The dark history of the Dalkon Shield IUD, with Chikako Takeshita

[00:00:00] I think people today have forgotten the history of the IUD. This is Chikako Takeshita. I'm an associate professor at the University of California, Riverside. Chikako is the author of a book called The Global Biopolitics of the IUD, How Science Constructs Contraceptive Users and Women's Bodies. The book is really about the evolution and development of intrauterine devices, or IUDs.

[00:00:25] And I wanted to talk to Chikako because, as a form of contraception, the IUD is having a bit of a moment right now. That's right. Because of Trump. Because he threatened to overturn Obamacare. So since the election, we found out a number of Bay Area women are rushing to see their doctor. Contraception requests for long-acting birth control like IUDs have surged.

[00:00:47] Meantime, Planned Parenthood says appointments for birth control implants increased 350% after Election Day. And that has led to a run on IUDs over fear of not knowing what might be covered in the future. And if we're paying closer attention to IUDs right now, then we should really take a moment to know and understand their surprising history. The history of the IUD shows that not all women are treated equal.

[00:01:20] Younger women especially have no idea that it was a population control device meant to control women's fertility. People who invented different models of IUDs, they were all population control advocates. They believe that poor women's fertility must be controlled with a device that is cheap and efficient.

[00:01:49] And there's one type of IUD in particular that changed the landscape of contraception for women in America. It was called the Dalkon Shield, and it was sold by a company called A.H. Robbins. This important announcement from A.H. Robbins concerns the use of the Dalkon Shield IUD, a birth control device. As a birth control device, it was on the market for four years, from 1970 to 1974.

[00:02:15] Whether or not you know of any injury resulting from this product, you must act now or you will lose your right to ever make a claim. And in those four years, it was inserted in about two million women in America alone. The design of this device was lethal in some cases. To make a claim, mail a postcard or letter with your full name and complete address to the court at the address below. It was finally recalled more than a decade later.

[00:02:44] It must be received by April 30th, 1986. The Dalkon Shield was made of plastic and had an unusual shape. You really had to shove it through the cervix. It had four little legs on each side that stick out from the shield. Those little legs embedded themselves in the uterus. It had a long string attached to it, which was there so that the shield could be removed.

[00:03:13] That basically introduced pathogens into the uterus and caused infections. And so there were many people who became severely ill and had septic abortions. And at least 15 people died because it spread to the body. It really violated women's right to their healthy reproductive bodies. And it was done for a very greedy reason.

[00:03:46] We use the term birth control a lot. But in learning about the history of the IUD and how it was created, I'm struck by this question. Who is doing the controlling? This is Overlooked and I'm Golda Arthur. This episode is about the history of the Dalkon Shield and its legacy for contraception for women in America today. We're back in a minute.

[00:04:08] This is Overlooked and my name is Carolyn. I'm listening from the beautiful west coast of Canada in the island city of Victoria. This is Overlooked and my name is Natasha. I'm listening from Crewe, a small town near Manchester in the UK. This is Overlooked and my name is Mel.

[00:04:37] I'm listening from Falls Church, Virginia in the States. This is Overlooked and my name is Kasia. I'm listening from Poland. I listen to Overlooked because I was diagnosed with ovarian cancer out of the blue three years ago. And Golda's platform has provided me with education, examples, knowledge, and delivered in such a calm and soothing way.

[00:05:03] For me personally, Overlooked is the educational aspect of ending discrimination regarding women's health matters. Each story on the podcast is very motivational and each woman that has shed hairs is a hero in my eyes. I started listening to Overlooked because I wanted to hear about Golda's mom's experience with ovarian cancer.

[00:05:26] I carried on listening because I love hearing all the women's stories, which have all been very honest, real, and inspiring. And I listen to Overlooked because I write and speak and obsess over what researchers tell us is the implicit bias against women in the history of our women's health care. The cure? Keep telling your stories. Hi, Chikako. Thank you so much for joining me on Overlooked.

[00:05:55] Thank you for having me on the show, Golda. I think I will not look at IUDs the same way again after having read your book. And there's a lot there that I want to ask you about. Let me start here. When we talk about IUDs in America particularly, we talk about several waves, it seems, right? We talk about the first wave of IUDs, the second. And I think we are in the third wave right now. And to me, it points to an evolution.

[00:06:20] You know, the IUD seems to be at the intersection of changing societal norms and medical innovation and technology and unbrittled capitalism because this is America, after all, right? Absolutely. What interests me is that at the root of this story about the IUD is a deep-seated inequality. And I think maybe that's been a little obscured by the passage of time.

