World Contraception Day 2012 (September 26) has come and gone, and 2012 marked the first International Day of the Girl Child. Together with the excitement from the London Summit on Family Planning this summer and the recent announcement of a major price drop for the contraceptive implant, Jadelle, it has been a banner year for media attention, political will and global resources on family planning and women’s and girls’ rights and empowerment. As part of these efforts, increasing access to safe, effective and affordable contraceptives will have a profound impact on the lives and health of women and their families throughout the world. To achieve the ambitious goals set forth by these international initiatives, however, the global health and development community must act on the current political momentum and not lose sight of the challenges that remain.
The task ahead is large. Over 220 million women living in low-resource countries do not want to become pregnant and yet are not using an effective contraceptive method. This may seem strange when we have so many contraceptive choices available to prevent unintended pregnancy. However, not only is access to contraception limited for many of these women, but also the currently available methods do not always meet their needs, preferences or budgets. Approximately two-thirds of all women with an unmet need do not use modern contraception for reasons including side effects, perceived harm to health and desire to preserve future fertility. Along with our current method mix, we need to consider new contraceptive approaches that address these concerns.
Women who are using less-reliable contraceptives often find themselves with an unintended pregnancy. Developing new, highly effective methods that improve consistent use could reduce unintended pregnancies in sub-Saharan Africa, South Central Asia and Southeast Asia by nearly 60 percent. In far too many instances, an unplanned pregnancy can lead to unsafe abortion, maternal mortality or other serious health effects for the mother, her baby and her family. Deaths related to pregnancy and childbirth are decreasing globally, but approximately 800 women a day still die from preventable causes related to pregnancy and childbirth. These deaths would be reduced by one-third simply by providing women who have a desire to avoid pregnancy with appropriate methods to plan their families.
We need to expand contraceptive choices for women and couples. Adding new innovative methods to the current method mix and making them affordable and accessible in the poorest countries and settings will address many of the existing limitations. For example, FHI 360 is evaluating approaches to extend the length of effectiveness of injectable contraceptives to six months and to develop a biodegradable implant that would not have to be removed. Moreover, if new methods could offer additional health benefits beyond contraception, such as protection from sexually transmitted infections including HIV, they would appeal to an even broader market and have an even greater public health impact. Current research is evaluating multipurpose technologies such as vaginal rings containing both a steroid contraceptive and an antiretroviral agent.
Unfortunately, global investment required to support research and development for the next generation of contraceptives remains limited. Given the profitability of the existing products and the cost and complexity of developing new products, multinational pharmaceutical companies have largely stopped investing in contraceptive research. Changes in market dynamics may be necessary to attract the pharmaceutical industry back as a source of innovation, especially for low-cost, long-acting methods that meet the expressed needs and realities of the world’s poorest women.
Some manufacturers based in developing countries are investing in contraceptive R&D activities. These companies in the global South offer the potential of lower-cost options that will ensure women everywhere — not just in the developed world — have access to the newest technologies. However, new product development is a complex, long-term process requiring a long-term investment, which some of these manufacturers cannot afford. Navigating the requirements of stringent regulatory authorities presents another challenge.
Many countries have stepped to the plate to address their family planning situation. Bangladesh remains an inspiration for the world, having confronted and improved women’s family planning choices for more than a quarter century. Kenya’s national family planning guidelines are a model for their neighbors. At the London Family Planning Conference, 24 nations from the developing world committed more than $2 billion over the next eight years to improving contraceptive choices and access for their populations.
Over the next decade, we owe it to women and couples everywhere to present them with more family planning options. We must infuse the field of contraceptive research and development with the same focus that has been applied to other therapeutic areas. Let’s build on the recent family planning momentum and market-shaping mechanisms to ensure that all women are able to achieve their goals to plan their families and their futures.