Effects on Navajo birthrate from loss of the intrauterine device.

The concerns of relatively powerless groups may not be adequately addressed by health-care decisions based on market forces and on considerations of the general population. Calculations of the number of Navajo women at risk of unintended pregnancy suggest that several hundred such pregnancies would have occurred as a result of the withdrawal of intrauterine devices from the United States' market. Analysis of birthrate data confirms this estimate: approximately four to five percent of Navajo births in 1988 may have been due to this market withdrawal. Available data are limited in their ability to assess impacts on small groups of health-policy decisions made for the population as a whole. A mechanism for surveilling such effects needs to be established to protect the interests of such groups, particularly when they have restricted alternatives.