[00:06:48] Does that make sense to you, how I laid that out? Absolutely. It makes a lot of sense. So the modern IUDs were developed during the 1960s when American men were very afraid of what they called the population bomb, which refers to the population growth and explosion in the countries in the global south, where resources were scarce and there were too many people in their eyes.

[00:07:15] And they were afraid of political unrest and communism coming into those countries. And what they really wanted to do was control population growth. And IUDs were developed as the solution for their goals. So very simple question to start with. What is the Dalkon Shield?

[00:07:34] So the Dalkon Shield is a type of an IUD that was developed by Hugh Davis at the Johns Hopkins University's OBGYN department. This was a time when IUD developers were looking for the perfect design. In order for an IUD to prevent pregnancy well, the device had to fit the uterus and cover as much surface possible.

[00:08:01] Hugh Davis invented this device that looks like a shield, kind of like an oval shape with a little bit pointed bottom. It's about the size of your nail. And it had four little legs on each side that stick out from the shield. In comparison to the IUDs we have today, which are the T models that's shaped like a T,

[00:08:28] there was a very bulky model that was very difficult to insert and extract. But it was meant to cover a lot of uterine surface. And those crab legs were supposed to dig itself into the uterine wall if the uterus tried to contract and expel the device. Let's set the scene a little bit here. And this is the 60s we're talking about, right? Yes, this is the 60s that we're talking about.

[00:08:54] So the modern IUDs came out in the very early 60s. And initially they were distributed to some countries in the Global South. The Population Council in New York, it's a nonprofit organization that we're doing a lot of advocacy around population control and supporting countries in the Global South, became the main developer of the IUD.

[00:09:18] The two main concerns for the developers were pregnancy prevention and spontaneous expulsion. What does that mean, spontaneous expulsion, that it would just like fall out of your uterus? Yeah. So, you know, your uterus contracts sometimes. Yeah. And occasionally it will respond to this foreign object in your organ. And it does that cramping thing, the contraction, and that could push the device out.

[00:09:47] So that's how it would fall out. Wow. And it's happened to women who, you know, who had a heavy period. Right, right. And didn't realize that her IUD had fallen out and probably put it away with her, you know, napkin. And she got pregnant. So many reasons to be glad we're not living in the 60s anymore. Oh, yeah. So many reasons. Okay, fast forward to 1970.

[00:10:18] Hugh Davis published an article in the American Journal of Obstetrics and Gynecology based on a study he had done of several hundred women using the Dalkin Shield. He called it a, quote, modern contraceptive device. The study stated that the shield had a pregnancy rate of 1%. What he didn't say was that he was the inventor of the shield. That same year, a pharmaceutical company called A.H. Robbins bought the rights to manufacture the Dalkin Shield.

[00:10:48] They changed the design of the device by adding copper to it. Copper by this time was known to be a spermicide. And they also added what you heard Chikako call a tail, a weaved thread, a multifilament thread attached to the device that would be used to pull it out of the uterus. Around that time, there was a lot of competition for IUDs on the market.

[00:11:14] So A.H. Robbins launched an aggressive marketing campaign for the shield to both doctors and women themselves. That 1% pregnancy rate was widely advertised, as well as the idea that the device was safe and easy to insert and remove. The Dalkin Shield was not regulated by the FDA because at the time, it wasn't considered a drug.

[00:11:41] Even though initially the IUDs were meant for what they called uneducated poor women, and the pills were supposed to be for the Western educated women, the IUDs quickly became a device for all women. The Dalkin Shield was also marketed to college students and was available at university health centers. I knew a few people who came up to me and said,

[00:12:07] you know, I had the Dalkin Shield and I can't have children now because they got infected. Oh my goodness. Yeah, it was kind of sobering. I wasn't that reproductive age. I didn't have this personal experience. And I was just talking about it as my research in talks, conferences, whatever. And they would come up later and say, yeah, let me tell you about this because I had one.

[00:12:37] And they are all like PhDs, educated women who requested it themselves at the college health center or from their doctors. And they had so much trouble with it. It's bigger than your cervix. So if the crab legs get embedded into the wall of the uterus, you can't just pull it out, right? They had to cut it up in order to pull it out and had infections later on. And they have no children as a result.

[00:13:07] The Dalkin Shield did destroy a lot of women's lives. What was the first sign that something was wrong? Because it would have been perceived as a successful product, contraception method until something happened, right? What were the first signs of the smoke behind the fire sort of thing?

[00:13:34] After a couple of years that the Dalkin Shield had been on the market, some physicians started to notice that there were serious complications among their patients. One of those doctors was Russell Thompson, who went to the Congress and he testified in Congress.

