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Australian Feminist Studies

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Intrauterine Contraceptive
Devices, Situated
Knowledges, and the
Making of Women's Bodies
Anni Dugdale
Published online: 09 Jun 2010.

To cite this article: Anni Dugdale (2000) Intrauterine Contraceptive Devices,

Situated Knowledges, and the Making of Women's Bodies, Australian Feminist
Studies, 15:32, 165-176, DOI: 10.1080/08164640050138680

To link to this article: http://dx.doi.org/10.1080/08164640050138680

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 Australian Feminist Studies, Vol. 15, No. 32, 2000

Intrauterine Contraceptive Devices, Situated Knowledges, and

the Making of Women’s Bodies

ANNI DUGDALE
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In the early twentieth century, from about 1908 to some time in the 1920s, the
intrauterine contraceptive device (IUD) was invented. This was a device that could be
compressed to a small enough size to be inserted through a woman’s dilated cervix into
the uterus. There it would spring back into shape, most of the time stay in the uterus,
and perform its expected task of preventing pregnancy. Inserting things into the uterus
is not what was new, nor was the use of such devices to prevent pregnancy.
Various devices known as stem pessaries were in use at the end of the nineteenth
century to treat a range of female troubles, including infertility, and uterine prolapse
which was common then. Holding the uterus in the correct position was of great interest
to a medical profession which for much of the century had associated female complaints,
famously hysteria, with the proclivity of the womb to wander. Stem pessaries were made
from hard rubber, metal, or from softer materials such as silk gut. They had three parts:
a part that Ž tted inside the uterus which was often designed so that it could be
compressed and would regain its shape once inside the uterus; a stem, which was the
segment of the device that extended from the uterus through the cervix, and, in the case
of devices used to treat infertility, was hollow and acted to straighten the cervix; and a
device that Ž tted over the neck of the cervix, which in the case of stem pessaries designed
to prevent pregnancy took the form of an occluding button or cap suspended from the
stem and Ž tting over the outside of the cervix to block the passage of sperm from the
vagina.
What was ‘discovered’ in the early twentieth century, so the story goes, was that the
stem and the occluding button or cap were entirely unnecessary to the effectiveness of
the devices in preventing pregnancy.
Whether or not these wholly intrauterine devices sometimes caused infection, and
hence were unsuitable for insertion by physicians sworn to the prevention of harm,
remained controversial. Stem pessaries were known sometimes to cause infection,
although for the unfortunate sufferers of most of the conditions they were used to treat
they were generally deemed acceptable. It was not the medical profession as a whole, but
the sex reform movement which included quite a few socially aware doctors, that
accepted and promoted these early IUDs for use by healthy women for the purpose of
contraception. They were in use in Europe, America and Australia in the 1930s and
1940s. But their insertion by the medical profession was never without controversy, and
the practice of this method of contraception remained conŽ ned to a minority of women.
In the early 1960s, this device was picked up and developed within the context of the

ISSN 0816-4649 print/ISSN 1465-3303 online/00/320165-1 2 Ó 2000 Taylor & Francis Ltd
 166 A. Dugdale

population control movement. A number of innovations were made. The new IUDs
were made of plastic and added a tail, a string that went through the cervix and allowed
easier removal, perhaps by non-medically trained health workers, and allowed users to
check that their devices were still in place. These devices were also tested, in large-scale
multi-centre trials organised by the Population Council, a Rockefeller organisation. So
they came with tables that showed their efŽ cacy and safety and allowed the comparison
of IUD models, and comparisons between IUDs and other contraceptive methods.
The widespread diffusion of this technology was partly due to the organisation of their
distribution through global aid programmes aimed at lowering fertility rates in nations
emerging from colonial rule. Population control during the 1960s and 1970s was pursued
by the West, and particularly the United States, as a strategy in the Cold War.
Population controllers believed that fewer people would mean fewer hungry mouths and
thus fewer people vulnerable to recruitment for communist insurgency. Aid agencies and
many new nationalist governments themselves perceived lower fertility rates as necessary
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to improving the standard of living of their populations. The IUD was often promoted
as the ideal method for populations where the conditions for reliable use of the oral
contraceptive pill or the condom might not exist. These methods required ongoing
motivation, a constant source of supply and, in the case of the condom, male co-oper-
ation. IUDs remain the most common method of contraception in Indonesia and China.
But their use has declined in many, although not all, Western countries. This followed
litigation in the United States throughout the 1980s and early 1990s that ended with a
class action, brought by 327,000 women, that found the manufacturer and distributor of
the Dalkon Shield IUD negligent for distributing an unnecessarily dangerous product.1
At the 1994 International Conference on Population and Development (ICPD) in
Cairo, feminist health workers and health activists found themselves taking up contradic-
tory positions in relation to the use of IUDs.2 Some have actively struggled against sexual
conservatives, who, in the United States and Australia, for example, have had consider-
able success in stopping aid for contraceptive programmes. These feminists have
demanded global access to the whole range of contraceptive and abortion technologies,
arguing that this improves women’s control over their own bodies, and that the decision
to use a particular technology should be in women’s hands. Other feminists have
objected to many contraceptive and abortion technologies, IUDs among them, arguing
that many of these reproductive technologies expose women users to unacceptably high
health risks. The debate has centred around two questions. First, with the shaping of
knowledge in a patriarchal society is it possible to provide the potential users of a
technology with adequate information for decision making? Second, are women’s selves
sufŽ ciently free, given the gender hierarchies in which we all participate, to have the
capacity for informed choice?
Whatever position is taken, however, the body is regarded in these debates as an
organic, entirely physical, material object. We have bodies. We alter the capacities of
those bodies by using technologies. With our minds we evaluate information concerning
various medical technologies and procedures, and make decisions about which technolo-
gies we are prepared to accept. These debates are framed by the mind/body dichotomy,
and are implicated in its reproduction. One of the consequences of this is that the way
in which contraceptive technologies, like all technologies, participate in the making of
bodies is overlooked. I believe that this model of the relations between minds, bodies and
technologies needs to be challenged. This article does this by seeking to understand the
kinds of women’s bodies made possible by two IUDs from two different eras, and
conversely, the sorts of IUDs made possible by these particular bodies. It is premised on
 Intrauterine Contraceptive Devices 167

