The Women’s Health Movement and the Dream of the Diaphragm

Half a century after the emergence of the women’s liberation movement, “the pill” remains ingrained in the iconography of second-wave feminism. Although the drug now comes in a sleek blister pack, the image of a retro Dialpak remains an aesthetic touchstone—a symbol of bodily autonomy now emblazoned on enamel pins, earrings, and rubber stamps. It is the image of the birth control pill, above all other contraceptives, that stamps women’s lib on America’s historical memory. It represents the “right to choose” – at least for the largely white, middle-class, and heterosexual mainstream feminist movement.

But, as with any feminist movement or technological development, the icons we cling to only tell part of the story. In the late 1960s, reports linked the hormonal contraceptive pill to deadly blood clots and breast cancer causing a nationwide “pill scare.” As a result, a distinct sect of women’s liberation activists galvanized around the idea that perhaps the oral contraceptive was not the redemptive feminist technology it promised to be. Under the banner of what they called the “women’s health movement,” these feminists sought to expose sexism in science and medicine and empower women to take ownership over their bodies.^[1] They argued that the pill was a technology designed, tested, manufactured, and prescribed by men. Wasn’t it, they wondered, just another way for the male-dominated medical establishment to control women’s bodies—down to the molecular level?^[2]

When the women’s health movement abandoned the pill as a viable means of achieving total bodily autonomy, they returned en masse to an older contraceptive method: the diaphragm with spermicidal jelly. What they originally considered a safe “backup” method of birth control, however, soon became more than just an alternative to the pill. Within the culture of second-wave women’s health activism, the diaphragm came to represent the feminist values of total bodily autonomy, sexual agency, and self-discovery.

Making the Old Diaphragm New Again

When the women’s health movement coalesced at the end of the 1960s, the diaphragm and jelly was already an old contraceptive method. In the decades preceding the development of the pill, the diaphragm was the best way to prevent pregnancy, and the only birth control consistently endorsed by physicians.^[3] Its long history as a safe and effective method appealed to activists who feared that the medical establishment underplayed the pill’s risks. Feminists who turned or returned to the diaphragm after the pill scare quickly realized that the diaphragm could be more than just a fallback plan until the pill was deemed safe or something better came along. No other options were both side-effect free and woman-controlled like the diaphragm. A condom was safe, and a surgically implanted IUD was effective, but the former required compliance from the male partner, and the latter required a medical procedure and could only be reversed by a physician. By the feminist activists’ estimation, only the diaphragm put the power of contraception fully into a woman’s hands – not their doctors’.

That the women’s health movement viewed the diaphragm as the least medicalized option is in fact somewhat ironic. Their first-wave feminist predecessors had actually fought to transform the diaphragm into a prescription medical device some fifty years earlier, when contraception was illegal under the Comstock Act of 1873. Thus, the (mostly white, middle-class) feminist organizers reasoned that the only way for women to safely and legally access diaphragms was to put them into the hands of (mostly white, male) physicians, who used their social and scientific sway to help lobby for the legalization of birth control.^[4] Although first-wave activists had given up some control over the diaphragm by putting it behind the pharmacy counter, they, like the second-wave health activists that came after them, still saw in the diaphragm the potential to exercise full control over their bodies once it was in their hands.

“Be righteous about using that diaphragm!”

Although the diaphragm necessitated a doctor’s expertise and prescribing power in the initial visit, physicians ceded all control over the method to their patient once they left the office. Its top competitor, the pill, was developed precisely to address this problem by minimizing how much a user’s control factored into the method’s effectiveness. Scientists advanced the pill as the solution to “overpopulation” among non-white, immigrant, and poor families (and even tested it on impoverished Puerto Rican women before gaining FDA approval) – a group they saw as imprudent contraceptive users. But they also saw the drug’s wider appeal, as the same pill would make family planning easier and more effortless for the “average” white, middle-class American woman, too. Because the diaphragm’s efficacy relied so heavily on the user’s knowledge of her anatomy and motivation to prevent pregnancy, physicians became reluctant to prescribe the device when the effortless, one-size-fits-all pill was available as an alternative.

