Intrauterine devices and reproductive health: American women in feast and famine.

Intrauterine contraception has been available in the United States since the early 1960s. During the past 4 decades, American women have mainly used nine different devices and accumulated approximately 47 million person-years of use. Interest in IUDs, as expressed by both use patterns and market forces that created and retired products, varied tremendously over this period. In the peak years, women had unfettered access to, and choice of, IUDs, over time availability has declined. The American experience with IUDs involved a unique combination of factors: invention, expansion of publicly funded services, mass media, medical missteps, conflicting research, medical opinion and tort law. The IUD generated a controversial balance sheet of risks, benefits and reputation that still impacts reproductive health today. Copyright 2004 Elsevier Inc.