TURNED ON / TURNED OFF
Investigating the Interaction Design
Implications of the
Contraceptive Microchip
Sarah Homewood
Thesis Project II Malmö University School of Arts and Communication (K3) MA Interaction Design Examination Date: 26th August 2016 Supervisor: Clint Heyer Examiner: Susan KozelAcknowledgments
Thanks to my supervisor, Clint Heyer, and to Peter Caapsgård, Simon Theis Hansen and Anna Navndrup Pedersen for their feedback and support. Thanks to Jenny Koos and Charlotta Andersson and all workshop and research participants for their valuable contributions to this research. Final thanks go to Georgina Hampton Wale, Diego Monsivais, Arzana Abazi, Daniel Hidalgo Maria Prieto and Rasmus Andersson for making filming possible and enjoyable.
Abstract
In 2018 a new contraceptive method in the form of a programmable microchip implant will be made available to women. This research attempts to unpack the interaction design implications of the marriage between contraceptive methods and digital technology that the contraceptive microchip represents. The contraceptive microchip comes with a remote control component that is handed to the user so that they can de-activate and re-activate their own fertility. This research uses a range of methods including performance-based speculative design in order to unpack the interaction design implications of the contraceptive microchip. The first major contribution of this research is the compilation of areas of concern for potential adopters of the contraceptive microchip relating to the implantation of digital technology. The second major contribution is the exploration into how the remote control component of the contraceptive microchip could mediate sexual relationships.
Acknowledgments 2 Abstract 3 1. Introduction 6 1.2. Research Challenges 7 1.3. Research Motivation and Aims 8 1.4. Key Terms 8 2. Introducing The Contraceptive Microchip: What Is Known So Far? 9 3. Designing Contraceptives 12 3.1. A Brief History of Contraception 12 3.2. Hormonal Contraception 12 3.3. Contraception for Men 14 4. Interacting with our Insides 15 4.1. Related Products 15 4.1.1 The Wearable Insulin Pump 16 4.1.2. The Pacemaker 18 4.1.3. The Looncup 20 5. Methodology 22 5.1. Performance Ethnography 22 5.2. Speculative Design 23 5.2.1. Performance Based methods within Speculative Design 25 6. Exploring Related Contraceptive Implants 29 6.1. The Participants 29 6.2. Props and Setting 29 6.3. Re-enactment of the Implantation 30 6.4. Expanding Performance Ethnography 32 6.5. Reflections 33 7. Imagining the Contraceptive Microchip 34 7.1. The Film 34 7.2. Reflections 35 8. The Workshop 36 8.1. Workshop Aims 36 8.2. The Questionnaire 37 9. Concerns About the Contraceptive Microchip: A Healthcare Professional’s Guide 38 9.1. Creating a Knowledge Base 38 9.2. Providing Expert Opinions 38 9.2. Showing “Imagining the Contraceptive Microchip” 40 9.3. Designing The Healthcare Professional’s Guide 40 9.5. Reflections 42 9.5.1. Using Experts 42 9.5.2. Showing the film 43 10. Designing the Remote Control Component 45 10.2. Modeling Remote Controls 46 10.2.1. Analysis of results 46 10.2. Enacting Remote Controls 47 10.2.1. Analysis of Results 47 10.5. Reflections 48 10.5.1. Modeling the Remote Controls 48
11. Collaborative Contraception 50 11.1. Inspiration from Workshop Participants 50 11.2. Imagining the Contraceptive Microchip – Part 2 52 11.3. Reflections 54 12. Discussion 55 12.1. Further work 57 13. Conclusion 59 References 60 List of Figures 64 Appendix 1. 65 “Imagining the Contraceptive Microchip“ Script 65 Appendix 2. 67 The questionnaire given to attendees of the event. 67 Appendix 3. 70 Thematic analysis of Questionnaire 70 Appendix 4. 73 “Imagining the Contraceptive Microchip – Part 2.” Script.” 73 Appendix 5. 75 Results of the Questionnaires 75 Appendix 6. 81 Transcripts of Remote Control Enactments 81
1. Introduction
In 2018 a new contraceptive method in the form of a programmable microchip implant will be made available to women. This research attempts to unpack the interaction design implications of the marriage between contraceptive methods and digital technology that the contraceptive microchip represents. The contraceptive microchip is an implant and can last for up to sixteen years. The microchip can be turned off and on through the use of a remote control component. This thesis is founded on the belief that there is a role for interaction designers to play addressing the experiences of users of implanted technologies such as the contraceptive microchip. Though there is a lack of canonical examples due to the novelty of this area of research, a related research group studying implantable technologies from an interaction design perspective is the Insertables research group (Insertable Digital Devices - organisers, 2015). The Insertables group discusses the relevance of interaction design to the case of the introduction of the contraceptive microchip in their article in the ACM Interactions magazine earlier this year;
“this (the contraceptive microchip) would provide extraordinary control over reproductive behaviors. It also introduces extraordinary challenges for interaction designers. How do we best interact with technology inside our bodies?” (Interactions.acm.org, 2016)
The contraceptive microchip is a result of advancements in technology and improvements in the compatibility between hardware components and human flesh. These developments now mean that we can embed computers beneath skin. The transition of technology from something we see and can handle to something invisible and unfelt brings new questions, concerns and opportunities to light.
As well as being an example of implanted technology, the contraceptive microchip also represents an example of digital technology that is designed solely for women and for their fertility. Currently, hormonal contraceptives are only available to women, meaning that this technology is unusable by men. The transition of digital technology into the realm of female fertility is not recent, assistive reproductive techniques, such as IVF, have existed for several decades and feature multiple examples of digital technology. Another related example is the WINK, a Bluetooth enabled digital thermometer that synchronizes with a mobile phone application and tracks the users most fertile points in their menstrual cycle by analysing changes in body temperature (Weigel, 2016). The WINK is possible to use as a form of birth control to avoid pregnancy as well as
an aid to increase the chances of conception. The complex and delicate subject of contraception and fertility will be navigated with care within this thesis.
1.2. Research Challenges
Three key factors pose challenges to this research:- As the contraceptive microchip will not be available until 2018, this research could be described as premature. Certain details can be gathered from research papers and press releases from MicroCHIPS Biotech, inc, (Microchipsbiotech.com, 2014) the company responsible for its development, but some aspects, such as the remote control component of the contraceptive microchip remains undefined. This lack of detail restricts certain aspects of research, but also allows for a more speculative approach.
