Contraceptive Technology Innovation

Overview

In an ideal world, women would be able to choose whether, when, and how often to have children. An expansive arsenal of contraceptive options would be available to them as their priorities switch between delaying pregnancy, spacing children, and limiting family size. Unfortunately, for millions in need, current family planning methods are unacceptable, unaffordable, or inaccessible.

While contraceptive technology innovation is needed to broaden the method mix, developing the next best family planning option is a daunting task. It can easily take 15 years to move a new contraceptive innovation from the discovery phase and early clinical research through clinical trials and regulatory approval to country registration and product introduction.

Continue reading to learn about contraceptive technology areas of research that should be explored:

Method acceptability: Behavioral research needs to be conducted in parallel with early development efforts to ensure that preferences of potential users are incorporated into product design. Method acceptability data could also inform product introduction messaging strategies.

Refinement of hormonal products for women: Hormonal contraceptives are highly effective at preventing pregnancy. However, real and perceived side effects lead to discontinuation and non-use. Further evaluation of dose levels and development of new delivery systems could improve side effect profiles for some of these methods.

Adding on-demand options to the method mix: A large percentage of women do not use hormonal methods because they do not have sex frequently. Novel non-hormonal technologies that provide short-term, switch on/switch off pregnancy protection could fill this gap in the method mix.

Developing multi-purpose prevention technologies (MPT): In areas with high incidence of HIV, MPTs could provide protection from both pregnancy and HIV. The same approach is being used to develop methods that concurrently prevent pregnancy and other sexually transmitted infections.

Identifying non-hormonal male contraceptive targets: While male hormonal contraceptive research has had recent clinical setbacks, discovery efforts that target sperm development and motility are providing new insights into reproductive biology and may clear a novel pathway for a non-hormonal male contraceptive.

Exploring new self-administered delivery systems: The need for discretion and a preference for self-administration are driving the development and scale-up of new delivery systems, such as the single-dose Uniject (already available in certain markets as Sayana Press®) and microneedle patches (still in the early research phase).

Increasing availability of products: The introduction of new or underused products gives couples more options and helps to keep the marketplace price-competitive. Investments in contraceptive research must be made in tandem with the scale-up of existing products in new geographies.

Like all therapeutic areas, contraception is an evolving science, with research and development efforts moving new and improved technologies forward. Continued investment in contraceptive technology innovation will enable people worldwide to choose from a broad selection of family planning methods to meet their changing needs.

Click through the menu below to explore messages, research, and educational resources related to this topic.

While the existing contraceptive method mix includes highly effective options, an estimated 214 million women in low- and middle-income countries still have unmet need for family planning. To address this gap, contraceptive technology innovation is needed to do several things:

  1. Identify more targeted approaches and novel delivery systems
  2. Refine existing products to reduce side effects and increase user acceptability
  3. Implement creative strategies to introduce and scale up underused products
  • Women, men, and couples have changing contraceptive needs throughout their reproductive lives
  • An expansive method mix must be available. One method does not fit all needs.
  • New technologies must be acceptable, affordable, and accessible to potential users worldwide.
  • Creative public/private partnerships are needed to guarantee that new technologies are available to those in need.
  • Introduction of new or underused contraceptive methods is a lengthy process. The time, cost, and complexity are underappreciated.
  • Method mix: The breadth of contraceptive products available in a locale.
  • Modern method: A product or medical procedure that interferes with reproduction resulting from acts of sexual intercourse
  • Multi-purpose prevention technologies: A class of products (films, gels, intravaginal rings, etc.) that deliver concurrent protection from pregnancy, HIV, and/or sexually transmitted infections.
  • Underused technology: Method not available in a country’s reproductive health program, despite its presence in a comparable country’s program. 

The Global Health eLearning Center offers several courses on various contraceptive methods:

  • Family Planning 101 offers basic information relevant to voluntary family planning programs and services, including unmet need, long- and short-acting methods, access and service delivery issues, contraceptive security, and considerations for clients with unique needs.
  • Hormonal Methods of Contraception provides information that program managers and clinic staff can use to improve the quality of care in providing hormonal contraceptive methods, including vaginal rings, implants, injectables, and IUDs. It also examines ways to meet the rising demand for hormonal methods and looks at service delivery methods to reach contraceptive users in their communities.
  • The IUD course explains the mechanism and advantages of intrauterine devices (primarily the Copper T-380A), as well as discusses what can be done to increase demand for IUD use in many countries.