the assumption that technologies do not simply act on pre-given bodies, but that bodies,
technologies and subjects are made together, each being implicated in the production of
the others. My hope is that the debate between feminist health workers and activists over
the impacts of reproductive technologies on women’s health can be reframed. If bodies
are not simply given but are always in-the-making, then these debates need to become
alert to the complexities of the practices that are co-constitutive of both reproductive
technologies and the bodies on which they work.
The aim of the article is to explore how bodies are made in the processes of technology
production. I compare two contraceptive technologies, let’s call them the sex-reform-
IUD and the population-control-IUD. Despite similarities in the actual artefact, these
contraceptive technologies were very different, as I have indicated above. The devices
were part of very different heterogeneous networks.3 They were linked to different social
movements, different understandings of the role of the medical profession, different
knowledge-making practices, and to different women’s bodies. The contextualisation of
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these contraceptive methods within two very different social movements, the sex reform
movement and the population control movement, required that in each instance a
contraceptive technology be built from the ground up. This is not to say that eugenic
interests, the forerunners of the 1960s population control movements, were absent from
sex reform debates, or that sexual emancipation discourses were absent from 1960s
contexts. The sex-reform-IUD might have been appropriated and reinvented in eugenic
contexts in the 1930s, and the population-control-IUD certainly was reconŽ gured within
the sexual liberation movements of the late 1960s and early 1970s. But what I want to
demonstrate here is how the making of these two particular contraceptive technologies,
the sex-reform-IUD and the population-control-IUD also involved the making of the
bodies into which they were to be inserted.

Situated Knowledge
A starting point for this enterprise has been the work of feminist science and technology
studies scholars who have contributed to rethinking the mind/body, nature/culture,
science/society dualisms. Donna Haraway’s work is well known both inside and outside
the science studies community for contesting commonsense understandings of science as
above the social, as providing a pure mind-view, a view from nowhere—performing the
God-trick, as she calls it. For Haraway, bodies do not exist and then get represented, they
are continually being performed into being as they are made and remade in locally
situated practices. ‘Knowledge is situated’, Haraway insists, and the processes of
knowledge-making forge bodies, social orders, and future worlds, along with the
representations and beliefs they are usually taken to be producing.4
My aim in this article has been to follow Haraway, extending her work on the
situatedness of science to technology. In the next two sections, I tell the story of the
sex-reform-IUD and of the population-control-IUD. Each of these technologies takes
shape relationally; that is, each of its elements take on their speciŽ cities in relation to all
of the other elements of the situation—the device, the body into which it is inserted, the
desires of users, the subjectivity of the inserting physician, what is meant by safety and
efŽ cacy, the knowledges generated to make claims about safety and effectiveness, the
social movements that invest in the technologies. Their juxtapositions with and against
each other co-produce what IUDs and bodies are in this particular situation.5
Haraway’s own work is symptomatic of a situated knowledge. Her texts are full of
narrative fragments, but these do not link neatly together into a linear causal history of
 168 A. Dugdale

knowledge making. Haraway pulls out and juxtaposes the threads tangled together in the
making of science and nature, whether their origins are research institutes or the
discourses of popular culture.6 I am not as good a writer as Haraway, and readers will
have to forgive my lapses into causal narratives, and read against the ways in which my
stories become implicated in causal historical logics. Perhaps I can arm you against this
creeping causal logic by stressing again that the difference between the sex-reform-IUD
and the population-control-IUD is not a function of some combination of the essentialist
trajectories either of the various objects being constituted, or of the various social forces
that become entwined in their making. I tell stories about how social movements,
mathematical practices and rhetorical strategies work together to make two technologies,
and the bodies co-produced with them. My hope is that these threads will not be read
as origin stories, as distributing causality amongst the various social and material actors
involved in the making of these two IUDs. Rather, taking up Haraway’s notion of
situated knowledges, my aim is to explore the fabrication of the female body as an effect
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of the juxtapositioning of a heterogeneous array of elements brought together in the two

contraceptive technologies discussed.

