The Unexpected Influence of Camel Herders on Modern Contraception

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Cover photo is licensed under public domain.

More females than ever are using intrauterine devices (IUDs) as their primary form of contraception. Among contraceptive users ages 15-44, IUD prevalence jumped from 5.6% in 2002 to 11.8% in 2014.[1]

This trend highlights an interesting shift in women’s reproductive health and pays homage to an ancient practice.[2] To understand how IUDs fit into today’s society, we have to first backtrack to 400 BC.

The fundamental idea of inserting a device into the uterus to prevent pregnancy is thought to have existed for centuries; it just originated from a different type of mammal. Stories of the Bedouins, nomadic Arab peoples from the desert regions of North Africa, provide some of the first insight into theories on pregnancy prevention.[2] On long treks across the desert, pregnancy among camels would impede the progress of the journey. To disrupt this natural occurrence, camel herders would insert rocks into the wombs of camels to prevent the attachment of a fertilized egg cell. While the myth of the Bedouin’s early contraceptive methods is still hotly debated, their story lives on in pregnancy prevention practices that were later translated to humans.[3]

About a century ago, a German doctor, Richard Richter, created the first IUD for humans.[3] The original IUD was a woven circle made of silkworms guts and metal that was inserted in the uterus through a folding method.[2] This device made the uterus inhospitable for a fertilized egg, but was still primitive in design.[3]

Dalkon Shield IUD

Sketch of a Dalkon Shield IUD by Andy Ratchick is licensed under CC BY-SA 3.0

In the 1970s, the company AH Robbins introduced an IUD model named the Dalkon Shield.[3] This device was plastic and had spicule structures that anchored onto the uterine wall, making it difficult to remove.[2] There was a long, cotton, multifilament string (similar to a kite string) attached at the base intended for removal. Despite its potential as a new player in the contraception industry, the Dalkon Shield had negative consequences on health and the industry as a whole. The string attracted foreign bacteria, contributing to a 5-fold increase in pelvic infections that could result in infertility among users.[2]

Due to its ineffective results, the Dalkon Shield is often blamed for low usage rates of IUD devices in the later half of the 20th century. Stanford School of Medicine Professor of Obstetrics and Gynecology, Dr. Paul Blumenthal, refers to it as “a bad actor” for its role in spoiling public perception of IUDs.[2] As a result, the Dalkon Shield was discontinued in 1985 and AH Robbins went bankrupt. Despite the existence of other successful prototypes on the market, the Dalkon Shield’s bad reputation became ubiquitous and IUDs were rarely used.[2]

Today, IUDs are leaving their bad reputations behind. When Dr. Blumenthal was asked why this trend was occurring, he immediately replied, “Number one, it’s a really good form of contraception. You don’t get pregnant.”[2] IUDs are what Dr. Blumenthal calls “forgettable,” because they require “nothing to remember in [a] busy life,” unlike a daily alarm for an oral birth control pill or insertion of a diaphragm before intercourse.[2] Modern IUDs are no larger than a toothpick and insertion is relatively quick and involves only minimal discomfort.[4]

mirena

The Mirena is a common hormonal IUD option. Photo by Sarah Mirk is licensed under CC BY-SA 4.0.

There are both hormonal and non-hormonal IUDs available on the market.[4] Hormonal IUDs are made of plastic and release progestin, a synthetic version of the natural hormone progesterone, to thicken cervical mucus and make it difficult for sperm to reach the uterus. The four most common brands are Mirena, Skyla, Liletta, and Kyleena, and can last for anywhere from three to six years.[4] Non-hormonal IUDs are also plastic-based but contain copper and can last up to twelve years. Paraguard is the most common brand; it has small traces of copper ions that interfere with the navigation of the sperm.[2,4] If sperm cannot fertilize the ovum in a limited window of time, fertilization, and thus pregnancy, never occurs.[2]

Most forms of contraception, like the pill, have two types of failure rates–a perfect failure rate and typical failure rate.[2] Perfect use assumes the form of contraception is used exactly how it should be with no mistakes, while typical use accounts for human error and mistake.[4] The IUD only has one of these two rates, because once inserted there is very little chance of human error. Users don’t need to think about the IUD until it’s time for removal a few years later. Dr. Blumenthal notes that, among IUD users, there are “0.5 women getting pregnant, maybe less, per 100 women [over] the course of a year.”[2] In comparison, condoms have a typical failure rate of 18 per 100 women and a perfect failure rate of 2 per 100 women. Birth control pills are slightly more effective, with a typical failure rate of 9 per 100 women and a perfect failure rate of 1 per 100.[4]

IUDs have become an ideal option for women who wish to delay or avoid pregnancy.[4] Dr. Blumenthal attributes this changed perception towards IUDs among the public to patient communication.[2] Enough people are now using the device that it’s essentially selling itself through word of mouth.[2] They are also cost-effective, especially over a five-year period, compared to other methods of contraception. Since the Affordable Care Act was passed in 2010, most insured individuals can get an IUD with no out-of-pocket cost. However, without insurance, an IUD can reach almost $900.[4] Increasing access to affordable health insurance over the next few years might contribute to rising rates of IUD use. Future health policy in support of accessible reproductive options might aim to fix these current barriers to contraception for low-income individuals.  

IUD

The modern IUD is a safe, cost-effective, and reliable contraception method being used more frequently than ever before. Image by Bruce Blaus is licensed under CC BY-SA 3.0.

What does the future have in store for IUDs? Physicians and researchers are working to create new prototypes to make the IUD an even better contraceptive option.[2] Dr. Blumenthal specifically noted the development of frameless IUDs and IUDs with small doses of ibuprofen to combat menstrual cramps.[2] IUDs have come a long way from rocks in 400 BC to a practical, cost-effective, and convenient method of contraception in the 21st century, and the future only holds more promise.

References

  1. Kavanaugh, M. L., & Jerman, J. (2018). Contraceptive method use in the United States: Trends and characteristics between 2008, 2012 and 2014. Contraception, 97(1), 14-21. doi:10.1016/j.contraception.2017.10.003
  2. Blumenthal, P., MD, MPH. (2018, May 2, 16). History of IUDs [Personal interview].
  3. Wessel, G. M. (2014). Of camels, silkworms, and contraception. Molecular Reproduction and Development, 81(9). doi:10.1002/mrd.22416
  4. Bedsider Birth Control Support Network. (n.d.). Retrieved from https://www.bedsider.org/
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