Below is a selection of peer-reviewed articles on contraceptive technology innovations and related topics.

Ali M, Bahamondes L, Bent Landoulsi S. Extended Effectiveness of the Etonogestrel-Releasing Contraceptive Implant and the 20 µg Levonorgestrel-Releasing Intrauterine System for 2 Years Beyond U.S. Food and Drug Administration Product Labeling. Glob Health Sci Pract. 2017;5(4):534-539. Highly effective LARCs can be an excellent contraceptive choice for clients wishing to avoid unplanned pregnancies. Recent studies find that both the ENG-releasing contraceptive implant and the 20 µg/day LNG IUS are highly effective for at least an additional 2 years beyond their FDA labels—from the current 3-year label for ENG-releasing implants to at least 5 years, and from the current 5-year label for the LNG IUS to at least 7 years—and with far better efficacy than many other contraceptive methods.

Binanga A, Bertrand JT. Pilot Research as Advocacy: The Case of Sayana Press in Kinshasa, Democratic Republic of the Congo. Glob Health Sci Pract. 2016;4(4):542–551. The emergence of the injectable contraceptive Sayana Press in some African countries prompted the DRC to test the acceptability and feasibility of distributing Sayana Press and other contraceptive methods at the community level through medical and nursing students. The pilot study obtained Ministry of Health approval to allow medical and nursing students to provide Sayana Press and other methods in the community, paving the way for other task-shifting pilots including self-injection of Sayana Press with supervision by the students as well as injection by community health workers.

Shattuck D, Perry B, Packer C, Quee DC. A Review of 10 Years of Vasectomy Programming and Research in Low-Resource Settings. Glob Health Sci Pract. 2016;4(4):647–660. The authors review areas including misconceptions and lack of knowledge among men, women, and providers; approaches to demand generation including community-based and mass media communications; service delivery innovations consisting of the no-scalpel vasectomy technique, whole-site training, cascade training, task shifting, and mobile outreach; and engagement of religious and community leaders to create an enabling environment.

Shelton JD, Jacobstein R. Vasectomy: A Long, Slow Haul to Successful Takeoff. Glob Health Sci Pract. 2016;4(4):514–517. Vasectomy use is plagued by low demand among men. Nevertheless, its compelling advantages make substantial investment worthwhile. On the supply side, a priority is to actively link vasectomy with service delivery approaches for the other highly effective long-acting and permanent clinical methods. Robust demand generation should include messaging specific to vasectomy, but should also draw on broader social and behavior change communication efforts increasingly aimed at engaging men in family planning.

Singh S, Das V, Agarwal A, Dewan R, Mittal P, Bhamrah R, et al. A Dedicated Postpartum Intrauterine Device Inserter: Pilot Experience and Proof of Concept. Glob Health Sci Pract. 2016;4(1):132-140. In the immediate postpartum time period, there is an opportunity to provide women with contraception they may not otherwise obtain. Post-placental and immediate postpartum insertions of the IUD are associated with more participant benefits than interval insertion. A proof-of-concept study was conducted to determine if a newly developed PPIUD inserter, specifically designed for the post-delivery setting, achieves the primary objectives of fundal placement and acceptable expulsion rates, provider and participant acceptability, and feasibility. Secondary objectives of participant satisfaction and IUD retention were also studied.

Starbird E, Norton M, Marcus R. Investing in Family Planning: Key to Achieving the Sustainable Development Goals. Glob Health Sci Pract. 2016;4(2):191-210. Family planning encompasses the services, policies, information, attitudes, practices, and commodities, including contraceptives, that give women, men, couples, and adolescents the ability to avoid unintended pregnancy and choose whether and/or when to have a child. The authors outline family planning’s links to the Sustainable Development Goals (SDGs) and highlight the transformational benefits that voluntary family planning brings to women, families, communities, and countries. They present family planning as a cross-sectoral intervention that can hasten progress across the 5 SDG themes of People, Planet, Prosperity, Peace, and Partnership.

Self-Injection Feasibility and Acceptability (PATH, 2018; PDF, 669KB) provides an overview of PATH’s research studies assessing the feasibility and acceptability of self-injection of subcutaneous DMPA in Uganda and Senegal, where injectable contraceptives are the most commonly used method of family planning. Subcutaneous DMPA (DMPA-SC, Sayana® Press) is a new, easy-to-use injectable contraceptive that is ideally suited for remote access and even self-injection.

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