The women’s health movement viewed that reluctance as a challenge. In a 1973 article for Woman Community Women’s Newspaper, a local feminist publication circulating in Kalamazoo, MI, an activist warned that a physician’s refusal to prescribe a diaphragm was “a limitation of my choice . . . If a doctor refuses to fit women for diaphragms as a matter of ‘principle,’” she wrote, “he is really trying to make a decision for them.”^[5] Demanding a diaphragm and then making use of it in the bedroom, she suggested, was the only real way for a woman to take ownership over her body. In a movement that prized lay women’s experiences of their bodies over medical expertise, the diaphragm and jelly was appealing precisely because physicians had so little control over the method once it was in a woman’s possession. Whereas the contraceptive properties of the pill required scientific and medical expertise to understand, no medical degree was required to know how the diaphragm prevents pregnancy.

If a user found the insertion process difficult, she could turn to women’s health activists, who would contend that their own tips on using the device were more valuable than anything a man with a medical degree could offer. Indeed, “most women don’t receive adequate instruction or encouragement from their doctor and leave his office insecure about the device itself and about their ability to use it,” noted an article in off our backs.^[6] In the spirit of Our Bodies, Ourselves, articles in feminist periodicals and newsletters counseled women in great detail on how to place the diaphragm, sometimes never mentioning the physician as a factor in the process at all. “Practice unabashedly,” urged an off our backs writer, for “all alone you are acquiring a skill that is roughly comparable in difficulty to learning chords on a guitar, knitting, or rolling a joint . . . Explore yourself sans guilt or embarrassment.”^[7]

Within the women’s health movement, bodily ownership also encompassed sexual self-possession. The diaphragm’s inseparability from the act of sexual intercourse singularly provided feminists the opportunity to promote and practice sex positivity. Because the diaphragm served no purpose other than to facilitate recreational sex, women’s health activists contended that the device represented a woman’s right to seek sexual pleasure on her own terms. One off our backs writer asserted that women should be not only unashamed of initiating sex in this manner, but empowered: “Men should take their cues from you. Be righteous about using that diaphragm!”^[8]

Our Birth Control, Ourselves

Throughout the 1970s, the diaphragm experienced a veritable renaissance – not just within the women’s health movement, but also among white, educated, middle-class, professional women across the U.S. The Chicago Daily News dubbed 1976 “the year of the great diaphragm shortage.”^[9] In 1979, the diaphragm made the Washington Post’s annual list of “what’s in,” alongside “Robin Williams,” and “hi-tech.” The pill, on the other hand, was “out.”^[10] At the time, the diaphragm and jelly method made a lot of sense to women simultaneously celebrating the Roe v. Wade decision and confronting the reality that the pill’s long-term effects on the body were still unknown. But even then, contraceptive choices among second-wave feminists were as variegated as the ideologies within the movement itself; many feminists continued to champion the pill as a win for women’s sexual liberation, which is why it remains a persistent icon of American feminism even today.

The diaphragm fit snugly within the ideals of the women’s health movement because it was emblematic of female control: in bed, in the doctor’s office, and over the very molecules in one’s bloodstream. While experts in reproductive medicine saw the minimization of a user’s control and responsibility as a net positive for users, women’s health activists viewed that responsibility as a form of power they wanted to reclaim. Importantly, the movement – overwhelmingly composed of white, educated, middle-class, heterosexual women – was already empowered to go against the grain of medical opinion and reclaim their bodies. They were motivated to opt for a more labor-intensive contraceptive method because most had the time, energy, and access it required. And, importantly, their calls to action were answered, at least in part. Pharmaceutical companies ramped up diaphragm production throughout the 1970s and 1980s to meet unprecedented demand, while the medical community got to work developing the much safer, lower-dose birth control pills still used today.^[11] Birth control may be an intensely personal choice, but a closer look at trending technologies and the people who use them reveals social circumstances and values that extend far beyond the bedroom.

Lea Eisenstein

Lea Eisenstein is a recent graduate of the University of Pennsylvania, where she received her BA studying the history of medicine, the history of technology, and gender and health. Her honors thesis, "From Icon to Bygone: The Rise and Fall of the Diaphragm in Twentieth-Century America," explores the social history of the contraceptive diaphragm.

• Lea Eisenstein

  https://nursingclio.org/author/lea-eisenstein/

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