- The fact that a medical procedure is required in order to place implantable technology in its required position beneath the skin restricts certain levels of design exploration or prototyping within this thesis. This is due to the medical risks of cutting into the skin without approved sterilized equipment or licensed medical knowledge and the risk of the body rejecting certain materials. Limited research has been completed so far within the fields of prototyping implantables within interaction design and human computer interaction, mainly due to this restriction. One key interaction design researcher in the field of implantable technology, Kayla Heffernan, instead observes hobbyists who create and insert their own DIY implants in order to collect findings that could be applied to other forms of implantable technologies from the perspective of the user experience (Heffernan et al. 2016).
- The challenges the contraceptive microchip poses as the subject of an interaction design thesis relate to the fact that there are relatively few observable interactions between a user and the technology itself. However, the fact that the contraceptive microchip chemically alters the body of the user could provide an argument that once the microchip is implanted, the body itself becomes the device.
The lack of tactile and observable interactions and the speculative approach needed to carry out research on an un-released piece of technology prompts this research to employ novel approaches and explorative methods. A key theme running through this research will be the employment of performance-based methods within speculative design. These methods are used with a belief that they allow emotional shifts, narratives and relationships within and around a
1.3. Research Motivation and Aims
“As technological fixes increasingly become integrated within a framework of medicalization, this confuses the international politics of women’s reproductive rights. In attending to the serious political challenge represented by this development, and related technology-assisted mystification, it is crucial not to lose sight of the importance of shared, popularized scientific knowledge as an instrument of resistance.” (1997 p. 122)
The words of medical anthropologist and a UN consultant Soheir A Morsy reflect my personal research motivation in relation to the contraceptive microchip. By exploring the interaction design implications of the contraceptive microchip I aim to mitigate the “technological fix” that this new form of contraception offers from both an economical and political perspective due to its ability to successfully reduce the number of undesired pregnancies. This research is concerned with understanding how future user’s lives may be affected by the contraceptive microchip and how to design the optimal user experience of a woman having the contraceptive microchip implanted.
My motivation behind using performance as a method within this research is partly due to my background in dance performance as well as a desire to present the contraceptive microchip to a wider audience through using more popular and understandable mediums than a written thesis in order to create “shared,
popularized scientific knowledge as an instrument of resistance”. This thesis is an
act of resistance, not to the contraceptive microchip itself, but to the introduction of digital components within contraceptive methods without due consideration to the consequences from an interaction design perspective. Therefore, my aim as author and researcher is to engage my designerly skills in order to present the contraceptive microchip as something tangible, understandable and therefore critizable.
1.4. Key Terms
The term “contraceptive microchip” will be used throughout this paper to refer to the microchip that delivers contraceptive synthetic hormones. Though the developers of the microchip technology have not officially introduced the term “contraceptive microchip”, the term will be used within this thesis to refer to the product in order to refer more clearly to the microchip contraceptive implant rather than the non-digital contraceptive implant.
2. Introducing The Contraceptive Microchip: What Is
Known So Far?
The contraceptive microchip can be implanted in the buttocks, upper arm or lower stomach. The microchip uses the heat from an one-volt electrical signal to melt small doses of the synthetic hormone levonorgestrel into the bloodstream to regulate the amount of progesterone in the user’s endocrine system. Levonorgestrel prevents conception by stopping the ovaries releasing eggs and thickening the cervical mucous so that sperm cannot survive. Tiny reservoirs of the levonorgestrel hormone are stored on a 1.5cm-wide microchip within the device. A small electric charge melts an ultra-thin seal around the levonorgestrel, releasing the 30-microgram dose into the body. Rather than having to be removed by a medical practitioner, the user of the contraceptive microchip is given a remote control that is able to turn off the microchip and stop the release of levonorgestrel when they want to conceive. The microchip can then be re-activated when contraception is once again required.
The company MicroCHIPS Biotech, inc. currently develops the microchip after being leased the microchip technology by the original patent holders Robert Langer and Michael Cima, both professors at MIT. Development of the microchip technology began in the mid-nineties as a reliable and consistent way to administer drugs to patients with long-term chronic conditions such as osteoporosis. One of the main benefits of the drug-delivery microchip being the avoidance of issues with patient compliance; as the microchip runs autonomously inside the body of the user, the risk of the patient forgetting to take oral pills, or making mistakes when self-injecting, are ruled out. Robert Langer also states that the drug-delivery microchip is also more effective at delivering drugs then oral methods where stomach enzymes and other factors can obstruct the absorption of drugs into the bloodstream (Langer, 2003 p.34, Prescott 2006 p.437). The first in-human testing of drug-delivering MicroCHIPS Biotech, inc. in 2012 showed that “daily release from the device increased bone
formation. There were no toxic or adverse events due to the device or drug, and patients stated that the implant did not affect quality of life” (Farra et al., 2012
p.1). Patient surveys, conducted at two points during the trial, returned concretely positive responses to the implantation procedure and the device itself (Supplementary materials, Table S4, Farra et al., 2012). The latest known development of the technology was in June 2015 when a MicroCHIPS Biotech, inc. press release announced a partnership with Teva Pharmaceutical Industries Ltd. hoping to apply the microchip technology to Teva’s portfolio of pharmaceutical products (Press Releases, Microchipsbiotech.com, 2016).
The idea to develop the drug-delivering microchip into a method of delivering contraception was reportedly sparked by the Microsoft founder, entrepreneur and philanthropist Bill Gates’ visit to Robert Langer’s lab at MIT in 2012. Bill Gates apparently asked Langer if it would be possible to design a type of contraception with a long life span that could be turned on and off by the user (MIT Technology Review, 2016). The Bill and Melinda Gates Foundation is famous for funding developments in vaccines and contraception and is a part of the global partnership Family Planning 2020, formed at the London Summit on Family planning in 2012 where more than twenty governments made pledges to address socio-cultural and economic barriers stopping women accessing contraception (Familyplanning2020.org, 2016). The Bill and Melinda Gates Foundation addresses these issues by investing in new forms of contraception and tools to educate women globally about contraception.