[00:13:51] He had inserted hundreds of devices into patients only later to realize that the device inflicted tremendous pain on his patients and condemned the people who were inventing IUDs. And he complained to the government that the government wasn't controlling these kinds of dangerous things that the doctors were putting into women's bodies.

[00:14:14] But the person who really brought it to the public's attention was a man named Morton Mintz. Morton Mintz wrote for The Washington Post and did deep reporting on the Dalkin Shield. Eventually, he wrote a book about it called At Any Cost, Corporate Greed, Women and the Dalkin Shield. That encouraged some other doctors to come out and say, yeah, we also had problems and urged the FDA to do something about it.

[00:14:42] And those problems, if we had to list those problems, the fact that it didn't really prevent pregnancy was really just the tip of the iceberg, right? The problems were pretty gruesome. Yeah, yeah. So pain infections, pain during insertion and extraction, because the Dalkin Shield was exceptionally bulky. Other IUDs were inserted in a straw that would be inserted into your cervix. And then you just leave the IUD in the uterus and you pull it out.

[00:15:11] That's how the T model and other models worked. But the Dalkin Shield, you really had to shove it through the cervix. But I think the biggest problem was that women using Dalkin Shields were more likely to get severe infections, especially during pregnancy.

[00:15:29] It's because when your uterus starts to expand, it also started to pull the string that's attached to the bottom of IUDs. They're there so that you could pull them out. And Dalkin Shield had one too. Usually called the tail, tail of the IUD. And that tail would be pulled into the uterus as the uterus expands.

[00:15:56] The part that's supposed to be left out in the vagina slides into the uterus. And the uterus is a sterile space and the vagina is not. And what was different about the tail of the Dalkin Shield was that it used a multi-filament string, which means that the tail was consisted of multiple weaved in thread. And it allowed the bacteria to move into in between.

[00:16:25] And when the tail went into the uterus, that basically introduced pathogens into the uterus and caused infections. So there were many people who became severely ill and had septic abortions. And at least 15 people died. And with this sort of horror, you know, with these gruesome stories with women dying, how long before the government acted?

[00:16:53] Because at the time, in my understanding, these IUDs were being developed by individual doctors or pharmaceutical companies, sold and marketed without any regulation. In this unregulated market, it was like a direct route to profit without any oversight. Is that right? That is correct. It was in a category that was not regulated by the FDA.

[00:17:18] It wasn't until August 1974 that the FDA recommended removing the shield from pregnant women. But they did not recommend removing shields from women who were wearing them without any complications. So that left the possibility of thousands of women having complications in the future.

[00:17:44] Studies on the shield much later showed that the pregnancy rate was a lot higher than the company had advertised. About 5% compared to the 1% that was initially claimed. Lawsuits were filed against A.H. Robbins beginning in the mid-70s. But it took until 1980 for the company to send a letter to doctors recommending that they remove the shield from their patients.

[00:18:07] This important help warning is for women still using the Dalkon Shield, an IUD birth control device obtained in the early to mid-1970s. A few years later, A.H. Robbins launched an advertising campaign recalling the IUD. If you're still using the Dalkon Shield, its maker, A.H. Robbins Company, will pay your doctor or clinic to remove it. It's that important. In 1985, A.H. Robbins filed for bankruptcy.

[00:18:33] As a result of these problems with the Dalkon Shield, fewer women chose to use an IUD in general throughout the 80s. By the early 90s, only 1% of all contraceptive users chose an IUD. There were a few lessons that different stakeholders learned.

[00:18:58] One is that contraceptives that might lead to a lot of litigations are not profitable and therefore unworthy for pharmaceutical companies to sell. And this is why all the IUDs were withdrawn from the U.S. market. This did mean that some women lost their choice of contraceptives.

[00:19:25] On the other hand, at least more attention is paid to the safety of these medical treatments. But it took so much going wrong. It took so much. It took so much going wrong before that sort of correction was made.

[00:19:52] Chicago, this is like a fascinating story and just one of several that you outline in your book. When you were writing this book and when you were researching this book, did you come across anything that surprised you? When I went to get my IUD in 2002 at the Planned Parenthood, it was not a very popular method yet. Those American doctors were scared of something going wrong, so they were very reluctant. But I wanted it.

[00:20:21] And I called the doctor at Planned Parenthood and asked for an IUD. And she immediately asked me, are you married? And I said, no. And then she said, are you in a committed relationship? Are you and your partner monogamous, etc., etc. And I started thinking, why is she asking so many personal questions? But then I realized that, oh, you know what?

