The Laogai Archive is a dense set of documents, full of aging papers and sepia-toned photos. Imagine my surprise, then, in finding actual medical equipment among the records of China's family planning policies - an Intrauterine Device, or IUD.
The IUD is a hormone-free contraception with a complicated history - it was widely unused for the first 30 years following its invention in 1928 due to high rates of infection. More recently they have become a relatively safe and effective long-term contraceptive method, and in China they are currently in use by 45% of married Chinese women, representing over two-thirds of all IUD users in the world. IUDs have long been widely used in China, where the One Child Policy strictly penalizes women and families who have multiple children.
This particular IUD is a TCuC-S model, manufactured in the Wuxi Medical Instrument Factory of Jiangsu Province under the brand Tian Yi. It promises to be "Sterile for 2 Years," although there is no manufacture date listed. The documentation submitted with this particular artifact includes a birth permit issued in May of 1996. It's a plastic model, T-shaped with 6 small copper bands wrapped around its skinny arms. A blue filament hangs down from its base. I am sure it is an unremarkable medical specimen, but as an American woman I find myself nevertheless struck by its presence. (Read more after the jump)
In the US, the IUD has had a problematic rise to its current levels of use (only about 5.5.%), having more than doubled since 2002. The IUD industry has by now created a safe and practical contraception used by millions of women around the world, but it has done so in part by the despicable adaptation involved in reacting to the irresponsible and sometimes fatal failures of its product on the general population of women. The incredibly dangerous Dalkon Shield IUD, released in the US in 1971 and banned in 1974 was individually responsible for an estimated 200,000 cases of serious uterine infection in the few years it was available in the US, and many of those infections required a hysterectomy and 17 resulted in death.
The disaster of the Dalkon Shield case was only just beginning as hundreds of thousands of unsterilized IUDs in bulk packs of one thousand were foisted onto USAID and freely distributed to family planning clinics in 42 developing countries around the world. It was a perfect example of the USAID "inundation approach", sending cut-rate contraception to developing countries in a selection process without safety controls, to be distributed (again without controls) to women in what has been called "the most massive medical experiment in the history of the world." The Dalkon Shield transaction was finalized in 1973, and by 1974 the Dalkon Shield IUD was banned by the USFDA. Following the FDA ruling, USAID issued a recall of the device, which was already in use by 440,000 women, and in the following years Dalkon Shield IUDs continued on their deadly trajectory among women in developing nations.
The Dalkon Shield was not a particular problem in China, where most IUDs were domestically manufactured and in any case US aid was unlikely to be offered to China during the Vietnam war (although Dalkon Shield IUDs were sold commercially in Hong Kong). Nevertheless, Chinese women's options were not notably superior to those of women in other developing nations during the 1970s and 1980s, and the Shanghai Ring IUD, a stainless steel ring-shaped IUD developed in China, led to its own human experiment.
For example, insertion under non-sterile conditions is one of the surest ways to cause infection from an IUD insertion, as "one of the greatest hazards associated with the use of any IUD is the possibility of introducing bacteria into the uterus." Medical requirements for the insertion of an IUD specify "careful practice of aseptic technique," to minimize risk of infection, which can be around 2 percent under sterile conditions in the US. The IUD in my hand only promises sterility for 2 years, but I can only guess when those 2 years ended. In any case, we can safely assume that Chinese clinics were relatively similar to the clinics in many other developing countries of that time inasmuch as rural clinics may be difficult to keep sterile. In China, as in many developing countries, statistics on infections resulting from IUDs were not accurately recorded or publicly available.
For the population controller, however, statistics are available: Research in China in the 1980s suggested that contraceptive failure attributed to IUDs was the second-highest in the world, with the users of the Shanghai Ring reporting first-year failure rates of over 10% and up to 20% failure rates by the third year of use. Sociologist and author Barbara Ehrenreich points out, "From a population controller's point of view, a contraceptive may, if expedient, be unsafe; but it should not, under any circumstances, be ineffective." Chinese-manufactured IUDs in the 1980s were exactly that and in 1993 the Shanghai Ring was banned.
But lest we forget, contraceptive failure is not an equivalent experience in China. In the US, an unwanted pregnancy presents an array of options that are systematically denied to women under the weight of the One Child Policy. One 1995 study estimated that "70% of the 11 million abortions carried out each year were due to contraceptive, especially IUD, failure," and a 2002 study indicated that number was now around 63% - among some populations it was as high as 96%.
IUDs have since improved in quality and they are a practical contraceptive solution for millions of women. And in any case, the IUD in my hand, still wrapped in its sanitary packaging, is certainly blameless.
But the history, and particularly the problematic nature of the IUD industry, gives this artifact significant weight. The IUD is a symbol of progress in that it represents a broadening of family planning choices for many women, but also a shameful reminder for Americans of deep injustices carried out upon some of the world's most vulnerable populations and individuals. This particular IUD is only 1.1 inches long and weighs in at 0.2 ounces, but it seems much larger after all.