Effectiveness and acceptability of intra-uterine contraceptive devices.

Abstract

GROWING awareness of the social and economic consequences of rapid population growth, particularly in the two-thirds of the world characterized as developing areas, has intensified interest in all aspects of fertility control. After several decades of neglect and even condemnation, intra-uterine contraception, the only known fully reversible method of fertility control requiring only the single decision to have the device inserted, rather than repeated measures by one or both sexual partners, is receiving the renewed attention of physicians and public health workers in general. Several new types of intra-uterine contraceptive devices (IUCD) have been developed in recent years. One is a replica in stainless steel of the Griifenberg ring, which was originally made of thin silver wire; others are made of nylon thread or polyethylene in various shapes and sizes. The plastic devices can be stretched into linear shape for insertion into the uterus without dilatation of the cervix. Some of them have appendages extending through the cervical canal into the vagina, thus permitting verification of the continued presence of the IUCD as well as its easy removal, if necessary, for medical reasons or if desired by the wearer. This report covers the first 20 months of a cooperative statistical program, undertaken by the National Committee on Maternal Health as part of a comprehensive evaluation of intra-uterine contraception, sponsored by the Population Council. It is based on individual case records submitted by the participating investigators during the first 20 months of the program, i.e., through February, 1965. In order to present data of maximum comparability and relevance, this report covers only investigators in hospitals and extramural clinics in the United States, including Puerto Rico, and only the four intra-uterine contraceptive devices currently used for parous women: the large Margulies spiral1'2 (Gynecoil regular), the large Lippes loop3'4 (Loop D), the large Birnberg bow5 (Bow 5), and the stainless steel ring of Hall and Stone.6'7 Furthermore, the experience presented here is limited to the period of uninterrupted use, following the first insertion of a device. All investigators in private practice or in foreign countries are excluded, as well as one major clinic in the United States, where such extraordinary efforts have been made to control bleeding and other complaints without removing the device that the rate of removals for