 times more effective,” said Peipert, “we would recommend it first.”

How long it takes medical science to escape the dark shadow of the Dalkon Shield, however, one might only hypothesize.

Kevin Charles Redmon
Kevin Charles Redmon is a journalist and critic. He lives in Washington, D.C.

More From Kevin Charles Redmon

A weekly roundup of the best of Pacific Standard and PSmag.com, delivered straight to your inbox.

Recent Posts

November 21 • 4:00 PM

Why Are America’s Poorest Toddlers Being Over-Prescribed ADHD Drugs?

Against all medical guidelines, children who are two and three years old are getting diagnosed with ADHD and treated with Adderall and other stimulants. It may be shocking, but it’s perfectly legal.



November 21 • 2:00 PM

The Best Moms Let Mess Happen

That’s the message of a Bounty commercial that reminds this sociologist of Sharon Hays’ work on “the ideology of intensive motherhood.”


November 21 • 12:00 PM

Eating Disorders Are Not Just for Women

Men, like women, are affected by our cultural preoccupation with thinness. And refusing to recognize that only makes things worse.


November 21 • 10:00 AM

Queens of the South

Inside Asheville, North Carolina’s 7th annual Miss Gay Latina pageant.


November 21 • 9:12 AM

‘Shirtstorm’ and Sexism in Science

Following the recent T-shirt controversy, it’s clear that sexism in science persists. But the forces driving the gender gap are still being debated.


November 21 • 8:00 AM

What Makes a Film Successful in 2014?

Domestic box office earnings are no longer a reliable metric.



November 21 • 6:00 AM

What Makes a City Unhappy?

According to the National Bureau of Economic Research, Dana McMahan splits time between two of the country’s unhappiest cities. She set out to explore the causes of the happiness deficits.


November 21 • 5:04 AM

Sufferers of Social Anxiety Disorder, Your Friends Like You

The first study of friends’ perceptions suggest they know something’s off with their pals but like them just the same.


November 21 • 4:00 AM

In 2001 Study, Black Celebrities Judged Harshly in Rape Cases

When accused of rape, black celebrities were viewed more negatively than non-celebrities. The opposite was true of whites.


November 20 • 4:00 PM

Women, Kink, and Sex Addiction: It’s Not Like the Movies

The popular view is that if a woman is into BDSM she’s probably a sex addict, and vice versa. In fact, most kinky women are perfectly happy—and possibly healthier than their vanilla counterparts.


November 20 • 2:00 PM

A Majority of Middle-Class Black Children Will Be Poorer as Adults

The disturbing findings of a new study.


November 20 • 12:00 PM

Standing Up for My Group by Kicking Yours

Members of a minority ethnic group are less likely to express support for gay equality if they believe their own group suffers from discrimination.


November 20 • 10:00 AM

For Juvenile Records, It’s ‘Justice by Geography’

A new study finds an inconsistent patchwork of policies across states for how juvenile records are sealed and expunged.


November 20 • 8:00 AM

Surviving the Secret Childhood Trauma of a Parent’s Drug Addiction

As a young girl, Alana Levinson struggled with the shame of her father’s substance abuse. But when she looked more deeply into the research on children of drug-addicted parents, she realized society’s “conspiracy of silence” was keeping her—and possibly millions of others—from adequately dealing with the experience.



November 20 • 6:00 AM

Extreme Weather, Caused by Climate Change, Is Here. Can Nike Prepare You?

Following the approach we often see from companies marketing products before big storms, Nike focuses on climate change science in the promotion of its latest line of base-layer apparel. Is it a sign that more Americans are taking climate change seriously? Don’t get your hopes up.


November 20 • 5:00 AM

How Old Brains Learn New Tricks

A new study shows that the neural plasticity needed for learning doesn’t vanish as we age—it just moves.


November 20 • 4:00 AM

The FBI’s Dangerous Misrepresentation of Encryption Law

The FBI no more deserves a direct line to your data than it deserves to intercept your mail at the post office. But it doesn’t want you to know that.


November 20 • 2:00 AM

Brain Drain Is Economic Development

It may be hard to see unless you shift your focus from places to people, but both destination and source can benefit from “brain drain.”


November 19 • 9:00 PM

Gays Rights Are Great, but Ixnay on the PDAs

New research suggests both heterosexuals and gay men are uncomfortable with public same-sex kissing.


November 19 • 4:00 PM

The Red Cross’ Own Employees Doubt the Charity’s Ethics

Survey results obtained by ProPublica also show a crisis of trust in the charity’s senior leadership.



November 19 • 2:00 PM

Egg Freezing Isn’t the Feminist Issue You Think It Is

New benefits being offered by Apple and Facebook probably aren’t about discouraging women from becoming mothers at a “natural” age.


Follow us


Sufferers of Social Anxiety Disorder, Your Friends Like You

The first study of friends' perceptions suggest they know something's off with their pals but like them just the same.

Standing Up for My Group by Kicking Yours

Members of a minority ethnic group are less likely to express support for gay equality if they believe their own group suffers from discrimination.

How Old Brains Learn New Tricks

A new study shows that the neural plasticity needed for learning doesn't vanish as we age—it just moves.

Ethnic Diversity Deflates Market Bubbles

But it's not in the rainbow and sing-along way you'd hope for. We just don't trust outsiders' judgments.

Online Brain Exercises Are Probably Useless

Even under the guidance of a specialist trainer, computer-based brain exercises have only modest benefits, a new analysis shows.

The Big One

One company, Comcast, will control up to 40 percent of Internet service coverage in the U.S., and 19 of the top 20 cable markets, if a proposed merger with Time Warner Cable is approved by regulators. November/December 2014

Copyright © 2014 by Pacific Standard and The Miller-McCune Center for Research, Media, and Public Policy. All Rights Reserved.