“Our Goal: to bring access to high-quality contraceptive information, services, and supplies to an additional 120 million women and girls in the poorest countries by 2020 without coercion or discrimination, with the longer-term goal of universal access to voluntary family planning.” (Bill & Melinda Gates Foundation, 2016)
Controversy around Bill Gate’s statement during his 2010 TED talk that vaccines and “Reproductive Health Services” are one way to reduce global warming and CO2 levels (Gates, 2016) caused some to accuse Gates of holding a stance where the lives of humans, particularly those in developing countries, were held unequal to the ecological state of the planet (Ungurean and Ungurean, 2015). In contrast this is the statement from Bill and Melinda Gates that contraception creates healthier, more educated and economically independent women who have “the chance to control their own futures”.
One aspect that has not been publicly covered in much detail is the remote control component that will accompany the contraceptive microchip that has the ability to remotely activate and de-activate the microchip whilst it is implanted in the user’s body. Though much detail is provided in papers about the microchip itself, no academic ground or research has been given about the remote control component. The capacity of the microchip to act as a contraceptive device is secondary to the original intention for the device to deliver drugs to patients with long-term chronic conditions. All that can be gathered from statements from MicroCHIPS Biotech, inc in press articles is that there will be a remote control provided, though there is no mention of this component on the MicroCHIPS Biotech, inc. website itself. An email to MicroCHIPS Biotech, inc. asking for more details about the wireless remote control aspect of the microchip was answered with a refusal to provide more details than featured on the website. The lack of detail available about the design of the remote control
component affects the conciseness of the investigating of the interaction design implications of the contraceptive microchip. What this lack of detail provides, however, is the opportunity for open speculation about the multiple possible futures that the design of the wireless remote control creates.
3. Designing Contraceptives
This chapter outlines the current field of contraceptive methods and provides a brief history of the political and social history influencing, and in turn being influenced by, the design of methods of contraception.
3.1. A Brief History of Contraception
“For as long as men and women have been making babies, they’ve been trying not
to.” (Eig 2014). Images dating back to 3000BC depict what is thought to be a
condom made of stomach lining, and throughout history women have used various compounds of natural substances as either drinkable contraceptives or barrier methods of contraception. These methods were occasionally harmful or ridiculous. Drinking lead as a form of contraception caused the sterilization and death of hundreds of concubines in ancient China. In the year 200 AD Greek gynecologist Soranus advised women to hold their breath during sex and sneeze afterwards to prevent the sperm being pulled into the body. More recently the Obscenity Laws, brought in in the mid 18th Century, hindered the development of contraceptive methods. This law restricted the spreading of information about contraceptives within healthcare. This attitude towards contraceptive techniques as being obscene is arguably still a reason they are not part of a wider, more public, discussion (Gibson, M. 2015). Catholicism still officially rejects the use of contraception, though most developed “natural birth control” methods such as the fertility awareness method (FAM) that tracks temperature and vaginal mucous to avoid fertile windows within the menstrual cycle, were designed, taught and practiced by catholic groups.
3.2. Hormonal Contraception
In the 1960s the FDA approved the daily contraceptive hormone pill, or “The Pill” as it was commonly known, developed by Carl Djerassi after discovering that the inedible Mexican yam vegetable could be used to produce the synthetic female hormone progesterone. The contraceptive pill was originally advertised as a drug to regulate irregular and problematic menstruations but the pill was covertly used as a method of contraceptive. By 1965 6.5 million American women where using The Pill. Carl Djerassi declared that after The Pill, “sex
became separated from its reproductive consequences” and “changed the realities of human reproduction.” (Djerassi, 2014). The Pill was revolutionary and touted
as a tool of liberation for women, who no longer had to rely on their male partners using condoms to control the risk of pregnancy. There were issues of
trust early on, and so The Pill was designed to include five days of sugar pills each month allowing a “fake period” where the user would bleed, though as the hormone in The Pill prohibited ovulation, this could not be medically classified as a period. This design choice can be seen to allow for incremental acceptance of a contraceptive method. In the 1960s, women still wanted to know that their body was working in its natural way, i.e. bleeding every month to let them know they aren’t pregnant. Later forms of contraception such as the Uterine Implant Device, a small t-shaped piece of plastic containing either copper or hormones, was not designed to include a “fake period”, therefore perhaps showing that people were gaining trust in medically engineered contraceptives. The introduction of Long Acting Reversible Contraceptive such as the injection, implant and now the contraceptive microchip also follow the incremental acceptance of contraceptives that last for longer and longer and require fewer and fewer interactions from users.
The long life span and efficacy of long acting reversible contraceptives such as the contraceptive implant has made these contraceptive methods popular with lawmakers and governments. The first contraceptive implant to be approved by the Food and Drug Administration (FDA) in the U.S. was the Norplant implant in 1990. Dorothy Roberts covers the effect that the contraceptive implant had on America (1999). Roberts writes that following the approval of the Norplant implant, state departments provided huge amounts of funding to make this contraceptive method freely available to women with low incomes, this demographic was mostly black and people living in inner cities (1999 p. 106). Some states even offered financial incentives to encourage women to have the Norplant implanted. Robert Farr, who introduced this incentive in Connecticut reasoned “It’s far cheaper to give you money not to have kids than to give you
money if you have kids” (Farr in Roberts p.109). The theme of governments using
legislation and financial incentives continued through to the 1990s, with some states discussing whether women who had had a state-funded abortion would be forced to accept a Norplant implantation. Roberts presents the ideas of Dwight Ingle, a University of Chicago physiologist, who in his book Who Should Have
Children? written in 1973, proposes that drug addicts, criminals or those with a
lower intelligence should be encouraged, or even forced to not have children (p.110). “One of Ingle’s proposals was the mandatory insertion of pellets
containing an “infertility agent” under the skin of every woman of childbearing age. Women would be required to apply for a license to have the pellet removed; only those who qualified for parenthood would be allowed to become pregnant …. Norplant has the potential to fulfill these eugenicists’ fantasies.” (Roberts, 1999.
p.110). Soheir Morsy echoes Roberts’ words in her article Biotechnology and the
Taming of Women’s bodies; “As purposeful instruments of population control, the new professional provider-dependent contraceptive technologies are a far cry from
long struggled for. Beyond the rhetoric appropriated from feminists by the international population establishment, the recent exposure of the potential for racist social engineering inherent in the “magical” Norplant technology underscores the dark side of international “family planning” (Morsy, 1997 p.120).