The Sex-reform-IUD
The name most often associated with the IUDs of the 1920s and 1930s is that of Dr
Ernst Gräfenberg. After tinkering with a number of different shapes made from a
number of different materials, Gräfenberg had settled on a design for his IUDs, known
at the time as the coil or Grafenberg Ring. Gräfenberg’s design shaped a coil of wound
German silver wire into a compressible ring. The Grafenberg Ring looked rather like a
miniature version of those silver armband coils popular in the 1950s as a way of pulling
up shirtsleeves. International support for the Grafenberg Ring largely began at the 1929
international sex reform congress held in London. The international sex reform con-
gresses brought together lay people and medical professionals interested in sex reform.
They provided an organising forum for linking social activists and medical reformers
interested in equality.7 This required the construction of a new woman’s body.8 The
women active in the Sexual Reform League were building new relations between the
suffrage struggle, the family and society. The struggle for equal rights to sexual pleasure
was represented as the extension of the suffrage struggle from the victories in the public
sphere into the private realm of the home. The freedom of choice to satisfy private sexual
desires (at least within the bounds of heterosexual unions) came to be perceived as
integral to the emancipation of women in the public sphere.9 Gräfenberg contextualised
the Grafenberg Ring within this new discourse of equality and sexual desire.
Gräfenberg’s presentation at the 1929 Congress of the World League for Sex Reform
performed the Grafenberg Ring in a particular way.10 I have argued elsewhere that there
were three sets of linkages patterning Gräfenberg’s situated IUD that seem to me to be
crucial to making the Grafenberg Ring into a solution to the struggle for women’s
equality:11
(1) Gräfenberg severed his wholly intrauterine devices from the stem pessary.
(2) The Grafenberg Ring was always presented as a scientiŽc contraceptive technology.
(3) Gräfenberg spoke of the users of his devices as rational individuals making their
choices about the control of their sexuality.
Gräfenberg positioned his intrauterine device as a new device. Gräfenberg’s claim of
newness was not predicated on differentiating between the mechanism whereby his
 Intrauterine Contraceptive Devices 169

devices prevented pregnancy, and the mechanism that made stem pessaries effective
contraceptives. Both devices were thought to be effective because they impeded the
passage of sperm and thus prevented conception.12 For Gräfenberg, newness was
the absence of dangerous parts and practices.13 This differentiation of Gräfenberg’s
devices from stem pessaries was embedded in the geometry and geography of Gräfen-
berg’s IUD.
Gräfenberg emphasised the difference in the physical arrangement of the parts of the
IUD to break their association with medically caused infections induced by stem pessaries.
But stem pessaries were also part of a sexual underworld, and this new arrangement of
parts served to break this link. Stem pessaries used for contraception were often obtained
from the rather disreputable rubber shops that sold them alongside rubbers (condoms)
and diaphragms. They could be purchased and then inserted by a sympathetic local
midwife, or by a lay-abortionist. Relocating the bodies into which this IUD was to be
inserted, from their couplings with rubbershops, midwives, abortionists and prostitutes,
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to the world of medical practice, made them available to ‘respectable’ middle-class

