“All by Myself” is the final poster for my graduate thesis presentation.
Women loathe the invasion of privacy, long waits and bureaucracy that come with conventional health care delivery. Lady Business is a public restroom vending machine that allows a woman to take care of her female health care needs without requiring face-to-face interactions.
First I address the challenges women face in obtaining health care, uncovered through interviews and research with 17 women and 6 medical professionals.
Getting your hands on female health care products can require jumping some hurdles. The Lady Business vending machine puts many self-care tools within women’s reach. Women don’t always have a caring doctor on speed dial, and see making appointments as a burden. Gaps in health insurance coverage also keep women away from clinics and pharmacies for fear of high prices. Women are interested in affordable self-tests and self-treatment so that they can avoid the hassle of dealing with the medical world. Women are also interested in self-care on the go, and asked for mundane products such as underwear and deodorant.
Women say, “Don’t make me go to the doctor”
“I hate having to go somewhere every month to get birth control. Because that’s what prevents me from doing it.”
“I don’t want to go to the doctor to find out or have to ask ten people, do I have a yeast infection?”
“I don’t want to go to the doctor if I just have a “feeling” something is wrong.”
“I chose antibiotics and urine test strips because I get UTIs sometimes and I don’t want to go to the doctor every time.”
Using a vending machine simply saves time. Public restrooms at school or work are always open and don’t require a long journey or an appointment. Making phone calls, setting appointments, waiting for exams and prescriptions, driving from place to place are all time-consuming parts of the process that offer the woman little value. Women would rather spend their time getting results and information about their health.
Women say, “I need it right away”
“I want a little shot of water to take the pills, so everything’s in the stall.”
“I’d want to buy emergency contraception and take it right now.
“UTI and yeast infection tests will help me figure out rather than speculate.
“More directions and explaining things better. Simple language. Less medical terms.”
Women want to take care of themselves without the judgement of others. Stigmas and taboos around female sexuality make many health care transactions so embarrassing, women area them or avoid them all together. Health care providers can’t assist women who don’t come in, and women end up with unplanned pregnancies, untreated infections, or just preventable problems. The vending system is designed to be used without forcing women to face anyone else – no asking, no permission, no shame.
Women say, “Help me hide”
“The bathrooms is private. It’s a good place to pull yourself together and contemplate.”
“I’m to embarrassed to pick up condoms, pregnancy tests or Plan B at a pharmacy”
“Maybe I’m a prude, but I don’t like the sales person knowing my sex life.”
“The self-care kit has to be hideable.”
“I need the packaging to stick in the waistband of my clothes. What if I ran into my boss?”
Women say, “Free means somebody cares”
“It makes you feel supported to have feminine products available for free”
“Maybe free every once in a while? I always feel such goodwill when they are free on campus.”
“Condoms should be free on campus already, like Free Condom Friday!”
Women do not want to be seen buying products, so the vending machine is designed to be used quickly and to keep others from knowing what she buys. The machine is triangle-shaped to fit in the corner of a public restroom, instead of hanging on a flat wall. The woman naturally blocks the narrow front of the vending machine with her body while she’s using it, protecting her transaction from curious eyes. She selects products from a dedicated keypad, instead of pushing buttons close to the products, so it’s less easy to identify what she buys from her gestures. The waist-high dispenser means she can easily slip the product into a pocket or purse without having it be exposed. Swiping a credit card or university ID for payment is less fussy than inserting bills and coins, and allows women to buy higher priced items without worrying about correct change.
Women identified several types of products they’d like to buy from vending machines in public restrooms. Top concerns include treating diagnosing and treating common infections, using contraception, caring for periods, keeping clean and pain relief. Women asked for a mix of medical and convenience items. While most items are available at pharmacies or convenience stores, the process of purchasing them involves a special trip to the store and a face-to-face interaction with a cashier. Women were more interested in products that cater to urgent situations (feeling ill, getting a period, preparing for sex) than long-term use products (pack of birth control pills, antibiotics).