Morsy begins her text by stating that the level of science and technology are seen as “progress” and “development” in western societies, and that these tools are used to dominate the “other”, the “other” in this case being womankind. Morsy includes the thoughts of feminist Judith Richter and states that Richter “considers
abuse potential in terms of inherent features of the technology (prolonged duration of effectiveness, difficulty of voluntary reversibility by the user, and ease of administration—“vaccination” on a mass scale) which increase the likelihood of uninformed, misinformed and coercive administration of the contraceptive”
(Richter 1994 in Morsy 1997. p.120).
3.3. Contraception for Men
Although female contraceptive methods now come in many different forms, male contraceptives are still fairly underdeveloped, with the main option still being condoms or irreversible sterilization through vasectomy. Male hormone contraceptives have not become popular or developed due to concerns about side effects, though researchers at the University of Minnesota revealed that they had made a major breakthrough in this area at a press conference earlier this year (American Chemical Society, 2016). Engineering based rather than hormone based contraceptive methods are predicted to be more successful. Vasalgel is a polymer gel that is injected into the vas deferens, the tube that sperm swim along. The polymer blocks the tube causing sperm to die and to be absorbed back into the body whilst still allowing for other liquids to pass and thus allowing an ejaculation (Newmalecontraception.org, 2016). Vasalgel is currently being trailed my male test subjects in India. In January this year a German carpenter Clemens Bimek invented a valve that can be opened and closed with a button located under the skin of the scrotum (Team, 2016). So far he is the only person to have this technology implanted, though tests on 25 men are scheduled for later this year. The excitement around engineering based male contraceptives could be seen to represent a difference in men and women’s relationship with their bodies, as well as culturally. Perhaps one reason could be that women naturally experience cyclical, changing hormones throughout their menstrual cycle. This means that women are meant to be more accepting of hormones generally. Men believe that they are generally hormonally linear, with the occasional spike of testosterone. This could mean that treating their bodies more like an object that can be hacked into and adapted is more attractive for them, rather than risking adopting a contraceptive method that transforms them hormonally and perhaps emotionally.
4. Interacting with our Insides
The contraceptive microchip implant delivers synthetic hormones into the blood stream of the user. These hormones alter the signals that the brain sends to the reproductive organs and chemically alter the hormone balance inside the body. The microchip becomes invisible, but rather than lying dormant, the contraceptive microchip implant is in a constant and terrific state of action, fighting the natural rhythm of the body in order to maintain an infertile state. The invisibility of the microchip but the palpability of the chemical transformation it causes can create dissonance. Thecla Schiphorst writes “one of
the promises of the invisible computer is that by its very disappearance, we are left with ourselves in our world” (2007 p. 15) however, when the body is
transformed by the device, finding a sense of “ourselves” becomes complicated. A person with a hormone delivering implant could reasonably question; “is this
reaction my own, or is this reaction influenced by my altered hormonal state?”
when responding to events in the world around them.
Though the effects discussed above could also be related to the current, non-digital contraceptive implant, the key difference, and the component that makes this technology ready for study from an interaction design perspective; is the remote control component. This component allows interaction with the bodies from the outside. What the remote control aspect of the contraceptive microchip allows is a literal perceptual shift from invisible computing to visible computing (Schiphorst, 2007 p. 8) that increases our awareness of the implant and allows a physical and tangible object that holds the power to represent the scenario as a whole. What the presence of a remote control also provides is the ability to express ourselves through our handling of the remote control, allowing us to physically act out and communicate our feelings about our invisible computers to ourselves and to others.
4.1. Related Products
The remainder of this chapter will be used to describe, analyse and compare three related products that provide examples of implants with some kind of remote control component that allows interaction with insides of the body. These current products that live with us in the here and now, will be used to gain understanding of what the future of the contraceptive microchip may involve. These products also provide a platform for the exploration of certain more philosophical or speculative ideas surrounding the subject of implants and remote controls that can be related back to in the discussion chapter of this thesis.
4.1.1 The Wearable Insulin Pump
4.1.1.1. Description
The implementation of microchip technology to control hormonal and chemical processes inside the body is new, though similar cases can be used to extend understanding of the realities of future technology. One similar use of digital technology and hormones is the wearable pump that is used to administer and control the insulin hormone levels of a person with diabetes. The wearable pump provides a digital interface to input the dosage of insulin needed according to the blood sugar level measured through a different device. The wearable pump either clips onto the waistband of the user and a wire carries the insulin to the skin surface where a subcutaneous tube delivers the insulin into the blood stream of the user. The subcutaneous tube is secured with a sticking plaster and is changed every three days. 4.1.1.2 Analysis The insulin device replaces the insulin pen that previously required the user to administer daily injections into their flesh. This was both painful and disruptive to the user’s daily routine (Kovatchev et al., 2013). The wearable and partially implantable insulin device allows the user to hand over responsibility of insulin delivery to the device that runs autonomously. The next step currently in development in the field of diabetes related technology is the artificial pancreas. This device combines data from a wearable blood glucose sensor with an algorithm in order to deliver the right amount of insulin in a closed loop system, no longer requiring manual input of numbers from the user. The aim of the artificial pancreas is to reduce the actions required by diabetics to maintain their own insulin levels. Another development in the field of diabetes related technology is the call from people with diabetes to open up of the data gathered by their diabetes devices. This phenomenon began life as a DIY hack by tech-skilled diabetics (DIYPS.org, 2015) until the company Tidepool picked up on this concept and took the lead making data available and understandable to all diabetics with user-friendly apps (Tidepool, 2016). The Blip Notes app tagline reads; “Diabetes is not just
numbers, life happens too”, showing their awareness of the holistic nature of
diabetes as a condition that affects a user’s whole life. The Blip Notes App combines insulin level data with note making, so that the user can see trends in their eating an exercise habits alongside their internal chemical states. Although the technology used by Tidepool is not complex, and not more developed than what was used by the DIY hackers, Tidepool products were only approved by the FDA after years of meetings between medical engineering companies and
4.1.1.3. Comparison
The outsourcing of self-care to a device, and the trust that this hand-over requires, represents the balance of pros and cons that comes with the implantation of technology for medical reasons. On the one hand, the reduction of conscious actions required by the user, such as not having to administer the painful daily insulin injections, can be beneficial for users on many levels, but on the other hand other subjects such as trust and reliance then come into play, both for the wearer themselves, and for others around them. This reduction in the actions that the user has to remember to complete relates to the fact that contraceptive implants do not require attention after implantation. One downside of the contraceptive pill is that the user has to remember to take it. This aspect of human error reduces the effective ratings of the contraception (Fpa.org.uk, 2016). The deliberate elimination of conscious actions relates to Manfred Clynes and Nathan Kline’s original definition of the term “cyborg” in 1960
"For the exogenously extended organizational complex functioning as an integrated homeostatic system unconsciously, we propose the term 'Cyborg,'" (Clynes, and Kline, 1995 p.27)
This quotation taken from the article Cyborgs and Space featured in Astronautics in 1960 (1995), proposes solutions for how the human body can function in space by adapting the body of the astronaut to the space environment, rather than creating an “earthly environment” for the body of the astronaut (p.26). Clynes and Kline even recommend the use of implanted autonomous drug-delivering devices.