women. In Gräfenberg’s words, here was a device for women with a ‘subjective reaction’
of ‘repugnance’ to contraceptive methods that involved ‘deliberate preparation on each
occasion’.14
Gräfenberg did his Rings as scientiŽ c contraceptives by presenting them as a medically
inserted contraceptive, and by accompanying his claims with a table of Ž gures derived
from his own patients’ experience with IUDs. This performed the Grafenberg Ring as
a modern scientiŽ c form of contraception. Doing the IUD as belonging to science was
inscribed in their design. They were designed to be inserted and removed using
gynaecological instruments. Connections were thus broken between this new IUD and the
association between women’s reproductive bodies and the supposed traditional knowledge
of midwives and lay-abortionists, knowledge that included the insertion of stem pessaries
for inducing abortion.
The Ž nal relational pattern between the heterogeneous elements of the Grafenberg
Ring that I want to draw readers’ attention to occurred during its distribution. The
Grafenberg Ring was offered as one possible contraceptive choice among many. It was
promoted alongside other scientiŽ c contraceptives such as the Messinga diaphragm as
superior to ‘folk’ practices such as withdrawal. It was a matter of personal preference
whether a woman chose the Grafenberg Ring, the diaphragm, or one of the many other
scientiŽ c contraceptives, perhaps one of the foams or spermicidal jellies being tested by
pharmaceutical companies. This positioning of the intrauterine device as a choice to be
made by conŽ dent scientiŽ c managers of the domestic Ž tted well with the discourse of
equality.
In order to link the IUD with the sex reform movement, a particular mode of
organisation of the IUD had to be put into place, a conglomeration of physical parts,
meanings and practices had to be produced that would enable a set of emancipatory
meanings to become associated with this contraceptive technology.15
Built with this IUD as part of its network was a new woman’s body. Gräfenberg’s IUD
enacted the body of its user as the body of the new woman. This was the desiring body,
subject to various tastes, part of a scientiŽ c world that promised a rational and equitable
society, under the control of an active and informed reason. This is not an argument
that as a scientiŽ c discourse this text enjoyed a privileged place in the formation of a
new sexual culture. Nor do I want to imply that the IUD ushered in a new age of
liberated sexuality for women. As historian of sexuality, Gail Hawkes has pointed out, the
twentieth century is not a story of women’s sexual desires being freed from their
 170 A. Dugdale

association with the fallen woman, but of the shaping of new forms of highly regulated
and organised coital heterosexuality.16
A new body was produced as part of a pattern of associations and displacements
enacted in Gräfenberg’s situated IUD, a body Ž t for the new woman. This modern body
is the outcome of many new conjunctions and juxtapositions of texts, things and body
parts. The speciŽ cities of the alignments and arrangements of these various elements of
the Grafenberg Ring produced women’s bodies as signifying in new and different ways,
and inserted them into new regimes of power.

The Population-control-IUD
The social movements that became linked to the IUD at the beginning of the 1960s
became part of a very different series of alignments and associations from those
evidenced in the IUD presented at the Sex Reform Congress of 1929. Christopher Tietze
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was a key player in recontextualising the intrauterine device at the centre of a global
movement aimed at population control. He worked for the Population Council, started
by John D. Rockefeller III to avoid con ict between the Catholic Church and Rocke-
feller interests in South America. Tietze’s multi-centre IUD Co-operative Statistical
Program became a programme with which the social goals of a wide cross-section of both
United States and international elites from across the political, business, and medical
arenas came to be associated. Through this testing programme, the diverse goals of a
variety of different organisations were transformed into a primary concern with rates of
population increase in the developing world. The population control movement, rather
than movements for sexual equality, became the extended network with which the nodes
of Tietze’s IUD articulated. This recontextualisation saw the massive globalisation of the
IUD network, but required the realignment and transformation of every element of the
IUD. Only then could it function as the carrier of these new goals of population
management and global fertility reduction.
The Co-operative Statistical Program, for assessing the comparative efŽ cacy and safety
of various IUDs, was run by Tietze and his wife and colleague Sarah Lewit. The situated
IUD of the Tietzes was embedded in a calculus of IUD risks and beneŽ ts. This mutated
the IUD. In the process of this ‘testing’ of a range of IUD designs at the beginning
of the 1960s, the population-control-IUD came into being. From a private
choice available in the context of the doctor–patient relationship for the re-ordering of
desire to allow for female equality, the IUD was transformed into a mass fertility control
device.
As well as remaking the IUD as an object, the Co-operative Statistical Program
remade women’s bodies and minds. The population-control-IUD was produced as the
ideal contraceptive for ‘unmotivated’ women. Women were constituted as recipients of
the population-control-IUD differently from their constitution in the intrauterine device
networks of the 1930s. Then, a singular but diverse category of women were envisaged
as choosing the sex-reform-IUD or other contraceptive methods to suit their variations,
in taste for example. In the 1960s, whilst women’s bodies were standardised, women
were divided into two sub-groups. We were not all born equal. Experts deŽ ned the
intrauterine device as the ideal method for a particular, although very large, group of
women. This group were not their wives, who in the early 1960s were competently using
diaphragms, their fertility already under the control of science and reason. But the
population-control-IUD was not merely one alternative available to women contracep-
tors as the Grafenberg Ring had been, it was perceived as unique, as the most efŽ cient
 Intrauterine Contraceptive Devices 171

