That’s what drove Kilbourne-Brook and her team to develop a new diaphragm—they wanted to provide a diaphragm women might actually choose to use. There were still gaps in the system. A 2012 study from the Guttmacher Institute found that 24 percent of women in the developing world who wanted an option for birth control weren’t using any form, because nothing met their needs. Women in developing countries were requesting non-hormonal methods that they could stop or start easily, and which could be used discreetly without a partner knowing. Kilbourne-Brook says that when they started doing research they saw some of these same needs in developed countries.
Part of the problem is that most readily available methods, from the ring to the pill, are hormonal. For the majority of women that’s not a huge problem, but some medical conditions, like cervical cancer, hepatitis, or blood clots, make them off-limits, and some women just don’t like the way they feel when they take hormones.
Kilbourne-Brook says they saw a need, albeit small, for an alternative. So, the question became: How to modernize a medical device that hadn’t been updated in 50 years? And then how to break the stigma that diaphragms are birth control for grandmas?
A makeover didn’t hurt. When Kilbourne-Brook pulls out the nine different sizes of diaphragms that a clinic would typically stock and sets the set next to a Caya, the old ones look a bit like shriveled pantyhose. They’re fleshy looking and saggy, while the Caya, in its plasticky purpleness, looks like a Barbie accessory.
That’s intentional. PATH spent 20 years trying to make the Caya both anatomically friendly and visually appealing. The idea to design a new diaphragm started in 1994, at the United Nations’s International Conference on Population and Development, to address the need for contraception in low-resource areas, where women might not be able access time-sensitive pills or IUDs, or might not want their partners to know they were using birth control. PATH, which does a lot of work on global family planning, spearheaded the project with funding from USAID and help organizing the trials from the Contraception Research and Development (CONRAD), research group.
Their goal was to make a diaphragm that was less awkward for the user and easier for health-care providers, who struggled with stocking nine different sizes of diaphragms, and spending the time to fit women for them. When they conducted surveys, Kilbourne-Brock said they heard stories about diaphragms flying across the room as women tried to insert them, or first-timers freaking out when they tried to find their cervix. “If you have a bad first time you’re not going to come back,” she says. “It was discouraging.”
They worked through six different iterations before they settled on the version currently being sold. The wanted the rim to be firm enough to stay in place, but not so firm that it sprung up and thwacked you in the insides while you were inserting it. The older models, with their stiff, watch-spring rims, would often snap open painfully when they were deployed. They worked with vaginal anatomists to size it so it would fit almost every woman and sit over the cervix instead of spanning the whole vagina. So it’s smaller, and one-size fits all. They thinned out the silicone membrane to make it easy to fold.