“One device helpful to consideration of the construction of Cyborgs (…) is the osmotic pressure pump capsule (….) for slow injections of biochemically active substances at a biological rate. The capsule is incorporated into the organism and allows administration of a selected drug at a particular organ and at a continuous variable rate, without any attention on the part of the organism.” (p.74) Just as the wearable insulin pump allows people with diabeties to live more like non-diabetics “without any attention” to their insulin levels, contraceptives allow us to have sex without remembering that there is the possibility of pregnancy. Perhaps this could be described as allowing us the option of augmented sex; the ability to fulfill our desires for sexual fulfillment of our desires without having to remembering the consequences of our actions as fertile bodies. One branch of the body modification trend is the placing of silicon implants into the shaft of the
augmented sex though one key difference is that “aesthetic” bodily augmentations take place in shops, without legal anesthetic, and contraceptive implants are provided by healthcare professionals with no pain or sensation involved.
Though hormonal contraception may more easily allow us to forget the natural function of our bodies; that unprotected sex between a fertile man and woman can result in pregnancy, hormonal contraceptives do not allow us to forget, or avoid, sexually transmitted diseases. Hormonal contraceptives ignore the undesirable consequences of the meeting of human bodies that can only be prevented through the use of barrier contraceptive methods such as condoms. The fact that the contraceptive microchip is not designed to prevent infections could be a sign that we live in denial that we are symbiotic with other life forms such as microbes and viruses. As Donna Harraway writes in When Species Meet,
“I am a creature of the mud, not the sky” (2008 p.3). Though these aspects are
relatable to all forms of contraceptive implants, it seems apparent that the long, sixteen-year, life span of the contraceptive microchip makes more clear the choice to accept contraceptive methods that do not prevent sexually transmitted disease. The consequences of this choice will have to be seen.
4.1.2. The Pacemaker
4.1.2.1. Description The second related product used in this thesis is the oldest example of implanted biomedical technology; the artificial cardiac pacemaker, which was first introduced in 1958. The world's first implantable pacemaker patient, Arne Larsson, went on to receive 26 different pacemakers during his lifetime. He died in 2001, at the age of 86, outliving the inventor as well as his surgeon. The pacemaker will be referred to within this research because it is an example of an implanted biomedical device that has been used for long enough to give clues about how the contraceptive microchip could develop in the future. A pacemaker is made up of a computerized generator, a battery, and wires with sensors on one end. Electrodes sense the heart's electrical activity and sends data through the wires to the computer in the generator. The computer sends electrical pulses through the wires if the users heartbeat is irregular. Newer pacemakers are able to monitor, breathing, blood temperature and adjusts the heart rate to changes in the users levels of activity (MedicineNet, 2016).4.1.2.2. Analysis
Recent developments in technology mean that new pacemakers are now fitted with an antenna that can wirelessly transmit information to healthcare professions about the wellbeing of both the pacemaker itself as well as the patient. This antenna also allows remote control of the device by healthcare professionals. Trials of this technology found that it allowed patients to halve the number of hospital check-ups required for themselves and their device (Ricci, Morichelli and Santini, 2008).
4.1.2.3. Comparison
The remote controllable aspect of the antennae-enabled pacemaker relates to the wirelessly connected remote control that accompanies the contraceptive microchip. The introduction of the antennae to the pacemaker sparked security concerns. In 2008 a team of computer security researchers managed to hack into and shut down an un-implanted pacemaker. This story was covered in the media (Feder, 2008) and culminated in a paper (Halperin, D. 2008) that opened up discussion about the new risks our bodies encountered with implanted technology. One key difference between the contraceptive microchip and the pacemaker is that the external remote control that can control the contraceptive microchip is handed to the user rather than a healthcare professional. This marks an important transition in the perceived control of the technological device but also means that the remote control itself can be lost, stolen or misused. The question of security and the fact that this concern may stop users adopting the technology has been reflected in the design of the contraceptive microchip. According to Robert Farra, one of the early developers of the contraceptive microchip, “Someone across the room cannot reprogramme your
implant. Communication with the implant has to occur at skin contact-level distance. Then we have secure encryption. That prevents someone from trying to interpret or intervene between the communications.” (Wainwright, 2014),
Although a three meter signal range might be possible between the implant device and the remote control (Higgins, 2007 p.52), developers of the microchip have made a design decision based upon the perceived sense of security by the user, rather than the maximum capabilities of the technology.
Just as the antenna-enabled pacemaker reduced the amount of hospital visits required by the user, some clear political and economic benefits could be seen in the introduction of the contraceptive microchip. The sixteen year life span of the microchip and the introduction of the remote control to disable the device both reduce the amount of times a user of the contraception will have to visit a healthcare professional. Every visit to a health clinic avoided is money saved by
the non-technological implant also mean that less materials are used within production. This provides certain environmental and economic benefits.