and indeed only viable contraceptive for large numbers of women deemed unlikely to
have the capacity to adopt ‘rational’ habits of fertility control.
The key patterns of association and differentiation of elements constitutive of the 1960s
IUD that meant that it could be attributed with the agency to control world population
were:
(1) The remaking of the IUD as the ideal method of contraception for population
control, a one-device-Ž ts-all, insert and ignore, cheap means of mass fertility treat-
ment.17
(2) The bringing together on a single sheet of paper representations of IUD-use from
diverse centres, thereby constituting population rather than individuals as the subject
of a therapeutics, and the physician as the rational actor in the best position to choose
the method of contraception to prescribe.
The simultaneous standardisation of women’s bodies, and differentiation of their minds
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was co-produced with these transformations to the IUD. Bodies and technologies
mutated together.
Allow me to address each of these transformations in turn. First, the Grafenberg Ring
IUD was aligned with other contraceptives in a mode that allowed for any effective
contraceptive to be substituted in its place, but when Christopher Tietze became the
manager of the transition of the IUD, this substitutability disappeared. The IUD was
represented as unique. This was despite the fact that the oral contraceptive pill had just
become widely available and was proving to be amazingly acceptable to women in all
countries.
The Population Council rejected the oral contraceptive pill as unsuitable for popu-
lation control. They differentiated the IUD from the Pill both rhetorically and through
the Co-operative Statistical Program. The IUD was portrayed as superior to the Pill
because it was cheap, did not require frequent repeat supply, and was more effective in
use. Risks could be standardised for all women, including women with ‘low motivation’,
or women prone to ‘forgetting’. Here was a
contraceptive device that need be inserted only once and can be left in place
for some time, during which no pregnancy occurs in the vast majority of cases.
Motivation is required only once, rather than before each sexual act or on a
daily schedule of medication.18
This ideal IUD—a standardised device that could be mass inserted and was suitable for
use by any women—was materialised in the organisation of the clinical testing of the
IUD as a comparative programme. In 1963 when the Co-operative Statistical Program
began to investigate IUDs, the testing of these devices was centralised. The results were
reported in a single comparative table with each IUD arrayed as a list of risk calculations.
Table 1 shows one such table.19
Across the top the various kinds of IUDs are listed. There are different shapes—loops,
spirals and bows, different sizes, and different construction materials. Down the side are
the events for which risk calculations were made, from data on the number of trial
participants who become pregnant, or found that their IUD had been spontaneously
expelled from their uterus, or had their IUDs removed during the trial either by choice
or for medical reasons. The numbers shown in the table purport to predict the
experience of any 100 women who use the IUD for a speciŽ ed period, in this case two
years. It calculates the probability that a woman will withdraw from the trial due to
pregnancy, withdrawal, removal, etc. in the two year period of time. The number is a
 172 A. Dugdale

TABLE 1. Gross cumulative rates of events by type of termination, per 100 users: all devices by type and size, all
segments, two years of use

Loops Spirals Bows

Events A B C D small large small large Steel rings

Pregnancies 11.8 8.2 5.8 5.1 6.4 3.3 18.0 8.8 10.6
Expulsions
First 25.2 24.1 19.4 12.9 37.1 26.9 5.6 2.1 20.5
Later 5.7 5.2 8.9 5.4 12.7 8.8 1.9 1.4 5.4
Removals
Bleeding/pain 15.9 20.8 18.8 19.5 16.2 24.7 18.6 17.9 14.0
Other medical 8.4 7.1 6.8 6.9 7.3 13.8 5.2 6.8 4.2
Plan pregnant 4.7 1.5 3.9 3.3 5.4 3.6 5.4 2.7 5.7
Other personal 8.9 5.7 4.5 5.1 14.8 7.9 9.1 4.8 4.3
Woman-months of use 13,453 12,463 50,775 121,566 5,938 29,331 19,636 41,755 25,829
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risk calculation, but it does not mean that (let’s say) 1,000 women began using the IUD
(concentrate on loop D) for two years, but 51 were closed out of the trial because they
became pregnant, leaving 949 women still in the trial and using their IUD at the end
of the second year of the trial.20 The Ž gure of 5.1 is calculated from the proportions of
a cohort entering a particular month of use of their IUD who survive pregnancy for each
of the monthly time intervals, up to the 24th month.21 The survival rates for each month
are then multiplied. Each gross monthly survival rate is a proportion:
Number surviving pregnancy for the month
Number of trial participants at the beginning of the month

Notably, this means:

(1) Trial data can be contributed by women with a lot less than two years of experience
of IUD use. Risk calculations can be made as the trial proceeds, which was important
to Tietze as there were many United States doctors ready to criticise the trial because
they thought these IUDs were dangerous.
(2) Whilst data from different clinics could be combined easily, allowing the mass testing
programme that Tietze conducted,22 1,000 women might begin the trial and
contribute to the calculating of the Ž rst monthly survival rate, but only 100 women
might still be in the trial after 11 months, and so calculations of the 12th month
survival rate would be based on the IUD experience of many fewer women.
(3) No data are collected on women after they become pregnant, or have a device
removed due to infection, and so forth. The events on the left-hand side of the table
are reasons for trial participants leaving the trial.
The calculating apparatus used by Tietze employed mainstream techniques with a few
readily accepted innovations. His data and risk calculations were considered exemplary
by many of the Congressional inquiries that occurred as a result of the Pill scare over
thrombo-embolisms and then the Dalkon Shield scare. But it is a re ection of the
enthusiasm for population control that these results were so readily accepted.23 ScientiŽ c
data are always contestable. The IUD was in use for several years before any data on
the women who left the trial were sought, and then it was to ensure that women did
become pregnant after ceasing IUD use.
 Intrauterine Contraceptive Devices 173