Women don’t want to be seen using the products they buy. Lady Business purchases are designed to be used in the restroom stall. Women even admitted they’d rather swallow pills without water while in a stall than go stand at the sink with the package. They don’t want anyone to see the package on the floor, so packages are small enough to be unfolded and used in the lap. Products are adhered to the package with glue so nothing falls out when you open it. Packages designed to be mailed away for lab tests turn inside out to become an overnight envelope.
Many health situations women face involve a lot of time wasted spent waiting on others to provide a service. Ironically, the technology used to diagnose and treat many infections is simple enough for a woman to do it herself. In research sessions, women expressed interest in kits to help them deal with urinary tract infections, yeast infections, sex, pregnancy and periods. Believe it or not, women can take urine, saliva, and even blood samples, swallow pills, and apply creams with the best of them.
This will be the front face of my vending machine prototype. I have a triangular, wall-mounted design that is meant to hang in a private corner of the bathroom. The machine will display a range of products, from convenience items (panties) to contraception (condoms and Plan B) to self-diagnostics (couples STI test). Users can pay with a credit card or swipe a university ID. Products are ordered via an alpha-numeric code on the right side, so their choice is less conspicuous to others.
I tried various combinations of Linotype Didot and Avenir to create the branding for Ladybusiness packaging. I experimented with different names for the couples STI test as well, to see if I could communicate that this is a home test for two. I chose the combination of lower case italic Linotype Didot for “lady business” with lowercase heavy Avenir and small caps Avenir.
The color palette is “Waiting for Someone” by PurpleScarf via Colour Lovers.
Interesting perspective on my Lady Business project. I realized the bulk of my energy for Lady Business has focused on creating evidence: the machine, selecting appropriate products and designing self-care kits. Because Lady Business is DIY female health care, there’s no onstage contact with any employee, which distinguishes it from many other health services.
Ten tiny paper models of vending machine shapes for the bathroom. Built to emphasize privacy and function in tight spaces. Wall-mounted design continues in the tradition of bathroom vending machines we see today. Interface will include grab-and-go literature, card swipe for credit cards or student IDs, and glass front to see products or touch-screen to select and vend.
During research sessions, women stressed the need for privacy when purchasing any female health product. My advisor, Suguru Ishizaki, also suggested mixing in innocuous products, such as candy or perfume, with the health products to help women self-camoflaugue when buying something possibly controversial. Previous machine shapes, such as those designed by IDEO and Frog, use side angles to help protect user privacy during transactions.
Wow! Vending machines have really been in the news lately, with a special spotlight on Shippensberg University’s health care vending machine. When surveyed, 85% of students at Ship U. responded that they would be interested in a vending machine at their student health center. Students buy hundreds of doses of emergency contraception from the machine each year. Pregnancy tests are also available. According to their website, they’ll be adding condoms to the machine soon. The school released a statement on their website about the availability of Plan B to their student population, and why they chose the vending machine system.
It’s exciting to see this idea in action in the real world! Back here at CMU, I continue to work on my thesis project developing a female health care vending machine design. Over the past few months, I’ve nicknamed my self-service healthcare concept “Lady Business.” I recently presented the Lady Business project at the TEDxCMU finalist auditions here on campus. I didn’t make the final cut, but it gave me the opportunity to share the project with a group of students from other majors, and I wanted to share it here online. The model in the images is Loretta Neal, a fellow design student.
The idea for Ladybusiness came to me last summer as I was hiding in a small room at work, making secret phone calls to my nurse practitioner back home. I was trying to convince her to refill my prescription for birth control pills. My prescription from last year prescription had run out, I was in a new city doing a summer internship, I didn’t have a local doctor, my health insurance had just changed, and the pharmacy nearest to me closed early.
