The date was Sept. 21, 1993. Nirvana was tasked with following up the groundbreaking Nevermind album that many people credited with breaking down the barriers for alternative rock and grunge acts who were now dominating the music scene. In a pre-social media world, the anticipation couldn't have been any higher for a new album.

And then it came .... In Utero, a head-scratching title with a somewhat unnerving album cover. So how exactly did the band end up with that title for the record? And what about that album cover? How did that tie in to it all?

Nirvana's In Utero Could Have Had a Darkly Different Album Title

Yes, we all now know Nirvana's third studio album as In Utero, but did you know that wasn't the initial suggestion for an album title? Given Kurt Cobain's dark sense of humor, he once suggested that the album be titled I Hate Myself and Want to Die.

Admittedly, Cobain revealed that it was a joke title, explaining to Rolling Stone, “I’m thought of as this pissy, complaining, freaked-out schizophrenic who wants to kill himself all the time. … And I thought it was a funny title. I wanted it to be the title of the album for a long time. But I knew the majority of the people wouldn’t understand it.”

But after initially tossing out that suggestion, he was urged to move on to something else. Verse Chorus Verse (which shares a name with a Nirvana song title) was one suggestion, but ultimately In Utero became the band's go-to album title for their third album.

What Does In Utero Mean and Where Did the In Utero Album Title Come From?

First, what does In Utero mean? It should be noted that the Latin title translates to "in the womb." And how did the band end up on the title? It was taken from a poem that Kurt Cobain's wife Courtney Love had written. Given the album's lyrical themes dealing with birth, death as well as other societal ills and Cobain's personal struggles, the title seems to fit the music quite well.

That wouldn't be Love's only influence on the album, as the song "Heart-Shaped Box" has ties to Love as well. Though initially viewed by many as a Cobain love song to Love, Michael Azerrad's "Come as You Are" book reveals that the song was also literally inspired by the physical manifestation of a heart-shaped box of possessions that Love gave to Cobain. The "Heart-Shaped Box" single artwork with the box reflects that as well.

However, Love has hinted at something a little more sexual in nature where the song's origins are concerned. As Rolling Stone reported, after Lana Del Rey performed the song in Australia in 2012, Love reached out to the singer on Twitter, noting, "You do know the song is about my vagina right? 'Throw down your umbilical noose so i can climb right back,' umm." She then added, "On top of which some of the lyrics about my vagina I contributed."

Nirvana, "Heart-Shaped Box"

What Is With the In Utero Album Artwork?

A listen to Nirvana's In Utero album finds the band trafficking in less commercial and more challenging fare musically, so why not challenge album listeners visually, too? The female winged figure is stripped free of her skin, allowing viewers to embrace the inner anatomy of the cover's central figure.

The image itself is actually that of a Transparent Anatomical Manikin (TAM), created by art director Robert Fisher, who worked off ideas presented to him by Cobain. A TAM is a human-sized, anatomically-correct model. It's typically a female body, and one that is used for instructional purposes in the medical field.

Why was Cobain interested in the TAM figure? In a 1993 interview with MuchMusic, the singer revealed he had held a fascination in human anatomy since his childhood. It was during a key period in his development of his youth when he received a "Visible Man" anatomical model kit.

Cobain recalled, “I guess I secretly want to be a doctor or something. I’ve always liked anatomy … And since I’ve become a big rockstar and made a bunch of money, I found this place in the Mall of America in Minneapolis that sells nothing but medical stuff.”

The singer scoured the store for everything from medical charts to anatomic figures. “It was like a dream come true," said Cobain. The Nirvana frontman, who was heavily involved in their artistic presentation as well, used plastic fetuses, replicated innards, a turtle shell and more in an arrangement that appears on the album's back cover.

Nirvana, In Utero Album Cover

nirvana, in utero

Was In Utero's Artwork Ever in Question?

Per Far Out Magazine, Nirvana did question whether or not the winged TAM was indeed something that would pass the watchful eyes of their label and the judging eyes of their fans. Worried that the chosen cover art might offend listeners or retailers, the record company had two alternate covers mocked up. One featured a simple image of a heart-shaped angel made of ribbons, and the other depicted the band’s name in yellow letters on a black background.

But, as Cobain and the band initially embraced In Utero as a title, so too did they decide to see what happened with the striking artwork. As it turned out, their fears of a backlash never came to fruition, enough so that Nirvana doubled down on their TAM presence using replica winged TAMs as stage props while they toured in support the album.

How Did Nirvana's In Utero Fare?

Despite some boundary pushing musically and visually, Nirvana continued their hot streak carry-over from the Nevermind album. As expected, the album debuted at No. 1 on the Billboard 200 Album Chart, buoyed by the success of the lead single "Heart-Shaped Box," which topped the Alternative Airplay chart while also enjoying heavy rotational play at MTV.

READ MORE: Nirvana's 30th Anniversary 'In Utero' Reissue Features 53 Previously Unreleased Tracks

The album's potential commercial success was a bit curtailed when Cobain took his own life on April 5, 1994, not too long into promotion for the new album. The band had moved on to the controversial second single "Rape Me," while "All Apologies" was soon to get a bump from the band's MTV Unplugged in New York taping. "Pennyroyal Tea" had been planned as the album's third single, but after Cobain's death, promotion for the album was halted. That said, the album went on to achieve five-times platinum status in the U.S.

In 2023, Nirvana's In Utero received a special 30th anniversary reissue, complete with 53 previously unreleased tracks. The cuts include two never before released Nirvana concerts from the In Utero tour that now stand alongside the album's classic and newly remastered originals. The collection, due Oct. 27, is currently available to pre-order.

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