But to return to the point that I want to make here about the refabricating of the IUD
as the standardised ideal population control device, what can be seen in the table is that
the IUD did not yet exist. No single IUD delivered low risks in all categories—preg-
nancy, spontaneous expulsion of the devices from the womb, removals resulting from
increased bleeding and painful cramping or other medical or non-medical reasons. But
the active programme of comparative trials, it was widely believed when the Co-operat-
ive Statistical Program began, would soon result in the identiŽ cation of the single
mass-insertion-IUD suitable for all women. By looking at the table it would become
evident what was needed to ensure the lowest risk of expulsion, the least pain and
bleeding, and the lowest pregnancy rates: the removal of a tail here, the use of a less stiff
material there, an increase in size, or a shift in shape. This phantom IUD is the
apparition constituted by Tietze’s trial data with its neat columns clearly displaying the
effects of size, shape, and material composition.
A standardised IUD required a standardised body. The stories each woman has to tell
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of pain or pleasure, freedom from worry or increased worry as health deteriorates, are
erased when the clinic participating in the trial Ž lls in the follow-up form, reducing each
woman’s experience to a continuing trial participant or a closed-out case in one of the
categories. The body survives only as two series—numbers of months of IUD use and
close-out category.24 This is inscribed back onto the bodies of IUD users as any pain and
suffering they encounter is lived as a ‘side-effect’, and even serious damage such as
uterine perforation, tubal pregnancy and pelvic in ammatory disease is experienced as
‘rare’, their bodies as unlucky to succumb to such an unlikely risk.
What this table also does is to bring together at a point location what would otherwise
be incommensurable and dispersed.25 The Tietzes’ table is thus constitutive of population
as an object of therapeutics. Table 1 makes the medical profession into population
planning experts. The table positions its reader as having an overview of the population.
This provides a warrant for them to be the choosers, the rational actors in the best
position to decide on the best contraceptive method. The relational space of the table
with its comparable columns and rows of Ž gures acts to produce the agency of the expert,
in a position to stand back and to be the decision maker.
This expert knower stands in stark contrast to the woman envisaged as the user of this
IUD. What the table is also producing are standardised users, users for whom the
calculated risks are the same, irrespective of differences in motivation and cultural
context. The table is implicated in the rhetoric of the intrauterine device being ideal for
women who might ‘forget’ to use more conventional methods. This rhetorical device of
‘forgetting’ stood in for a powerful and pervasive set of Western dichotomies. Western
philosophy and popular cultures had long equated woman, the East and nature;
excluded reproduction from the realm of culture, and constructed class and race
hierarchies along an imagined line of evolutionary progress from the animal realm of
biology to the high culture of Western civilisation. These elements did not have to be
spoken. Any Western-educated reader of the mundane statements and tables of the
intrauterine device protagonists and population control advocates understood that it was
this linkage between woman, nature and tradition that could undermine the potential of
the East and South to imitate the Western manly virtues of progress, virility and
economic growth. The ‘unmotivated contraceptor’ was not merely a reference to a
person with different desires about the number of children they wanted, it was a phrase
that mobilised a series of dichotomies that white middle-class men in industrial society
formulated themselves against. These dichotomies include city/country, rational/ir-
rational, progress/tradition, in control/accepting fate, active/passive, culture/nature,
 174 A. Dugdale

industrial/rural, male/female; the dichotomies of the modernisation discourse. The mind

of the IUD user constructed in this rhetoric and present in the table was thus collapsed
onto the body, a body that was deŽ ned by race and class, and made in opposition to an
ideal of masculinity—as in nature, bound by tradition, childlike, and so forth.
The Population Council produced both a new IUD and new bodies. The IUD became
a new thing—a mass produced and cheap device suitable for any woman regardless of
her sexual practices, culture, or motivation. In the processes making this IUD, women’s
bodies were also remade. Whilst some women’s bodies would remain under rational
control, other women’s bodies were reduced to their fertility. Stripped of their minds,
contraceptive experts were released from any responsibility for engaging with the cultural
identities (imagined as located in the mind) of IUD users. This woman’s body—sexually
available, endlessly fertile, constantly threatening to avert progress and economic
growth—became subjectable to the management of experts.
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* * *

