Co-authored with Régine Sitruk-Ware, distinguished scientist, Population Council
When the U.S. Food and Drug Administration approved it in 1960, the birth control pill was revolutionary. For the first time, couples could safely and reliably plan their families with the help of effective medication. Today, the generation of women who first used the pill are collecting Social Security. Since then, major strides have been made in contraceptive research and development, and women of reproductive age have many more contraceptive options. But no single method meets the needs of every woman, and continued development of new contraception remains essential.
Steady progress in the development of safe and reliable modern methods -- from the first oral contraceptive pill to IUDs to vaginal rings -- has created a wide landscape of choice for women who want to plan their families and space their pregnancies. When women have access to contraception appropriate to their needs, desires, and budgets, the potential benefits are many, including reduced maternal mortality and morbidity, improved infant and child health, and a reduced number of abortions. In addition to its health benefits, family planning allows families and communities to invest more in education and health care and helps reduce poverty.Yet there's still a long way to go. Today, 222 million women in the developing world wish to avoid pregnancy but are not using modern contraception. Reasons for this include lack of access, lack of methods that meet their needs, and fear of side effects. If we could meet the needs of these women, each year we would avert another:
- 54 million unintended pregnancies
- 26 million abortions
- More than 79,000 maternal deaths
- 1.1 million infant deaths (Singh and Darroch, 2012)
One group of researchers pursuing the development of new contraceptive methods is the Population Council's International Committee for Contraception Research (ICCR). This network of scientists from around the world was formed in 1970 to design new contraceptive technologies and to conduct clinical trials to test their safety, efficacy, and acceptability. In addition to facilitating research on contraception, the committee strengthens the research capacity of clinical centers in developed and developing countries.
Some of their interesting new research includes:
- Identifying new compounds. Many of the products under development by the Population Council and the ICCR employ Nestorone (NES), a versatile synthetic progestin similar to the natural hormone progesterone. The Council and the ICCR have successfully completed phase 3 trials on a contraceptive vaginal ring containing NES and ethinylestradiol that women can use for one year. The Council is preparing to submit a new drug application to the U.S. Food and Drug Administration for this new product. The Council and the ICCR are also investigating contraceptive implants for men that deliver the hormone MENT. MENT is a powerful synthetic steroid that resembles testosterone but can be used in much lower doses and is safe for the prostate. Preliminary studies in male volunteers show promising results.
- Developing innovative contraceptive strategies. For men, nonhormonal contraception candidates include compounds such as Adjudin, a compound that interferes with the sperm maturation process, and other substances that block the function and synthesis of retinoic acid, which is required for normal production of sperm.
The ICCR and the Council are also studying ulipristal acetate, a selective progesterone receptor modulator (SPRM) that could be delivered as a female contraceptive via a vaginal ring. The principal contraceptive effect of SPRMs is the suppression of ovulation.And research is establishing the extent of the non-contraceptive health benefits of hormonal contraception. Long-acting, low-dose hormonal contraceptive delivery systems are now being recognized as suitable primary therapies for a range of gynecologic and other disorders.
- Combining current technologies. Multipurpose prevention technologies like vaginal rings and gels that contain a contraceptive steroid and an antiretroviral compound could offer women dual protection from pregnancy and HIV.
- Understanding human reproduction and contraceptive action. Concerns regarding the mechanisms of action of emergency contraception (EC) create major barriers to widespread use and could also lead to incorrect use of EC and overestimation of its effectiveness. ICCR researchers have demonstrated that existing EC methods act mainly through inhibition of ovulation or prevention of fertilization.
The latest issue of Contraception covers a lot of this work in a special section. Members of the ICCR -- along with many others in the field -- are creating better contraceptive technologies that improve the lives of women and men around the world. Working together, we will speed the search for new methods that meet the diverse needs of women and their partners.