As a prying adolescent I one day opened my mother’s hidden, shell-like, plastic case and found her carefully washed and powdered diaphragm, smelling slightly of rubber. I marvelled that she could be sufficiently well organised to safely store and use this device to prevent babies. I now better understand her strength of motivation – and the value there must have been for her of being in control of contraception, given my father’s Catholic faith. For decades the diaphragm was used successfully as a method of contraception by millions of women in developed countries. With the advent of the highly convenient Pill in the 1960s its popularity waned – and the diaphragm never became well established as an option in developing countries. In this issue, Coffey and Kilbourne-Brook contend that the use of the diaphragm in low-income settings should be reconsidered. 1 They present findings from their acceptability study about the ways that women in the Dominican Republic, South Africa and Thailand were able to use, clean and store a diaphragm. Their findings support the idea that motivated women in low-income settings would find ways to use and care for the device appropriately. In recent years the diaphragm has received renewed attention because of hope that it might enable women to protect themselves against sexually transmissible infections (STIs) and HIV. 2 It is plausible that the diaphragm could be protective because it covers the cervix, which is more susceptible to infection with HIV, chlamydia and gonorrhoea than the vaginal mucosa. Early observational studies suggested that the diaphragm prevents STIs, 3,4 although diaphragm users may have been at lower risk for other reasons. A randomised controlled efficacy study, the ‘Methods for Improving Reproductive Health in Africa’ (MIRA) trial of the diaphragm and Replens ® lubricant gel (Lil’ Drug Store Products