Probably most readers know about IUDs since the Dalkon Shield, which continue to be a contraceptive option around the world, including in the United States. For a wide variety of reasons (breastfeeding and hormonal birth control immediately after having a baby are not particularly compatible; people tend to be inconsistent with condoms, at least in part because they don't like them; people _really_ don't like diaphragms, etc.), IUDs have been recommended to and used by several women friends/relatives of mine.
Uniformly, they volunteered that this wasn't like the Bad IUDs of the past, that it didn't have the complications/risks, etc. And here are the outcomes I've encountered in a very small (count 'em on one hand) number of women I know who've used an IUD in the last decade:
(1) Disappeared. This was discovered when she was going to "start" trying to get pregnant a second time.
(2) Persistent bleeding that continued for a year. Complained after a few months; health care provider convinced her to try just a little bit longer.
(3) Failed, that is, got pregnant. Arguably, this could be lumped in with (1), because the IUD was never found.
I don't know anyone who developed an infection/PID.
But ya gotta admit -- that's a bad set of outcomes for such a small number of users. But I have taken a statistics class and, honestly, I'm apparently still really naive and optimistic; I chalked this up to what can happen when you have a small data set.
Prior to the Dalkon Shield, a massive variety of designs of IUD were tried around the world over a period of years. And guess what? 40% failure rates were absolutely typical (either pain or bleeding leading to the woman insisting it be removed and/or spontaneous ejection/disappearance of the IUD) within the first two years. Infection/PID/uterine puncture are much, much rarer.
But don't you think that 40% would have been worth mentioning to the women who are having one inserted _now_? Given the design variations tried, it's hard to imagine that a new version is going to behave that differently. And my small sample size indicates that past trend is playing out in the here and now. So why are health care providers telling my friends/relatives that Things Have Changed and This Version is Better?
As a little further commentary on the whole IUD thing, Connelly describes how many of these were inserted in various years in India and China and around the world. He also describes how the Population Control/"Family Planning" crowd of those years was willing to take money away from public health/operate in advance of the ability of the local medical industry. The justification was that pregnancy and childbirth was a larger threat to the health of women than the "small" risk associated with IUDs, sterilization, etc. Let's sit with that idea, and contemplate, literally, MILLIONS of IUD insertions in some years in one of those two countries. Which implies tens of thousands of cases of PID, uterine rupture, bleeding, etc. On top of this, the devices used to insert the IUDs had to be sterilized between each use (this didn't happen even with sterilizations on men, and there were tetanus epidemics that resulted from mass vasectomies -- that's gonna really encourage the local populace to sign up the next time the "family planners" are in town, hunh?) because it was considered to expensive to ship single use, pre-sterilized kits. Anyone who has read about the transmission of Ebola and similar recognizes this is how hospitals wind up amplifying/creating epidemics of diseases that are otherwise very difficult to transmit.
No medical professionals were involved in implementing these insertions, in many cases (just like what would happen with Depo, years later), policy was _not_ to take medical history because it would just slow the process down. Etc. All in the name of, the bad cases are going to be rare, the outcome is Really Important and We Know Better Than You Do.
Don't even get me started on the connection between X-raying women's pelvises to determine a baby's position when she was in labor, and how when they finally stopped doing that the childhood leukemia rate took a dive off a cliff.