When is the last time you bought a new cell phone? If you live in the United States, the United Kingdom or a similar developed country, it’s likely that you purchased a new cell phone within the last 2 years. Some cell phone models are on the market for less than a year before they are replaced with a newer, improved version. We live in a world driven by innovation. Yet, as we approach the Family Planning Summit in London later this week — which promises to be a catalytic event designed to transform the global family planning landscape — we are confronted with the reality that the world has had few game-changing transformations in contraceptive technology in the last 20 years.
A recent Guttmacher report illustrated that while there are many effective family planning methods available, each has its limitations. Currently, more than 100 million women in sub-Saharan Africa and South Central and Southeast Asia have an unmet need for family planning due to method-related factors. A major reason is women’s concerns about the side effects of current contraceptives. Another is that some women have sex infrequently; they want additional choices of methods that they can use as needed. Other women have partners who oppose the use of family planning, and they want a method that can be used covertly. Structural challenges also create hurdles; longer-acting methods require clinical infrastructure for insertion and removal services, and shorter-acting methods require ongoing visits to a provider for resupply.
How can we fill these gaps and expand choices for women? Fortunately, exciting possibilities are within our reach. Later this year, FHI 360 and partners will initiate early testing of several options for a new longer-acting injectable that would last 6 to 12 months. Injectable contraceptives are one of the most popular methods worldwide, yet discontinuation rates can be as high as 50 percent in the first year, often because women miss their follow-up appointments. An injectable method with longer intervals between reinjections would be easier for women and for providers and likely lead to better long-term continuation compared with current injectable options.
Other possibilities are a biodegradable implant that would avoid the need for removal services, which can be difficult to access in resource-constrained settings, or an implantable reservoir system that could be turned off and on by a woman at will and would never have to be removed. In addition, efforts are under way to develop easy-to-use methods that provide dual protection from both pregnancy and sexually transmitted infections, including HIV. Nonsteroidal approaches would address the needs of women who want to avoid the side effects of common hormonal methods, while nonsurgical approaches to sterilization could be safer in low-resource settings for women who do not want more children.
Affordability is a critical issue. The most innovative technologies are often too expensive to be within the reach of women in the poorest countries. This is particularly true for several long-acting methods. Despite being available for over 25 years, implant use has been limited in developing countries until recently, largely because of cost. The increasing availability of the more affordable Sino-implant (II), however, has the potential to increase access and help drive down implant prices overall. The hormone-releasing intrauterine system (known as the Mirena) that has become very popular in American and European markets is only available on a very small scale in developing countries, due to its high price.
In recent decades, investment in contraceptive research and development has stalled. We must reverse this trend. The cost and time of developing new products is significant, but we owe it to women to embrace a long-term vision and commit the funds to support new discovery. We must also forge innovative public–private partnerships to accelerate the development process and decrease the time it takes to get new products to market.
You wouldn’t be satisfied if your cell phone model was 20 years old. Women and men around the world deserve the same commitment to innovation when it comes to safe, effective, affordable and versatile contraceptive technologies.