There, she identified a recurring cycle that kept women in a downward spiral: families that were already poor and struggling to stay alive kept having more babies, dragging them down still further. In the 1870s she became the country's first advocate for contraception, and one of the first anywhere. In the midst of a society and a medical profession that were rigorously Victorian in their attitudes about sex, she had patients conduct trials of contraceptives and concluded that the pessary, a kind of diaphragm, was the most effective birth control device.