Between all the phone calls and time spent on online with my health insurance company and doctor’s office, waiting for my insurance to go through, and getting to the pharmacy before it closed, it took me three weeks to get my hands on a pack of birth control pills. I thought, “My god, shouldn’t this be easier?”
So, I picked this as my thesis topic and started doing research this fall. I interviewed women to find out what experiences they were having with their health, and it turns out, I’m not alone. Women told me their stories of visits to the gynecologist, trips to the pharmacy, problems with health insurance and their experiences with common infections like UTIs or yeast infections.
During these interviews, I heard over and over three major issues that women were facing in these situations:
Having to overcoming barriers to access care, ranging from problems with administrative bureaucracy, cost, having no insurance or being dependent on someone else, which compromised their privacy. Mom knows when a young women on her parents’ insurance goes to the gynecologist because the explanation of benefits gets mailed back home. Some women end up going to Planned Parenthood and paying in cash instead of using their own health insurance. So, they have insurance, but it compromises their privacy to use it. Some women don’t have insurance at all, and therefore don’t really have access to contraception bedsides what they can buy on the drugstore shelves, which are one-time use barrier methods, like condoms. They aren’t able to access more effective, long term methods because they require prescriptions.
One woman told of a day when she was getting a haircut and her hairdresser seemed unusually upset. The hairdresser eventually apologized and said she was suffering from a very bad UTI, but her doctor refused to give her a prescription for antibiotics until she came into the clinic for a urine test, despite having had UTIs in the past and knowing the symptoms were. The woman, unable to leave work, had to spend the day giving haircuts in extreme pain.
The burden of time, from having to take time off of work or school to make appointments, getting to a clinic, waiting in waiting rooms, exam rooms, pharmacies, or for the mail to hopefully arrive on time. Taking care of your health means going through a complex system in which you must rely on others to give you what you need, and that takes time.
One CMU student reported that she went to student health twice in an attempt to get birth control and eventually gave up, because they wanted her to make a third appointments for a full exam. Another woman says she feels like she’s playing Russian roulette every month when she receives her birth control pill in the mail, because if it arrives late and she misses a few days, she experiences pain. She’s one of 14% of birth control pill users who take it for therapeutic reasons.
Feelings of shame are felt by virtually every woman when she has to face another person to ask for what she needs. Women talked about fear of being judged at the cash register at the pharmacy to buy condoms, even tampons! Women feel ashamed when dealing with health care providers that they feel don’t listen to them, or when they feel their privacy isn’t being protected in a place like a pharmacy. One woman was horrified when she went to a pharmacy to buy, and the pharmacist went around to every other person working in the pharmacy to check and verify if it was okay for her to buy two boxes. She left with about four or five people knowing that she needed EC. Another married woman told me every time she buys condoms, she’s afraid that the cashier thinks she must be running around on her husband! Some women say that they’ve discovered that the self-checkout at the grocery store is the best way to buy female products to avoid the unpleasantness of a face to face interaction. Fear of facing a cashier makes taking care of your female health needs unpleasant for many women.
Attitudes, not science
The protective barriers put into place to prevent women from having access to medicine and contraception make it difficult for women who need it to obtain care. The paternalistic attitudes of healthcare community are not science-based.
Doctors treat ladies like “damsels in distress” who need to be protected and monitored. This attitude creates a hindrance for women who want to decide for themselves. Some pharmacists think women can’t handle the drugs without their help and control. During interviews, they expressed Irrational fears such as people “gobbling down the entire pack of pills,” or “Someone will find out a UTI treatment has antibiotics and they’ll buy it and take it for the sniffles.” These silly fears are used to keep medications under lock and key. In Australia, birth control is available over the counter with a blood pressure check and medical history. In the US, often a pelvic exam is required.
Let’s look at a typical customer journey for a woman who wants oral contraception. She makes her decision, then begins the search for a provider. She’ll call a clinic or make an appointment online and hopefully schedule a visit a few days or weeks away. She’ll then drive down to the clinic, wait in a waiting room, have a pelvic and breast exam, pap smear, medical history discussion, and then the doctor will select a prescription for her and give her a piece of paper with the name of the pill, granting her permission to go get the pill.
