It’s been, what, 45 years since sales of the infamous Dalkon Shield IUD were suspended. And virtually everything we “know” about how bad IUDs are comes from… the Dalkon Shield. It’s also been roughly 40 years since the first copper-wrapped mini-IUD was introduced.
This is still not to say the IUD is perfect for everyone, but as you say it’s more perfect for more people than The Pill or other heavy-duty hormonal contraceptives like shots or Norplant.
If the ACOG has greenlighted it a lot of caregivers who’ve been reluctant to prescribe IUDs are more likely to get on board.
For what it’s worth, one of the biggest arguments against IUDs is that they don’t protect from STIs. But since hormonal contraceptives don’t either that’s always been a wash. But with IUDs you can use condoms for what they do best: minimize risk of STI transmission, while leaving the IUD to do what it does best: preventing pregnancy when there are condom slip-ups.
Finally, speaking of condoms, for people who could be “fluid bonded” but still rely on condoms for contraception, the up-front cost of an IUD might be relatively high but five to ten years worth of condoms aren’t exactly cheap either.