[00:20:48] She is trying to make sure that I am a safe user. What happened in the past was that women who had never had children became sterile with the Dalken Shield. And so that was never to happen again. So the IUDs were not supposed to be inserted in women who have never had children. That was sort of the norm in 2002. I caught that soon enough. So I told the doctor, I'm past 30. I already have a child.

[00:21:17] And even if I couldn't have any more children, I would not blame the IUD for it. So rest assured, I'm a safe user. You can insert it in me. You said earlier American doctors were scared. They were cautious. What was that based on? So because the Dalken Shield sterilized so many women who had never even had a chance to have a child, as a result, the IUDs were labeled as unsafe.

[00:21:46] IUD developers who wanted to reintroduce IUDs to the American market told the doctors that, look, this device should not be inserted in women who have never had children. Don't put it in young women who are promiscuous. Promiscuous, yes, was the keyword. Because they sleep around and they might get infections and that infection might result in sterilization. And then they're going to blame the IUD for it. So it's not a good idea to put it in younger women.

[00:22:16] And as you know, today, college women use the IUD. They're promoted to college women. But this is like part of how the discourse of the device and the reproductive politics around it have shifted throughout the decades.

[00:22:42] We've been talking about IUDs and the origin story of IUDs and this disaster story of one IUD in particular and where we are today. What do you think is the most overlooked aspect of the evolution of IUDs? And where do you think that inequality is felt most deeply? I think people today have forgotten the history of the IUD.

[00:23:05] And a lot of women, younger women especially, have no idea that it was a population control device meant to control women's fertility. The history of the IUD shows that not all women are treated equal. Even though we are supposed to supposedly have the same bodies and an IUD is a universal tool, it never has been.

[00:23:30] It probably will never be because it really depends on the context that they are used. It depends on how much agency the women have when they're using the device. You say this very early in your book, and this was the thing that really stopped me in my tracks.

[00:23:49] You write, as an imposable contraceptive method, the IUD embodies the paradox of the simultaneous possibility of giving women control over their bodies and taking it away from them. Tell me about the paradox. So an imposable device was exactly what population control advocates were looking for because they thought the pill is user controlled. And we have to rely on women to take the pill regularly.

[00:24:19] And, oh, those women who are, in their words, uneducated and unmotivated, in their words, poor countries are not going to do that. So we need something that we could do to them and forget about it. Once you get to the women and insert it, done. It doesn't matter what the woman wants. Well, in many occasions, IUDs are imposed on women.

[00:24:45] And in other contexts, they are sold to us as something that would empower us because it allows us to control our own fertility. You can't say the IUD is bad because it's imposable or you can't say the IUD is great because it gives control to women because the IUD is both. That's the paradox. It gives me a very heavy heart somehow. Oh, no.

[00:25:13] Well, you know, because I think that we don't think about these things enough. You know, right now, 2025, when we talk about women's health, we're not talking about it in a wide enough lens. You know, the point that you raise about not all women are created equal or we're seen equally by the folks trying to market this product to us, which we can use to empower ourselves.

[00:25:37] I sort of just worry that we're still being segmented or segmenting ourselves into different kinds of women who have different rights and different values. And that should not be the case. And so that's I'm just trying to explain, I suppose, where the heavy heartedness comes from. Oh, yeah. OK. Yeah.

[00:26:01] I'm so glad to have done this conversation with you and to be able to, like, take a minute and look at things through a different lens and kind of explore the history of one aspect of women's health in this way. So thank you so much for joining me on Overlook to talk about this. You're so welcome. I started my conversation with Chikako Takeshita talking about how IUD development came in waves.

[00:26:27] Right now, third generation IUDs are modern and safe to use for most women. We've learned a lot from the mistakes of the past. And at some point, we'll get a fourth generation of IUDs. And that means that women's health history is still being made. Overlooked is here for information and empowerment, but not medical advice. Every person's body is unique.

[00:26:54] So if you have questions about your IUD or IUDs in general, it is best to speak to your doctor or health care provider. Overlooked is an independent show, and we would love your support to keep the show going. You can support us on Patreon. And we want to say a big thanks to our patrons, Sally Herships, Yi Yang, and Aaron Arthur. We're building a community around women's health so that no one is overlooked.

[00:27:21] If you'd like to be part of it, hit the follow button on this podcast wherever you're listening to this. Or you can show us some love by writing us a review and sharing this episode with someone. Overlooked is written and created by me, Golda Arthur. Jessica Martinez-Dios is the show's producer. You can stay up to date with the show by signing up for the newsletter. And following us on Instagram and LinkedIn. We read every review and email.

[00:27:48] So write to us, hello at overlookedpod.com. Thanks for listening.