Money for mischief: USAID and Pathfinder tag-team women in 

the developing world

The case of the Dalkon Shield

by James A. Miller

U.S. Government officials, A.H Robins executives and Pathfinder Fund administrators (among others) conspired in the early 1970’s to dump hundreds of thousands of dangerous, unsterilized contraceptive devices — unmarketable in the United States — into the developing world, according to a recent analysis of government and other documents.

 These devices were Dalkon Shields.

With the possible exception of Norplant, the Dalkon Shield intrauterine device (IUD) was arguably the worst contraceptive ever foisted upon American women.

In just five years time following its January 1971 introduction into the United States, at least 18 Shield users died, several hundred suffered life-threatening septic abortions, and thousands more developed infections which often resulted in sterility.

By the time the filing deadline for the class action lawsuit against Shield manufacturer A. H. Robins was reached, more than 161,000 American women had filed personal injury claims Robins was forced to pay billions of dollars to those injured by the Shield and the company went bankrupt.

Most investigators believe that the actual number of those killed and injured was much higher, since not all those injured were properly recorded or, for one reason or another, they failed to file a claim. 

If the Dalkon Shield took such a toll in the United States, which has the finest medical services in the world, how many deaths and injuries did it cause in countries where medical care is often grossly inadequate?

The Dalkon Shield was dumped into the developing world by Robins with the aid of Dr. R. T. Ravenholt, the fanatical head of USAID’s Office of Population, who used USAID surrogates such as the International Planned Parenthood Federation (IPPF) and the Pathfinder Fund as conduits. 

With angry correspondence about Shield complications pouring into its corporate headquarters, with U.S. domestic sales declining, and with future prospects ever bleaker, the Robins company eagerly sought to expand exports of the Shield into foreign markets. 

Since USAID’s population office had a budget of $125 million to spend on the purchase and overseas distribution of

contraceptives, and with Director Ravenholt a known population control enthusiast who would likely ask few questions about a cut-rate deal on Dalkon Shields. Robins naturally turned to USAID to boost its sales.

Robins’ international marketing director wrote to USAID to interest it in placing “this fine product into population control programs and family planning clinics throughout the Third World.” 

The deal was sweetened with a special discount: the company offered USAID the Shield in bulk packages, unsterilized, at 48 percent off the standard price!

One of the greatest hazards associated with the use of any IUD is the possibility of introducing bacteria into the uterus. Accordingly, all

IUDs sold in the United States come in individual, sterilized packages, with a sterile, disposable inserter for each device. The sale of nonsterile IUDs would be highly irregular in the United States, and would probably result in product liability suits.

Careful to preserve its image and to protect itself legally, Robins emphasized that USAID could not distribute the nonsterile Shields in the United States. 

A January 1973 Robins’ memo declared that the nonsterile form of Shields “is for the purpose of reducing price…[and] is intended for restricted sale to family planning/support organizations who will limit their distribution to those countries commonly referred to as ‘less developed.  

Robins expected practitioners in such countries to sterilize the Shields by the old-fashioned method of soaking them in a disinfectant solution, a procedure which, in the U.S., would border on malpractice. 

Moreover, Robins provided only one inserter for every 10 Shields, thus greatly increasing the possibility of infection.

Robins included only one set of instructions with every 1,000 Shields, and those were printed in just three languages, English, French and Spanish. Although the devices were destined for distribution in 42 countries, many of them Moslem and Asiatic, it is highly unlikely that they were read by more than a small number of people.

When USAID officials asked whether Dalkon Shields could be safely inserted by staff workers of remote family planning clinics, who would not have had the benefit of an American medical education, Robins replied that was no problem. 

This was not what the company had argued in the U.S., where it customarily countered reports of adverse medical reactions by blaming unqualified personnel, such as the occasional general practitioner, for inserting the device.