4.1.3. The Looncup
4.1.3.2. Description As well as being an example of implanted technology, the contraceptive implant is also an example of technology that is solely designed for women. A related product that also represents an example of implant technology designed for women is the Looncup – “worlds first smart menstrual cup” (Kickstarter, 2016) that connects a Bluetooth enabled menstrual cup to an app and sends a notification to let the user know when the menstrual cup is full of menstrual blood so it can be emptied. The Looncup also promises to analyse the colour of the menstrual blood in order to give the status of the “health, stress and body” of the user. 4.1.3.2. Analysis Whether a smart menstrual cup is an implant is debatable. Inserting a device into the body through the vagina is a different phenomenon than inserting a device by cutting into the skin. However, there are enough related aspects of this product to the contraceptive microchip to argue for the inclusion of this example. The Looncup is currently in-development after having tripled its funding requirements through the crowdfunding platform Kickstarter. The Looncup is, unintentionally, a collectively designed product. Looncup received over 4,000 emails giving feedback and thoughts about the functionality and design of the product from the women donating money to fund the product. In a post in April 2016, they reveal their decision to halt production in order to implement the design changes suggested by those financially backing the product. To reach such clear criticisms from potential users perhaps shows that Looncup did not carry out the user research they should have done before the product reached Kickstarter. Interestingly, the changes being implemented by Looncup are partly related to the security concern that having a Bluetooth device inside the body could be damaging to the user’s health. Looncup say in their post that this is not a danger, but still adhere to the changes requested by limiting the activation of the Bluetooth signal to when the cup is on the outside of the body. Another change being implemented is based upon feedback from current users of the non-bluetooth enabled menstrual cup. Users say that they often cut the stem of the cup off for comfort but the Looncup uses this stem to house all the technological parts. Looncup are now developing a way to house thetechnological components in the upper part of the menstrual cup rather than the stem. 4.1.3.3 Comparison The Looncup is an example of a trend of medical technology that uses technology to in order to get to know our bodies better. The tag line of the Looncup labels menstruation as something that must be dominated and controlled; “Take back control with the world's first SMART menstrual cup. Measure, Analyze, and Track. Help us redefine menstruation.” (Kickstarter, 2016). There is a clear message that
the body, and the fluids that it produces, are unruly and must be controlled. There is also a theme of commodification and the promise to harness our menstrual blood for good by analyzing it to give us a better idea of the status of our insides. Jenny Koos, who professionally teaches (non-hormone based) natural birth control method to private clients and holistic reproductive health in schools, responded to the Looncup by saying:
“.. the (menstrual) cup is great, but it already makes women meet their blood. Why should we have an intravaginal sender and battery to connect to an app what will worry us constantly? I want women to see for themselves what is healthy and what isn't. Sure it has a point, but it is all about having an app for what you can already see when you empty it. It is promising with regards to having some sort of a device to track hormonal changes with respect to ovulation, but I guess few women would wear a cup everyday for that. Also, the environmental aspect of the cup is lost with a 6 month battery...” (Koos, private communications, 2016)
For Jenny Koos, the Looncup and its app circumvent knowledge that women should learn about their own menstrual blood. Apart from lack of information available and lack of incentive for women to take time to study, one hypothesis that could be drawn from why this app is attractive to some people is that it allows the user to maintain the dependent relationship with medical professionals. With the Looncup, the doctor or nurse is inside your phone. Traditionally we employ doctors and nurses to keep us healthy and hand over knowledge of our bodies and rely on them completely. Biomedical technology is used to outsource this role, but one aspect that is missing is the human-to-human care that takes place at a visit to a clinic.
5. Methodology
Returning to the case of the contraceptive microchip, the following chapter will introduce the methods that will be employed by this. As stipulated previously, this research aims to make this new method of contraception more tangible, understandable and therefore critizable in order to unpack interaction design implications of the contraceptive microchip.
5.1. Performance Ethnography
Relating to the challenges of understanding the interaction design implications of implanted technology that lies beneath the skin; the method of performance ethnography will be employed within this research.
Performance ethnography is referenced by Brenda Laurel in her article Design
Improvisation, Ethnography Meets Theatre (2003). The article describes her
practice and the merits of combining user research with performance tools in order to understand user experiences within a situated context (p. 49). Brenda Laurel’s performance ethnography uses props, improvisation and the James Lang theory of emotion to understand the emotional interiors of other people through mimicking interactions through re-enactments. Performace ethnography employs the designers “intuitive, haptic and emotional capabilities” (p.51). A development of Laurel’s performance ethnography will be used within this research that emphasized the generative (Burns et al. 1994 p.119) character of performance to gain new insights and inspiration for further research. “The
designer uses empathy to perform design solutions that are drawn from deep identification with real, individual people in specific situated contexts in the real world… Getting inside the body and emotions of a person performing as a postman, a computer user or an ice-cream server can help us as designers notice what we might design to make the role one that would be more enjoyable and rewarding to play.” (p.54).
The ability of performance ethnography to allow the researcher an understanding of embodied interactions with technology (Dourish 2004) allows a novel relationship between the researcher and research subject to form. Through enactments and physical embodiments, narratives flow and emotional journeys are followed together. When there are few outward interactions to observe, understanding the emotional experience of the user is a vital tool when investigating a users experience of an artifact. This method will be employed in Chapter 6. in order to attempt to gain an embodied, full and accurate
understanding of the experience of users of the current, non-digital contraceptive implant in order to predict the experience of future users of the contraceptive microchip.
5.2. Speculative Design
There are multiple unknown aspects to the contraceptive microchip, predominantly the remote control component and how the product will be presented to, and received by, potential users. Stuart Candy’s diagram, adapted by Dunne and Raby in their influential book Speculative Everything (2013 p. 5) chart how the properties of “the future” change over time. The unknown components of the contraceptive microchip mean that my design process crosses the border from designing for the “probable future” where the components are known and fixed, to the “possible future” where there is more openness and fluidity. To address the possible future, the practice of speculative design is optimal, and perhaps the only way to unpack the interaction design implications of an artifact with an, as yet, unknown form. I feel that the term speculative
design fits this research for the same reasons as James Auger specifies in his
article Speculative design: crafting the speculation (2013). Auger defends the use of the term speculative design rather than critical design, design fiction or design
probe for semantic reasons; “these terms act to dislocate the object from everyday life, exposing their fictional or academic status.” (p.12). As this research is
investigating the interaction design of a product that is currently in development and is set to come onto the market, it is vital that findings are not dislocated from the real world and real world applications. Auger gives this definition of speculative design. “a combination of informed extrapolations of an emerging technology and the application of techniques borrowed from film, literature, ecology, comedy and psychology can be used to develop and present plausible futures. (p. 11) (…). existing paradigms can inform future developments of technology: speculative futures imagine, through the extrapolation of contemporary systems and product lineages, near future products and services. These are intended to act as a form of cultural litmus paper, testing potential products and services on both a mainstream audience and within industry, before they exist.” (p.12)
These definitions sit well with the research undertaken in this thesis where the
“emerging technology” is the contraceptive microchip itself and “existing paradigms” are used to inform “potential products and services”.