She’ll then drive down to the pharmacy, where she’ll drop off her prescription, wait, and then pick up 28-day supply of pills. She’ll either pay with her insurance, which limits her supply to 1-3 packs at a time, or if she doesn’t have insurance or her insurance doesn’t cover birth control (as is the case with two women I interviewed), she’ll pay out of pocket, anywhere from $10-70/pack.
After a year, her prescription will run out and she’ll have to return to the clinic to have another exam and request a new prescription. The idea of this system is to screen women to prevent contra-indications, or negative side effects. But because the pill has been in use for so many years, and is taken by so many women, it is generally considered safe for healthy women under 35 who don’t smoke. Serious side effects are rare. So, the protections become a barrier for women who don’t have access to this kind of care, and it places a very high burden on the woman to keep up with this level of care in order to stay on the pill.
To put this in perspective, women have 30 child-bearing years, but most contraceptions are designed for one-time use like condoms, or supplied for one month at a time, like pills. To avoid an unplanned pregnancy, this means dozens to hundreds of trips to doctors and pharmacies. More effective birth control is harder to get, because hormonal methods are available by prescription only. What are the consequences of making birth control hard to get? 50% of pregnancies in the US are unplanned (CDC).
So, in this journey to get an everyday contraception like birth control, the woman deals with several people she makes trips to several places and she takes time out of her day. This is not just about birth control, women have to go through the same routine for common infections, like urinary tract infections or sometimes yeast infections. There are many obstacles that make these journeys difficult or impossible for women to get care. But I think it doesn’t have to be this way.
Vending machine solution
Let’s take another look at these vending machines. First, they’re found in public bathrooms everywhere, at work, at school, in shops and restaurants…everywhere women already are. There’s no phone call to make, no driving around, no special hours, no appointments, permissions or conversations. To find one, you just have to go to the ladies’ room. So, the biggest advantages of these female product vending machines is that they already exist. It’s a place women can enter and leave at their convenience, it’s not a separate trip, it’s women-only and anonymous.
So, what is this vending machine all about? Well, we’re all familiar with the big, clunky vending machines we see in public bathrooms. They’re everywhere, especially in women’s restrooms, but if you’re like most people I’ve talked to, you rarely use them. My idea is to re-claim this small vending space and re-design it, to dispense a variety of women’s high quality healthcare products. I’m proposing a radical departure from the current healthcare system that requires women to make doctor’s appointments and go to pharmacies for needs as simple as birth control pills, treatments for urinary tract infections, some treatments for yeast infections, that are designed to facilitate self-diagnosis, self-treatment, contraceptions, as well as products for the period.
Customer journey with vending machine: Woman enters the restroom, she scans the range of products available. If she has an infection, she takes a free testing strip and can walk into a stall and test herself. If its a quick urine test, she may be able to see results in a few minutes, then proceed to follow the instructions in order to pick a treatment from the machine and take it on the spot. If its a test that must be cultured, she can put it into an envelope and mail it away for test result. She could them receive a response from the lab and instructions on what treatment to buy or if she needs to go see a doctor. If she’s buying contraception, she could read a brochure to self-screen for the best method, or just refill her usual brand. If she prefers a long-term method that requires insertion by a doctor, like an implant or IUD, she could purchase it from the machine and take it to the doctor at her convenience. Again, instructions could come from several places: there could be a phone number at the machine to call for guidance, there could be free instruction sheets to help guide purchase, or there could be a website
Self-care for women
Let’s make things clear. What I’m proposing is a radical departure from the current health care system in the US. My project proposes to make many prescription-only treatments over-the-counter in order to make them more accessible to women. You see, the problem with restricting things like birth control pills, antibiotics, and other prescription products, is it denies the women a chance to consider a range of options and make an informed choice. Instead, a medical provider is making the choice for her, with drugs that are unfamiliar to her and aren’t designed and packaged for consumer use. Therefore, women sometimes feel like they’re flying blind when it comes to selecting contraception because they can’t see the choices in front of them. Or they feel frustrated and helpless when they have a UTI or yeast infection and can’t get treated until they see a doctor, even if they know what they have.
