The Truth About Birth Control Series: Part 3: Seriously? She got Arrested Over a Diaphragm???

Seriously? She Got Arrested

Over a Diaphragm???

 

The diaphragm has actually been around for a really long time. In the 1940’s they were prescribed regularly for contraception and was the best woman controlled option available. Advertisements touted them as being discrete so that the male partner wouldn’t know it was there, many men at the time didn’t approve. It gave women a new level of control over their fertility.

Diaphragms have actually been around longer than this; they were more like cervical barriers and were sometimes called “womb veils”. They’ve actually been around for almost as long as condoms and were made from things like oiled paper disks, algae and seaweed, beeswax, rubber, wool, pepper, silver, seeds, tree roots, fruits, vegetables, sponges in silk nets with strings. Whatever they could find to cover the cervix or in some cases plug the entrance to the womb.

 

Diaphragms Have an Interesting History in the US


MargaretSangerMargaret Sanger was a woman dedicated to empowering women; she was an early American birth control activist, nurse and sex educator. She opened the first birth control clinic is the US in 1916 which led her getting arrested for telling women about birth control.

You might wonder why she got arrested for talking about birth control, especially since she’s a nurse. Well, you see back then we weren’t allowed to talk about birth control because birth control was considered obscene and was prohibited by the 1873 federal Comstock Law. She became determined to do something because as a nurse tending to working class immigrant women, she was often on the front lines of the aftermath of a self-induced abortion or “back alley” abortions. Margaret came to believe that the only way for true social change would take place would be to challenge governmental censorship of practices of “family limitation”.

Margaret decided to take action and force the issue, the only way to change laws is to go through the system as cumbersome as it may be. So this is what she set out to do. It started with a newsletter called The Rebel Woman promoting birth control, a phrase she popularized and said that a woman should be “the absolute mistress of her own body”. Her goal with the newsletter was to instigate a legal challenge to the federal anti-obscenity laws, her goal to provoke a response succeeded. The postal service only delivered two of the seven volumes of her newsletter. She was arrested and indicted in 1914 and she jumped bail and went to Canada and from there to England.

As she fled the country, her associated initiated step two of her plan, releasing another publication called Family Limitation, this publication, even more radical than the first was designed to really take a stick to the hornets’ nest!

While in Europe, Margaret was introduced to the diaphragm and got really excited because she saw this as a superior contraceptive method to the suppositories and douches that American women were relying on to prevent pregnancy. The device was not available in the US and so she sent some back home, even though she was breaking the law and with the help of her second husband she smuggled large quantities into the US from Europe for distribution.

In 1932, Margaret arranged for a package of diaphragms sent from Japan and when it was confiscated by the post office it opened the door which allowed her to challenge the laws preventing women from getting information and access to birth control. Her success in court was a huge win for women all over America, opening the door to having more control over their bodies and fertility.

 

What is a Diaphragm Anyway?


ppdiaphragmThe diaphragm hasn’t changed too much over the years; it has a spring in the rim to hold the shape of the device and allow flexibility for insertion. The dome is usually made from latex but other materials are sometimes available. It fits behind the pubic bone and extends back to cover the cervix. The dome is a reservoir for spermicide. I don’t know about you, but I’m not all that crazy about bathing my cervix in spermicide for eight hours after sexual activity.

When learning fertility awareness methods, I don’t encourage my clients to use this method because it can hide fertility signals. Should my clients decide that they want to use the diaphragm, I also teach them about natural alternatives to spermicide which they can use instead so that they can avoid putting chemicals in their most sensitive areas.

What you need to know about Diaphragms:

  • Can be inserted several hours prior to intercourse and thus doesn’t interfere with spontaneity.
  • Can remain in place for up to 24 hours
  • Recommended to leave in 8 hours after intercourse
  • Needs to be used with spermicide
  • No protection against sexually transmitted diseases like HIV
  • Needs to be fitted by a physician

 

The Cervical Cap


cervicalcapsThe cervical cap has had a spotty history here in the US; it has been used more extensively in England and other European countries. The FDA inhibited the availability of the cervical caps for many years, allowing only one of the three available to European women to be sold in the US. The one they allowed is the second to the right; it only fits a particular shape of cervix. If your cervix was a different shape you wouldn’t be able to use it.

ppcervicalcap

Today, the only cervical cap that is available in the US is the Fem Cap. It’s still used with spermicide and is more effective for women who have never given birth vaginally. It’s much easier to remove than previous versions and it has a slightly higher failure rate than the diaphragm.

 

Perfect Use vs. Typical Use


Something else that is important to know about barrier methods is their effectiveness is very dependent on you. With this in mind, most contraceptive failure rates are calculated two ways. First, when they’re used perfectly every time with no mistakes ever, meaning the method was used consistently and correctly every time. Second is a “typical use” rate in which they take into account the errors that people make when using the method, when they blow off using their birth control, etc. These types of behaviors increase the chances the method will fail.

Barrier Contraceptive Method: Perfect use: Typical use:
Condom (male) 98% 82%
Diaphragm with spermicide 94% 88%
Condom (Female) 95% 79%
Fem Cap (never given birth) n/a 86%
Fem Cap (post-vaginal birth) n/a 71%
Birth Control Pill (for comparison) 99.7% 91%

 

So you can see that someone who uses a condom perfectly every time would have a more reliable method than someone on birth control pills who sometimes forgets to take their pill.

 

Spermicides


Even less effective is using spermicide by itself. There are things like Contraceptive Vaginal Film, spermicidal jelly inserted with an applicator; these methods should only be used by women who would be OK with getting pregnant. They reduce the risk of pregnancy by about 70%.

 

Is the Diaphragm or Cervical Cap Appropriate for Teens?


My main concern with diaphragms and cervical caps is that they’re a “thing” that you have to carry around with you in order to have it with you and you also need to bring spermicide. I remember as a teenager experimenting with sex, there usually wasn’t a nightstand to keep my birth control supplies in, nor a bathroom close by to “get ready”, and so my concern would be that it wouldn’t be used consistently, which is also one of the reasons that MDs so heavily favor hormonal contraception for teens. In general, these are not ideal methods for teens, but it’s important to know about them and if your daughter really wants to try this as a method we can help make sure she’s not caught unprepared.

 

Final thoughts….


Barrier methods are powerful tools for women who don’t want to use hormones and would like to avoid getting pregnant but fortunately not the only tools available because people get sick of using them. Join me next week as we dive into one of the most popular and effective contraceptives in the world but under-utilized in the US. Stay tuned for more!


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