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One readily apparent explanation is discomfort: the idea of inserting a strange object into the uterus and leaving it there for years at a time can seem unappealing and even counterintuitive to many women. Dr. Richman notes, “There is…squeamishness about the idea of the insertion and leaving a foreign body in,” although she adds that in our age of ubiquitous body piercing, such an explanation may seem “a bit ironic.” The actual procedure by which IUDs are inserted does little to ease this anxiety: a clinician holds the vagina open with a speculum while pushing the IUD into the uterus through a tube; the process can be uncomfortable and even painful.

The ambiguity of how IUDs actually work may also contribute to the suspicion surrounding them. IUDs have traditionally been viewed as a means of precluding the implantation of a fertilized egg in the endometrial layer of the uterus, thereby preventing pregnancy. This presents an ethical dilemma for women who believe that life begins at conception. The development of Mirena IUDs would seem to solve this moral dilemma since it prevents fertilization from occurring in the first place by building up a barrier to sperm. Yet even for non-hormonal IUDs, researchers have questioned whether conception actually occurs, since they rarely find fertilized eggs in the fallopian tubes of IUD users. This seems to indicate that even ParaGard IUDs present no compelling ethical dilemma. Many scientists now believe that an IUD triggers an inflammatory response in the uterus, which prevents sperm from ever reaching the fallopian tubes.

In the early 1970s, the deaths of twelve IUD users put a black mark on the method’s record, a scandal that lingers in the American collective memory and still presumably wards women away from IUD use. The health problems that have come to be associated with IUD use are encapsulated in the troubled history of the Dalkon Shield, a particular brand of IUD that was introduced in 1970 and eventually sold to 2.8 million women. The Dalkon Shield had an attached string that hung from the cervix and into the vagina, allowing a woman and her physician to check on the IUD’s placement or remove it if necessary. The Dalkon Shield’s particular tail, however, was unique: instead of a single filament, it consisted of many fibers wound together and enclosed in a sheath. It is this tail design that has since been blamed for drawing bacteria into the uterus and promoting the debilitating, fatal infections of the early 1970s.

By June 1974, when the Food and Drug Administration (FDA) recommended a suspension of all IUD sales, twelve IUD users had already died from severe, miscarriage-related infections and public scrutiny had grown into an outcry. Ten of these women had been using the Dalkon Shield. Actual deaths resulting from IUD-related complications had stopped months earlier when physicians began removing the devices from women who became pregnant, but social uproar and a series of faulty studies had already driven many women away from IUDs. Physicians presented evidence that seemed to show an astonishingly high rate of pelvic inflammatory disease (PID), an infection that can cause infertility, in IUD users.

These charges, however, have not held up very well over the last 30 years. While women are indeed at an increased risk for PID during the first three weeks after IUD insertion, and rates of PID are in fact higher for IUD users than for those who use the pill or barrier methods, a woman using an IUD actually has less chance of contracting PID than one who uses no contraception at all. Many experts now claim that PID risk was increased not only by the flaws of the Dalkon Shield, but also by the frequent sex of its users with multiple partners—common behavior during the sexual revolution of the 1970s. Today’s IUDs are far more advanced and safe than those produced in the 1970s, and no one has died from an IUD-related infection or miscarriage since 1977.