Women aren’t able to buy antibiotic treatments over the counter for common infections like UTIs, yet often it only takes a series of questions to determine if a woman has one, and can be diagnosed over the phone with 90% accuracy. However, some doctors insist on women coming in for a lab test before prescribing treatment.
Now let’s talk about the concept of self-service. Once upon a time, you had to ask someone for help to make a phone call, pump gas, buy a plane ticket, or take a pregnancy test. While many services have been converted from a personal service to a self service, health care for women remains very dependent on permissions, gatekeepers and access to expensive insurance, and healthcare providers. By converting the most common female healthcare needs into a self-services, a woman saves time, encounters fewer barriers to care, and doesn’t have to face anyone to get the products she needs.
Packaging could make it easy to test, treat, and refill on women’s health care supplies. Packaging could be an educational tool to help guide women’s choices. Women in Mexico are more likely to use birth control pills since they’re available over the counter, but they’re less likely to be on the right type of hormone mix. This is an issue that needs to be address in the way medicine packaging is designed for the consumer. Women should be able to self-screen for contraindications. In fact, it seems a woman is more likely to be honest when asking herself questions versus being asked by a health care practitioner — avoiding what’s known as “courtesy bias,” or responding “no” to questions about health conditions that could be used as a barrier to receiving the desired treatment.
Instructions and packaging are an important part of the design, because women will need to know how to select the method that’s right for them. Instead of a health care provider picking it out, the woman herself selects the method based on her lifestyle, age and health history. Tools could be developed, such as questionnaires, to help guide the woman’s choice, and advise her on what to do if she’s unhappy with her method. Contraceptions that are not self-administered, such as implants or IUDs could also be sold, then brought to a health care provider for insertion. Having the choice in front of her makes a woman aware of the variety of methods and puts her in control of what she uses and when.
Women in India are less likely to use condoms because of shame of buying them from a pharmacist. (Guttmacher)
Women under 18 who get pregnant are less likely to finish high school, yet legislation prohibits them from using Plan B without a prescription. (news source?)
What could go inside?
Lady business vending machines could stock a range of female products, designed to inform and educate a woman on doing what’s right for her body. Self-diagnosis and treatment kits could be created for common infections, STIs, using simple dipstick or swab tests. The technology for many of these tests is very low-fi, and could involve taking a test strip into a stall, using it, and seeing results in minutes, then following advice to purchase a particular treatment, right there out of the machine. Test strips could be free, so you only buy the meds you need.
Oral treatments for yeast infections (Diflucan) isn’t available over the counter in the US, but it is available over the counter in Italy. (source: personal experience)
Contraceptions such as birth control pills, patches, rings, condoms, female condoms and other self-administered barrier and hormonal methods could be sold from a vending machine. In many other countries, hormonal contraceptions like pills are already sold over the counter. An advanced care clinician at CMU’s student health clinic said that foreign students who come here are often surprised they have to come in for a medical exam and a prescription just to get birth control. They’re used to getting contraceptions over the counter.
Women with a range of free choices of contraception are more likely to pick IUDs over other methods, 50% opted for IUDs in a Wash U study.
Women with a larger supply of birth control pills at home are more likely to stay on their prescription over time. (Source: Obstetrics & Gynecology) Yet insurance companies limit how many packs they will pay for at once, usually a 30 to 90 day supply. Some women use birth control pills for years at a time. Some for decades at a time.
