(November 2010) What are the most promising recent new developments in contraceptive research and implementation? What are current priorities in the research and development of new contraceptives? What are some of the new contraceptive technologies currently in the field? Which technologies are being developed for future testing and implementation? And once a new contraceptive has been developed, how is it introduced into a country? These and other questions from science to research to field implementation were addressed by a panel of experts as part of PRB's 2010-2011 Policy Seminar series.
Jeff Spieler, the senior technical adviser in science and technology in the Office of Population and Reproductive Health at USAID, presented priorities in contraceptive technology, including working with existing technologies and adapting them to improve use. Not only does family planning enable couples to space births, but it also reduces the incidence of abortion and prevents infection from diseases that normally exist in animals but can be transmitted to humans. "If we could develop contraceptives that have other health benefits than just preventing unintended pregnancy, which is a huge health benefit, it really would change the equation for some people on why they would choose a method," he said. He stressed the unmet need for injectable contraceptives, including a new formulation of Depo-Provera that community-based health workers can safely and effectively administer to patients. Spieler also described new hormonal implants and intrauterine devices that are low-cost, safe, and highly effective. Contraceptive vaginal rings are also an effective and convenient method. But one very low-cost method, a condom for women, is made in China; this condom is less expensive than current options, costing about 20 cents each. Spieler described some current options for men: condom, vasectomy, withdrawal, calendar/rhythm, and hormonal regimens.
Régine Sitruk-Ware, a distinguished scientist of the Population Council and an adjunct professor at Rockefeller University, outlined research and development priorities in contraception for the next decade. In the R&D pipeline are 58 technologies that promise to be longer-acting and user-controlled; and among them, better spacing methods. The technologies include vaginal rings and one-year contraceptive rings; a progesterone vaginal ring will have additional health benefits; and transdermals will be available both as a spray and a gel. Sitruk-Ware also emphasized the importance of finding methods that are more popular with young people, such as vaginal gels for occasional use. The future for male contraception is uncertain, but new targets are on the horizon, including nonhormonal methods like a tissue-selective androgen called MENT, implants that are effective for one year.
Michael Welsh, vice president for centrally funded programs and applied research at FHI, gave an overview of contraceptive introduction, "where the rubber meets the road." Because of the family planning revolution, millions of lives have been saved, but as the number of women of reproductive age rises in sub-Saharan Africa, more work is needed. He discussed the subdermal contraceptive implant, Sino-implant (II); and he talked about the importance of strengthening the service delivery system for injectables, which are very popular in sub-Saharan Africa. But there are too few trained providers and access is still a barrier. Welsh summarized the attributes of "introduction success," using the acronym CORRECT: Credible, Observable, Relevant, Relative advantage, Easy to install, Compatible, and Testable.