Speculative designs … are played out in real life. The presence of the designed artefact in popular culture allows for the viewer to project its presence into his or her own life. Then they effectively become the protagonist in the story, playing out individual and informative roles. Their reactions become the true products of this form of design research. (p.20)
This statement almost precisely sums up the intention of the use of speculative design within this research. In order to unpack the interaction design implications of the contraceptive microchip, there must be empathy and understanding created where people can imagine themselves either using the contraceptive microchip, or someone close to them using the artifact. Throughout the phases of research presented in this thesis, there is a strong emphasis on encouraging the viewer to empathize and position themselves inside the speculative scenarios presented. The consequences of increased empathetic reactions from viewers are potentially more personal, emotional reactions to the contraceptive microchip.
Dunne and Raby adapted Stuart Candy’s diagram (Dunne and Raby, 2013. P.5) to include a “preferable future”. Though they accept the term “preferable” is problematic; “What does preferable mean? For whom and who decides?” (p. 4), they also see value and potential in the implementation of speculative design in opening up discourse and collectively finding preferable futures for specific groups of people in specific contexts. They ask; “could design help people
participate more actively as citizen-consumers?” (p.6). Jonas Löwgren advocates
including critics and criticism within interaction design research.
“Critics and criticism in a design field contribute to the collaborative growth of knowledge by placing design examples in broader historical, cultural and societal contexts; by examining ideas from perspectives other than those of the designers; by putting unexpected questions; by pointing out unexpected consequences. Critics and designers are complementary actors in the knowledge community of a design field.” (Löwgren 2007 p. 3).
One example covered in Auger’s article is his own project, the result of a collaboration with Jimmy Loizeau “The Audio Tooth Implant” (Figure 1.), a speculative object in the form of a telephone that can be implanted into a tooth that was a result of a brief to explore implantations whilst steering the design away from more science-fiction-based notions of human augmentation through implants. Whether or not this aim was reached is inconclusive but as a result of the design being taken as real and picked up by international news, a poll run by the news channel CNN asking their viewers if they would like a telephone implanted in their tooth revealed that 86% of the fifty-four thousand votes that were cast said “no” (Auger 2013, p. 24). This poll, though not run by the
designers themselves could be an example of speculative design being used more concretely as a method to test concepts and explore what modifications could be made to optimally suit potential users of new products and concepts. Figure 1. “The Audio Implant”. Used with permission. Auger, 2013 p. 21.
The original motivation behind this research was to make the contraceptive microchip understandable, tangible and therefore critizable. The fact that the contraceptive microchip does not yet have a context because it is not yet released means that tools such as speculative design can be used to imagine the
“broader historical, cultural and societal contexts” that this technology may fit
into in order to discover the interaction design implications of this new method of contraception.
5.2.1. Performance Based methods within Speculative Design
Though the research conducted in this thesis falls under the umbrella of speculative design, the techniques employed to conduct the speculating will be performance-based. Performance creates “elastic space” (Koefed and Kozel 2007, p.210) and allows “public dreaming” (Schechner 2003 [1988] p.265). Performance entails the creation of a microcosm, a time apart, where paradigms are changeable and all elements are physicalized, controllable and critisisable. Eric Dishman describes performance-based methods as “tools of situated,
embodied criticism enable us to release, albeit temporarily and in limited ways, the shackles of our current subjectivities” (Dishman 2002 p.244.) Dishman employs
performance “in order to counteract this hype-driven tendency to focus on the
This research proposes that within interaction design, performance is a strong method to use when understanding interactions where emotional shifts and internal processes are at the focus point. This becomes particularly relevant within the exploration of how implantable technology chemically alters our bodies. Giulio Jacucci, whose work cited widely within the field of performance within interaction design, argues that the use of performance “proposes the
individual, the local and the emergent as opposed to the universal, the general and the static.” (2004 p. 9) Jacucci recruits the organizational theorist, Ciborra, to
describe how performance can acknowledge and include the “the moods of the
actor” (Ciborra in Jacucci, 2004, p.32). Ciborra states “the way we care about the world unfolds according to the passing mood that attunes us with the situation”
(p.32). The ability of performance to allow us to tap into the “moods of the actor” within interactions makes it suitable for this proposed investigation into how technology has now been employed to take command of the insides of our bodies. Making Parents: The Ontological Choreography of Reproductive
Technologies (2005) by Charis Thompson employs a methodology that follows
the narrative accounts of people using assisted reproductive technologies (ART) such as IVF, and the emotions, structures and politics surrounding their situations. The relevance of Thompson’s work to this thesis is due to the fact that Thompson provides an inspiring example as to how to approach sensitive, complex and controversial topics such as fertility with humanity, respect and empathy. Charis Thompson employs the method of ontological choreography
“involves the physical places and configurations in which the instruments and body parts touch, and also involves the coordinating, grafting and often expanding of the very properties and processes that make up the thing.” (Thompson 2005, p.10).
Thompson’s method of ontological choreography results in short accounts of the stories she observed in ART clinics across America. These short narrations allow the reader to meet the people who are becoming (or sadly not becoming) parents and understand their whole situations, from their sperm and egg counts to their financial positions and political or religious views. These accounts allow the reader empathy, full understanding and a certain level of embodiment through being allowed to step into the biological insides of the character’s bodies. Though written accounts, there is some performativity to Thompson’s accounts. Each account includes drama, emotional journeys, props, settings and quotations that provide a script that could easily be constructed into theatre.
Within this research investigating the interaction design implications of the contraceptive microchip, short films present fictional scenarios that imagine how the contraceptive microchip might affect the lives of users. These short films are the result of the writing of a script, the design and collecting of props and set and the casting and rehearsing of actors. This process of forming a futuristic scenario from present day objects allowed a reflective design process. Schön (1983)
conversations between people and materials.