The ontology of the IUD, and the ontology of women’s bodies, what each is, are intricately
linked together. Each is an effect of the other and is made possible by it. Both are
co-constituted in the practices that perform technologies, bodies and subjects into
existence. This article has explored the ways in which technologies make bodies. I have
traced the making of two different bodies in the processes producing two contraceptive
technologies. I have shown how the body is not a Ž xed thing on which technologies have
impacts, but are outcomes of the juxtapositioning of diverse components—social move-
ments, texts, plastics, silver wire wound into coils, body parts, organisms, organisations,
international politics, and social desires. Each of these components needs to be imagined
as itself in the making, as bits and pieces pushing and pulling against one another in
disparate directions. This article is about the linkage of diverse elements, bodies, texts,
and practices, positioned as sharing the same ontological status. These diverse elements
undergo metamorphosis as they are continuously realigned. The various alignments and
breaks, conjunctions and linkages discussed produced two very different IUDs, and thus
two different bodies. It needs to be kept in mind, however, that the bodies enacted in the
research and development work discussed in this article, that is, during the production
phase of the technology, are not the end of the story. The task is beyond the scope of
this article, but an exploration of the consumption phase would continue to tell a story
of new juxtapositions and transformations, new bodies and new IUDs.

NOTES
1. On the Dalkon Shield debacle see Morton Mintz, At Any Cost: Corporate Greed, Women, and the Dalkon Shield
(Pantheon) New York, 1985; Susan Perry and Jim Dawson, Nightmare: Women and the Dalkon Shield
(Macmillan) New York, 1985; Ronald J. Bacigal, The Limits of Litigation: the Dalkon Shield Controversy
(Carolina Academic Press) Durham, NC, 1990; Richard Sobol, Bending the Law: the Story of the Dalkon Shield
Bankruptcy (University of Chicago Press) Chicago, 1991; Karen M. Hicks, Surviving the Dalkon Shield IUD:
Women v. the Pharmaceutical Industry (Teachers College Press) New York, 1994.
2. United Nations International Conference on Population and Development (ICPD), 5–13 September
1994, Cairo, Egypt. Documents at , http://www.iisd.ca/linkages/cairo.html . .
3. On the heterogeneity of technologies see Wiebe Bijker, Thomas Hughes and Trevor Pinch, The Social
Construction of Technological Systems: New Directions in the Sociology and History of Technology (MIT Press)
Cambridge, MA, 1989; Donald MacKenzie, Inventing Accuracy: a Historical Sociology of Nuclear Missile Guidance
(MIT Press) Cambridge, MA, 1990; Cynthia Cockburn and Susan Ormrod, Gender and the Technology in
 Intrauterine Contraceptive Devices 175

