From Clarence's perspective, IPPF ignored the reality faced by women wanting to be fitted for a diaphragm. He advocated that health workers could be trained to fit diaphragms. His idea sparked controversy because of the implications that it was appropriate to use different standards of care for women in the developing world than for women in the developed world. While provoking disagreement, Clarence's pragmatic approach reflected the reality of patient-to-physician ratios, which in 1947 was estimated to be 6,000:1 in India, making it impossible for physicians to meet patient demand for diaphragms.