I am seeking to push change in attitudes about women’s health. The vending machine concept questions the wisdom of the current state of women’s health care. My project proposes a possible future where we shift to a low bureaucracy model of health care for everyday needs. It focus is on educating the woman herself, and putting her in control of her health care. The vending machine isn’t designed to conform to the restrictions and bureaucracy of the current model, but is a proposal to change the model of care.
Personal interviews with 17 women and 5 health care providers
Articles and related topics
Waiting room: Copyright Carl R. Darnall Army Medical Center, http://www.flickr.com/photos/crdamc/6350013423/sizes/z/in/photostream/
Vending machine: http://www.flickr.com/photos/specialkrb/3397007256/
Reception desk: http://www.mlive.com/news/kalamazoo/index.ssf/2009/06/open_house_at_planned_parentho.html
On December 16, I presented my thesis poster, “Lady Business.” The poster reviews my research, design ideas, prototypes and approach. Responses varied from horrified to enthusiastic about the idea of putting women’s health care products into a vending machine.
This project began after it took 3 weeks for me to obtain a pack of birth control pills this summer. My prescription had run out, my insurance changed, I was living in a new city, and I didn’t have a doctor to see. While hiding in the phone booth at work to call a nurse I thought, why is this so hard?
I started daydreaming that I could buy my birth control pills from a vending machine in the restroom. Soon, I became interested in using my thesis project as a piece of design rhetoric. By showing an easier way, I want to argue that the current system is too burdensome.
Getting care for your female needs is time consuming, can sometimes be embarrassing, and may require access to health insurance, a clinician or a pharmacy. No matter her situation, one of these issues will affect a woman’s care experience.
Women fear being judged when they walk up to a counter to buy virtually any female product.
Interviews reveal women often deal with their care in isolation from their peers, and rely on scraps of information from doctor’s visits, commercials and hearsay.
Because many contraceptions and treatments for common infections are available only by prescription, women don’t often see their full range of choices.
DAMSELS IN DISTRESS
On the loose
Doctors speak about women’s health in tones of fear, saying common contraceptions and treatments are “dangerous” and subject to “abuse” if made widely available. In reality, serious side effects are rare and the consequences of not having access to care are much more severe.
Too much faith
Some providers believe women aren’t educated enough to handle self-care. But women say, “Nobody knows my body better than me.”
In the ladies’ room
So how can women get the care they need without the hassles of the current system? Well, the answer is hanging on the wall of a women’s restroom near you. Yes, the humble and archaic feminine product vending machine.
We have the technology
The women’s restroom offers several advantages. It is public and accessible to women as they go about their day. The space is inherently women-only and anonymous. Vending machines are ubiquitous but under-used.
On the spot
Buy what you need and use it right away, even if you’re away from home.
PRODUCTS AND PACKAGING
Self Diagnose and treat
A sample testing and treatment kit for urinary tract infections (UTIs).
What a pill
Refilling birth control pills is a pain. Refill‑at‑will packaging could be topped up when you’re running low.
In a second round of user research, I plan to ask women to assemble their ideal self-care kits for treatments and contraceptions. After they assemble the kits, they’ll stock the vending machine prototype and place it in a bathroom mock up.
“Proposals” not solutions
Roberto Verganti said, “We do not look at the market, we make proposals to people.” I am proposing a future scenario for women’s health. This design isn’t about designing a solution around every medical regulation that exists today.
This project aims to suspend disbelief and ask viewers to imagine women’s health care as a selfservice. My prototype is presented as a possible future, meant to convince the world that this is a problem that needs solving. Women and care providers don’t question the system, even though it isn’t ideal for many. Rhetoric is needed to push women out of their “This is just the way it is” mindset and towards new models of care.
MDes candidate 2012
Communication Planning & Information Design
Advisor: Suguru Ishizaki
Carnegie Mellon University
I presented the poster formally to a group of three design faculty members, Nick Durrant, Bruce Hanington and Terry Irwin. Here are my talking points: