Guest blog contributors are Julia Bunting, OBE, President of the Population Council, and Laneta Dorflinger, PhD, Director of Contraceptive Technology Innovation at FHI 360. Their two organizations are long-time leaders in the field, bringing decades of experience in developing, evaluating and introducing new contraceptive technologies.
This “Why do we need contraceptive technology innovation” blog series has showcased the critical need for new approaches in contraception development and some of the most exciting advances in process. We’ve highlighted upcoming technologies—from biodegradable implants, microneedle patches, and male contraceptives to vaginal rings, cervical mucus fortifiers, and mobile phone applications. We’ve explored innovations beyond technology, including the importance of placing the needs and preferences of end users at the forefront when starting any new product development and we’ve considered what it takes to scale up contraceptive access and actually get new technologies to end-users.
But there is still so much work left to do.
While the current contraceptive method mix is broad, the reality is that acceptability, affordability, and accessibility limit product choice for many in need. Nearly 40 percent of women who have an unmet need for contraceptives in developing countries actually tried contraceptives but discontinued them. A recent analysis confirmed that discontinuation contributes to about 35 percent of unintended pregnancies. While improved counseling can address some discontinuation, women, men, and young people also need new and improved options to meet their evolving reproductive health needs across their lifetimes.
In a perfect world, there would be a plethora of options: short- and long-acting, hormonal and non-hormonal, male- and female-based, on-demand and permanent to meet everyone’s changing reproductive needs. In a perfect world, constraints like storage/temperature conditions, clinic staffing shortages, or local procurement budgets would never hinder access nor available options. And in a perfect world, women would not have to sacrifice a day’s work and find transportation to get to a family planning clinic for time-sensitive contraceptive refills or injections.
If we are intent on ensuring that individuals and couples worldwide have access to the broadest choice of top quality, affordable, and acceptable contraceptives—including new options with fewer side effects and added health benefits—we must aggressively work to fill several remaining knowledge gaps. These gaps include:
Enhancing our understanding of reproductive physiology of men and women. While a lot is already known, new insights will enable us to focus on new targets for non-hormonal contraception—including potentially genomic methods—as well as more topical hormonal methods.
Identifying and applying the needs and preferences of women, men and young people in product design. New product target profiles should be fine-tuned to reflect different needs, different geographies, different cultures, and different age groups. Everyone deserves greater choice, convenience, and control in exercising their contraceptive options.
Investing in male contraception. Even if female contraceptives become universally available, leaving men out of the responsibility for family planning remains one of the world’s greatest health inequities. Research shows that as many as half of men surveyed would use a male contraceptive if it were reversible and easy to use. By giving men options to be able to regulate their own fertility and not be forced into fatherhood, we can lessen the burden of reproductive choice on women.
Assess the needs and develop products that have added health benefits, most notably the opportunity to develop a range of multi-purpose prevention technologies that not only prevent unintended pregnancy but also protect against several sexually transmitted infections, including HIV.
Improving business analytics so we can better assess which markets, especially those in developing countries, are amenable to underused methods; determine public and private sector price points; and generate demand for new methods being introduced.
And strengthening manufacturing capabilities and distribution networks to cost effectively produce and scale up new and underused technologies.
As long as there is unmet need and gaps to fill, there is a need for contraceptive technology innovation; both in terms of refining existing methods and in developing new methods. But bringing a new method to market comes with significant costs of resources and time. It will take a coordinated effort to see the exciting opportunities mentioned in this blog series come to fruition – because contraceptive technology innovation is everyone’s business.
There is a role for private donors, like the Bill & Melinda Gates Foundation, to invest in early research when risks are high and many intriguing concepts quickly fall by the wayside. There’s a role for government (like the Eunice Kennedy Shriver National Institute of Child and Human Development and U.S. Agency for International Development) to financially support both new research and novel delivery platforms as well as acceptability and operational research to evaluate uptake and continuance. There’s a role for research institutions, like the Population Council and FHI 360, and their network of collaborators to move novel ideas from proof-of-concept through early clinical trials.
And now more than ever, there is a role for pharmaceutical companies, both big and small, from the Global North and the Global South, to engage more boldly in contraceptive product development. We need their scientific know-how, their research experience, and their business acumen. We also need them to increase their level of social responsibility as it relates to the contraceptive products they market. They need to commit to the concept of global access whereby contraceptives are accessible at a reasonable price to people most in need, wherever they live in the world. In the global contraceptive implant market, Bayer and Merck/MSD are already demonstrating that a business model that links preferential pricing to volume guarantees is doable and that these innovative partnerships can deliver impact in terms of increased access and use.
Everyone must be engaged to move the science of contraceptive technology innovation forward – to bring it out of the laboratories and get it to the people who need it on the ground. We are convinced that a win/win/win outcome is reachable: a win for advancing the science of contraception, a win for socially responsible women’s health companies answerable to their shareholders, and a win for the millions of people who deserve a full range of contraceptives to meet their changing needs.
Contraception is everyone’s business, and we need everyone at the table to develop and support the path forward.