A BILL OF HEALTH FOR THE IUD - WHERE DO WE GO FROM HERE

Although intrauterine devices (IUDs) are a highly cost-effective contr aceptive method, they have been unfortunately associated with increase d risk of pelvic inflammatory disease (PID). However, new studies, inc luding a 1992 World Health Organization (WHO) report, have demonstrate d that there is little evidence of a causal link between IUD use and P ID. IUD-related risk of PID is increased only during a short period fo llowing insertion, and exposure to STDs is probably the major determin ant of PID risk for IUD users. Furthermore, no increased risk of PID u se has been demonstrated with long-term IUD use. This paper examines t he evidence, focusing on the 1992 WHO study, and looks to the future w ith suggestions for IUD research and programmatic approaches in the ho pe of vindicating the IUD's reputation and broadening the indications for its use.