A History of the IUD: From Controversial Beginnings to Empowering Reproductive Choice

The intrauterine device (IUD), a popular form of long-acting reversible contraception (LARC), has a rich and complicated history. While it’s now seen as a tool for reproductive autonomy, its early development is rooted in a troubling legacy linked to eugenics and population control. Understanding this history can provide valuable context for the IUD’s evolution and how it became a leading choice in birth control today.

Early Beginnings: A Legacy Tied to Eugenics

The IUD’s journey began in the early 20th century, during a time when the eugenics movement promoted the use of sterilization and contraceptives, including the IUD, as tools for population control. Many eugenicists saw contraception as a way to control the reproductive rights of marginalized communities, including low-income women and people of color, reinforcing patriarchal and white supremacist ideals. 

In 1909, Dr. Richard Richter documented the first known use of a foreign object—silkworm gut—as a contraceptive device. This marked the earliest step toward developing the IUD as we know it today. Over the next several decades, physicians like Karl Prust and Ernst Gräfenberg continued to innovate by creating different versions of intrauterine devices. Gräfenberg’s work, which led to the creation of the Gräfenberg Ring, introduced the idea of using metals like silver to improve effectiveness. Despite these innovations, widespread acceptance of IUDs was still far off.

Mid-20th Century: A Period of Controversy and Caution

The years following World War II saw renewed interest in IUD research. Dr. Mary Halton's experiments with silkworm gut and gelatin capsules in 1949 provided new hope for an effective intrauterine device. However, it was the 1960s that brought significant developments. Dr. Lazar Margulies introduced a coil-shaped polyethylene device, while Dr. Jack Lippes created the "Lippes Loop," a plastic device that became the most widely used IUD in the world. By this time, strings attached to the IUD allowed for easier detection and removal.

Despite these advancements, IUDs were not without complications. The 1970s saw the rise—and dramatic fall—of the Dalkon Shield, an IUD that caused severe infections, infertility, and even death. The design flaws of the Dalkon Shield led to over 300,000 lawsuits and dealt a devastating blow to public trust in IUDs. In the aftermath, many IUDs were pulled from the market, leaving only one—Progestasert—available in the United States.

The IUD’s Renaissance: Copper and Hormonal Innovations

In the 1980s, the introduction of the Copper T 380A (ParaGard) marked a turning point for IUDs. This copper IUD, approved for use up to 10 years, offered an affordable and highly effective contraceptive option. The 2000s ushered in a new era with the approval of hormonal IUDs, starting with Mirena, which slowly releases levonorgestrel to prevent pregnancy. Mirena’s approval helped reestablish the IUD as a popular, safe, and long-term birth control method.

Since then, several new IUDs have entered the market, including Skyla, Liletta, and Kyleena, each designed with varying hormone levels and approved durations. These developments have expanded options for people seeking discreet, effective, and long-lasting contraception.

IUDs Today: Reproductive Autonomy and Challenges

Today, the IUD is recognized as a safe and effective birth control option for people of all genders. The once-controversial device is now hailed for its ability to give users more control over their reproductive health. According to the Guttmacher Institute, 13% of contraceptive users in the U.S. choose IUDs, a testament to the method’s growing popularity.

However, despite the resurgence in trust and popularity, challenges remain. Misinformation about IUD safety persists, and access to IUDs can still be difficult for some, especially in areas with limited healthcare access. The insertion procedure requires an in-person visit, and some clinics may not offer same-day service. Furthermore, insurance coverage varies by state, adding another layer of complexity for those seeking this method of contraception.

Moreover, the history of coercion around LARC methods reminds us of the importance of providing patient-centered contraceptive care. Health care providers must ensure that patients are empowered to make their own reproductive choices without pressure or bias.

The Future of IUDs: Continued Innovation and Advocacy

As contraception becomes more politicized, the need for accurate information and equitable access to all forms of contraception—including IUDs—becomes even more critical. The IUD’s history, marked by both triumphs and missteps, highlights the importance of ethical care, reproductive justice, and advocacy for marginalized communities.

IUDs have come a long way from their beginnings in the eugenics movement to becoming a modern tool of reproductive autonomy. Today’s IUD users have a range of options that fit their unique reproductive needs, ensuring that they have control over their own bodies and reproductive choices.

For more information on IUDs and to explore other contraceptive options, book an appointment with The Contraception Clinic.

Note: While many sources reference women when discussing IUDs, it’s important to recognize that people of all genders who have uteri may use this form of contraception.