BACKGROUND In Africa, use of the intrauterine device (IUD) is avoided because of perceived risk of pelvic inflammatory disease (PID) associated with sexually transmitted infections (STI). However, one recent model suggests that the risk of PID attributable to the IUD is very low, only 0.15% or less than 1 in 600. STUDY DESIGN Using rates from a 2004 study of cervical STI prevalence in Benin, Burkina Faso, Ghana, Guinea, and Mali; we calculate PID risk attributable to the IUD in West Africa. RESULTS Based on 4.4% combined prevalence of chlamydial and gonococcal infections, we estimate the risk is 0.075%, or less than 1 in 1,300. CONCLUSIONS In West Africa, PID risk from IUDs is extremely low. This should be better communicated to family planning providers in the region who may under-provide the IUD based on erroneous perceptions of PID risk.