the Making (Sage) London, 1993; and Wiebe Bijker, Of Bicycles, Bakelite and Bulbs: Towards a Theory of
Sociotechnical Change (MIT Press) Cambridge, MA, 1995.
4. Donna Haraway, Simians Cyborgs and Women: the Reinvention of Nature (Free Association Books) London,
1991; in particular see ‘Situated Knowledges: the Science Question in Feminism and the Privilege of
Partial Perspective’; see Donna Haraway, Primate Visions: Gender, Race and Nature in the World of Modern
Science (Routledge) New York, 1989; Donna Haraway, ‘The Promises of Monsters: a Regenerative Politics
of Inappropriate/d Others’ in C. Grossberg, P. Nelson and L. Treichler (eds), Cultural Studies (Routledge)
New York, 1992.
5. On the shift in science studies from metaphors of production to metaphors of performance that suggest
that reality is performed into being see Annemarie Mol, ‘Ontological Politics. A Word and Some
Questions’ in John Law and John Hassard (eds), Actor Network Theory and After (Blackwell) Oxford, 1999,
pp. 74–89.
6. In particular see Haraway, Primate Visions.
7. Norman Haire, Proceedings of the Third Congress of the World League for Sexual Reform (Kegan, Paul, Trench,
Trubner & Co. Ltd.) London, 1930.
8. Carroll Smith-Rosenberg, Disorderly Conduct: Visions of Gender in Victorian America, (Oxford University Press)
New York, 1985; Ludmilla Jordanova, Sexual Visions (University of Wisconsin Press) Madison, 1989; Mary
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Poovey, Uneven Developments: the Ideological Work of Gender in Mid-Victorian England (University of Chicago
Press) Chicago, 1988.
9. See the following in Haire, Proceedings: Dora Russell, ‘Welcome Speech, Sex Reform Congress’; Dr
Hannah Stone, ‘Birth Control as a Factor in the Sex Life of a Woman’; Janet Chance, ‘A Marriage
Education Centre in London’; Helene Stocker, ‘Marriage as a Psychological Problem’; Elsie Ottesen-
Jensen, ‘Birth Control Work Among the Poor in Sweden’; Vera Brittain, ‘The Failure of Monogamy’;
Stella F.W. Browne, ‘The Right to Abortion’; Naomi Mitchison, ‘Some Comment on the Use of
Contraceptives by Intelligent Persons’.
10. Ernst Gräfenberg, ‘The Intra-uterine Method of Contraception’, 1930; Hans Lehfeldt, ‘Contraceptive
Methods Requiring Medical Assistance’, in Proceedings.
11. Anni Dugdale, ‘Inserting Gräfenberg’s IUD into the Sex Reform Movement’ in Donald MacKenzie and
Judy Wajcman (eds), The Social Shaping of Technology New Edition (Open University Press) Milton Keynes,
1999.
12. Interestingly, Gräfenberg’s German silver had a high copper content and the IUDs used today enhance
their effectiveness by winding copper wire around the plastic device. The slow dissolving of this copper
into the uterine lining is assumed to work by preventing the implantation of the fertilised egg, but
precisely how IUDs work remains controversial.
13. Ironically, it was the addition of a tail-string to the 1960s IUDs that led to the failure of the Dalkon
Shield. The design feature so important to the distancing of the Grafenberg Ring from the stem pessaries
and their connections to prostitutes and midwives became the focus of litigation. The accusation was that
the Dalkon Shield caused pelvic in ammatory disease precisely by facilitating the breaching of the
vaginal/uterine barrier, which Gräfenberg had warned was what made the stem pessaries harmful.
14. Gräfenberg, ‘The Intra-uterine Method of Contraception’, 1930. English Translation on p. 611.
15. The term ‘mode of organising’ is John Law’s. See John Law, Organizing Modernity (Blackwell) Oxford,
1994.
16. Gail Hawkes, A Sociology of Sex and Sexuality (Open University Press) Buckingham, 1996.
17. Nelly Oudshoorn, ‘The Decline of the One-size-Ž ts-all Paradigm, or How Reproductive Scientists try to
Cope with Postmodernity’ in Nina Lykke and Rosi Braidotti (eds) Between Monsters, Goddesses, and Cyborgs:
Feminist Confrontations with Science, Medicine and Cyberspace (Zed Books) London, 1996.
18. Population Council, The Population Council, Annual Reports 1952–1964 (Population Council) New York,
1965, pp. 11–12, 1962–3.
19. Taken from Tietze and Lewit, ‘Evaluation of Intrauterine Devices: Ninth progress Report of the
Co-operative Statistical Program’ (Ž rst published 1970) in Tietze and Lincoln (eds), Fertility Regulation and
the Public Health: Selected Papers of Christopher Tietze (Springer) New York, 1987.
20. The gross cumulative event rate stands for the probability of each type of event occurring independently
of all other types of events. The gross rate of 5.1 pregnancies is a calculation of a Ž ction: the risk of
pregnancy amongst a cohort of 100 women who have the IUD inserted if none discontinued for any
other reason than pregnancy during a two year period. The net rate is also usually calculated and is
slightly lower because the number of people who might leave the trial because of pregnancy is not the
whole 100 who begin using IUDs, but only those who survive other causes of elimination—expulsions,
removals for pain and bleeding, etc.
21. If 9/10 survive their Ž rst month, 2/3 of those survive the second month, and 1/2 of those survive the
 176 A. Dugdale

third month, the cumulative survival rate is 9/10 3 2/3 3 1/2 5 18/60 5 3/10. That is, from a popu-
lation of 100 who begin using an IUD the cumulative chance of surviving pregnancy for the Ž rst three
months would be 3/10 3 100 5 30. Of the 100 starters, 90 would continue into the second month, of
those 60 would continue into the third month, with 30 Ž nishing the month. The gross cumulative
three-monthly pregnancy rate per 100 women entering the Ž rst month in this example would be
100 3 (1–3/10) 5 100 3 7/10 5 70, a much higher rate per 100 starters than the 5.1 calculated from
Tietze and Lewit’s population of loop D users.
22. As a clinic or a group’s experience with a contraceptive increases, the risk of pregnancy will decrease.
Perhaps clinic insertions become more proŽ cient. Different pregnancy rates for different clinic popula-
tions might relate not to the efŽ cacy of the contraceptive device being tested, but to the length of time
the clinic has been in the programme. In combining the pregnancy (or other reasons for leaving the trial)
rates of two populations the life table holds constant this variable ‘age structure’ of the two clinic
populations. The techniques were used to compare mortality risks in populations with different age
structures.
23. This is discussed in Marcia Lyn Meldrum, “‘Departures from the Design”: the Randomised Clinical Trial
in Historical Context, 1946–1970’, PhD thesis, State University of New York at Stony Brook, 1994.
24. See Paul Rabinow, ‘ArtiŽ ciality and Enlightenment: From Sociobiology to Biosociality’ in Jonathan
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Crary and Sanford Kwinter (eds), Incorporations (Zone) New York, 1992.
25. I am indebted here to John Law, ‘Organising Accountabilities: Ontology and the Mode of Accounting’
in Rolland Munro and Jan Mouriston (eds), Accountability: Power, Ethos and the Technologies of Managing
(International Thomson Business Press) London, 1996.