“Design knowledge is knowing in action, revealed in and by actual designing. It is mainly tacit, in several senses of the word: designers know more than they can say, they tend to give inaccurate descriptions of what they know, and they can best (or only) gain access to their knowledge in action by putting themselves into the mode of doing.” p.3
What is also allowed through the creation of a performance using actors and a narrative is a reflective conversation between the emotional and narrative content of the scenario. With the rehearsal of the script comes statements such as; “Can you sound a little more annoyed/happy/sad?” and as actors get to know their characters there are changes of phrases and the editing of lines so that the scenario becomes more natural and therefore more relatable to an audience. Garabet et al. (2002 p. 634) proposes that performance art can be used to push the boundaries of what is acceptable within design, specifically in this case, wearable technology. A head mounted camera and projector that projects the live feed from the camera onto the ground are worn in public and modified for each of the three performances. The observations and findings from their experiments are based upon the reactions of those around them within the public spaces where they took the performance. One conclusion of the research includes the statement that the acceptability of the performance is about the perceived level of control the wearer of the head mounted camera and projector has on the device. Garabet et al.’s research also explores how making their interventions look like adverts made them more acceptable to their subjects, as advertising is a known medium to us, we do not see any form of it as strange. Basing findings on the general reactions of passers by that they noticed, rather than taking a sample group of people and asking them individually and systematically their opinion of the performance, means that some reactions were missed. Using performance to illicit information about opinions within design usability is shown in the research of Garabet et al. to be fruitful, but more information about precise reactions, perhaps in the form of transcribed interviews, and guidelines for how reactions to a performance could be gathered would make this research more constructive for others using performance within design. The following research in Chapter 7 presents an attempt to employ performance-based speculative design in the form of a short film as a platform to allow an audience to fully understand all aspects of the contraceptive microchip in order to prompt debate and to more systematically collect opinions and reactions.
non-designers to design their own props and use performance to speculate upon possible designs for the contraceptive microchip’s remote control. This method was inspired by the work of Ann Light who uses performance to democratize the design of technology (2011). This paper is a contribution as part of her involvement in the DemTech research group who believed that representatives from non-design backgrounds should be involved within the design process of digital artifacts (Demtech.dk, 2016). Light’s research turns elderly people into designers by using performance and props such as gloves and feather bowers to open up discussions about possible future digital artifacts. Analogue props are used to open up design possibilities that come from participants handling the props and enacting scenarios. “Shifting between 'real' and 'practice' situations is a
powerful way to suggest potential and support empowerment” (p. 2240).
6. Exploring Related Contraceptive Implants
The contraceptive microchip is not the first contraceptive implant, though it is the first implant to use digital components. The non-digital contraceptive implant, as introduced in Chapter 3.2, resembles the contraceptive microchip in the respects that the implant uses the daily release of synthetic hormones into the blood stream, though the release method is non-digital and the implant lasts for three years, rather than sixteen. The amount of similarities between the contraceptive implant and the contraceptive microchip make the contraceptive implant a related and relevant product to study within this research. This research is based on the hypothesis that fully understanding how such a similar method of contraception has impacted the lives of its users can provide findings that can be used to estimate the impact of the contraceptive microchip on the lives of future users. The focus of this stage of the research was in understanding how the implantation of the contraceptive device had affected research subjects emotionally and physically; therefore the performance ethnography began by focused on the implantation process itself where awareness of the implant was heightened and ended with an exploration into how the act of the implantation had subsequently affected their lives. These findings will go on to be used to create the scenario developed in Chapter 7.
6.1. The Participants
The performance ethnography-based method that is used in this stage of research was developed over four research sessions. Participants were either selected based on the fact that they were current users of the non-technological contraceptive implant, or if they were past users who had had it removed. There were four participants in total, two who were current users, and two previous users of the implant. All participants were between the ages of 25-32 and all were university students living in the south of Sweden. The four sessions all lasted between 30 minutes and 1.5 hours. Sessions were held with each participant independently with only myself and in the room. Audio recording were made of each session with the participant’s consent. Research participants had no knowledge of the scope of my research or the contraceptive microchip except that I wanted to discuss their experience with the contraceptive implant.
6.2. Props and Setting
used had to be portable and easy to set up. The props included bandages, plasters, surgical gloves, disinfection wipes and a pen to represent the implant applicator. Scene-setting objects included a medical plastic sheet and a cushion. These were used on top of a table or a bed to represent a bed in a clinical surgery (figure 3).
6.3. Re-enactment of the Implantation
Upon arriving at the room where the research session was to take place, participants were invited to remove their coats and leave their bags in a corner. Participants were informed that this research session would focus on their use of the contraceptive implant. The first task explained to participants was that we would re-enact their implantation process together, but that this time they would play the part of the medical practitioner and that I would play the part of them. I asked them to direct me in how to physically re-enact their experience. Three participants began by telling me to lie down on the bed, one participant began with us both sitting in chairs that she found in another room and brought in herself. All four participants independently understood the role of the props and appeared to be comfortable in using them. Two out of the four participants extended the use of the props by using the pen, given to represent the applicator Figure 2. Props and set of the performance ethnography sessions
of the implant, to draw on my arm where the implant would be, and to represent the insertion.
Participants switched between the “I” and “you” form, either telling me what they did or telling me what I did in order to direct my actions. Two participants actively moved my body around to re-arrange me into the position they had taken. One participant enthusiastically played the part of the medical professional and adapted her posture and voice to that of a strict nurse.
I let myself become relatively passive physically during the re-enactments; I instigated no movement of my own accord but held my posture enough so as not to fall over. This let my participants take charge of my body and to direct my movements either physically, for example lifting my arm over my head into the correct position, or verbally by telling me to reposition myself. This allowed me to embody my participants and their memory of themselves during the implantation. They saw themselves in my body and were able to reflect on their past actions. One notable result of the re-enactments was the remarkable detail with which the implantation was remembered. I believe that seeing their past selves from the outside and projecting their memory onto me brought back clarity to the order of events and the details of the interaction between the medical practitioner and their past selves. One aspect that I found both a help and a hindrance was that I have also had a contraceptive implant. This means that I have personally experienced the implantation myself. I deliberately chose not to reveal this to participants. I felt that if I allowed them to show and tell me about their experience was in more of a pedagogical roll then there could be more openness and fear of mis-remembering and of asking my agreement according to my personal experience.
What particularly struck me about the re-enactments was how differently each participant had experienced the procedure. It became clear that with some Figure 3 and 4. Pen marks on my arm made by participants
