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Momentum Population Council Newsletters
2008
New contraceptive developments
Population Council
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Recommended Citation "New contraceptive developments," Momentum newsletter. New York: Population Council, 2008.
This Newsletter is brought to you for free and open access by the Population Council. NEWS FROM THE POPULATION COUNCIL Momentum DECEMBER 2008
New contraceptive developments
A health worker counsels a Kenyan woman on contraceptive options after the birth of her first child. IN THIS ISSUE: ONE RING FOR ONE YEAR OF CONTRACEPTION A COMPREHENSIVE APPROACH TO CONTRACEPTION CONTRACEPTIVE CHOICES FOR DIVERSE POPULATIONS CREATING MORE CONTRACEPTIVE OPTIONS FOR MEN SEEKING A WINNING COMBINATION PROFILE: A CONVERSATION WITH DR. RENSHAN GE PROFILE: DONOR KATY STOKES PRESIDENT’S MESSAGE
NOT ONLY CAN UNINTENDED pregnancy and birth be lethal to mother and child, they often trap women in a cycle of poverty in which they are unable to educate or support themselves and to provide for a baby. Modern contraceptives are available in most countries, but with only a few options the rate of unplanned pregnancy remains stubbornly high. This unmet need for contraception puts women’s lives at risk and keeps women and children in a state of poverty. At the Council, clinical research is driven by the principle that no one method of contraception will fit everyone’s needs. An IUD might be ideal for a mother of three living in Mexico City, while a young woman in rural Kenya, without reliable access to a medical facility, may require a different method. We draw on biomedical and social science research to create new contraceptives that meet different CONSIDER THESE FIGURES: women’s needs while maintaining the high standards for safety and effectiveness for which Council products are known. Once we’ve Number of women in developing Percentage of American women who developed a safe and reliable product, we work hard to see that it’s countries using no method or only switched contraceptive methods in less traditional methods of contraception: than a year, suggesting dissatisfaction: 246 made available in developing countries at an affordable price. 201 million1 This issue of Momentum highlights our most recent solutions to Percentage of women surveyed in meeting the unmet need for contraception. Our pioneering work on Estimated annual cost of providing South Africa who thought a male con- male contraception (see page 8) challenges the idea that women are contraceptive services to those traceptive pill was a good idea: 907 solely responsible for controlling fertility. Our new vaginal ring (see women: $3.9 billion2 page 2) will, we hope, make ring technology a viable option for Percentage of contraceptive research women in developing countries. The improvements we are making to Percentage of married women aged 15 budgets allocated to male methods: 88 contraceptive distribution in resource-poor areas (see page 4) help to to 49 in sub-Saharan Africa not using ensure that the right products reach the people who need them. any contraceptive method: 773 Number of women globally who have Contraceptives save lives and give people a chance to provide for used long-term, reversible contracep- themselves, their families, and their futures. Your contributions make Estimated annual number of women tives developed by the Population this empowerment possible. Please support us in developing contra- worldwide who have an abortion: Council: more than 100 million9 46 million4 ceptive solutions for the people who need them most. Number of American women who have Number of unintended pregnancies received free Mirena IUSs as a result Sincerely, globally between Jan. 1995 and Dec. of the Population Council’s agreement 2000: 338 million5 with the manufacturer: over 50,00010 Peter J. Donaldson Sources found on page 13.
COVER PHOTO: © 1994 JOHN RIBER, COURTESY OF PHOTOSHARE THIS PAGE: POPULATION COUNCIL 1 One ring for one year of contraception
NEW LOW-COST, EASY-TO-USE CONTRACEPTIVE METHODS are critical to meeting the family planning needs of the world’s most vulnerable women. Current methods require regular access to either a pharmacy or health care provider. The Council has developed a new contraceptive vaginal ring that may be especially attractive to women who have limited access to health facilities.
COUNCIL RESEARCHERS TERESA SALLENT AND BRUCE VARIANO; PHOTO: KAREN TWEEDY-HOLMES/POPULATION COUNCIL
THE PROBLEM Women living regular access to a pharmacy or ing distribution costs. As an added ring will end in mid-2009. Prelimi- in rural or resource-poor areas medical provider. benefit, many women may find the nary results indicate that the ring often cannot obtain modern meth- ring especially easy to use since, is as safe as other contraceptives on ods of birth control. Many rural THE PROGRESS The Council unlike oral contraceptives, no daily the market, effective, easy to use, communities lack well-stocked has developed a new contraceptive routine is required. Women leave and that most participants prefer pharmacies where women can vaginal ring that is particularly the ring in for three weeks, take it the ring to their current method of dependably get pills or patches. suited to women in resource-poor out for one week of menstruation, birth control. Longer-term methods such as an settings and could also be ideal for and then reinsert the ring for three IUD or implant can be too difficult many women in more developed weeks. Unlike the one-month vagi- THE SOLUTION Women in to obtain, since these options areas. A woman can insert and nal ring currently on the market in resource-poor settings are especial- require a trained medical worker remove the ring without assistance the US, the Council ring does not ly vulnerable to the consequences to provide or remove the device. from a health care provider, and the need to be refrigerated before use, of unwanted pregnancy. The Coun- These women need a new meth- same ring can be used for a full making the ring particularly suited cil’s contraceptive vaginal ring will od of contraception that they con- year, eliminating the need for regu- for distribution in the developing be an important new option for trol and that does not depend on lar access to a pharmacy and reduc- world. Clinical trials of the new these women. 2 3 A comprehensive approach to contrac eption
COMMUNITY HEALTH CARE WORKERS OFTEN DISTRIBUTE contraceptives to women in rural areas. To be most effective, however, the workers must be trained to provide accurate information and follow-up. The Council developed a successful training program demonstrating that community health workers can, in many settings, deliver quality services better than clinics and at a lower cost.
PHOTO: POPULATION COUNCIL
THE PROBLEM Access to THE PROGRESS The Council, reproductive health specialists. reach workers or starting a new quality medical care, or medicine together with governments and After completing the Council’s program at a clinic. In addition, of any kind, is especially difficult in partner organizations, developed a training program, community the Council has proven that com- remote rural areas of the develop- community health worker training health workers provided excellent munity-based contraceptive distri- ing world, where reaching the program to address the need for quality of care, including informing bution increases the acceptability nearest health center or pharmacy accurate information and confiden- clients about available contracep- of family planning, especially in may mean walking for many hours. tial access to contraceptive services. tive choices, providing current and traditional societies. Community health workers may In Senegal, Council research illus- accurate information on benefits represent a low-cost alternative trated how trained community and drawbacks, and offering clients THE SOLUTION Training for delivering basic health services, health workers could increase a chance to change methods if nec- community health care workers including contraceptives. In order access to family planning services essary. Moreover, contraceptive to provide family planning services to be most effective, however, more effectively than investing in distribution using community can expand contraceptive access these workers need appropriate clinic-based family planning pro- health workers is less expensive to populations living in remote training. grams or training a new cadre of than hiring and training new out- rural areas at relatively low cost.
4 5 Contraceptive choices for diverse populations
THE PROBLEM A woman THE PROBLEM A woman THE PROBLEM A new THE PROBLEM A young in India just had twins and does in Ghana has been anemic mother in rural Chile knows couple in Egypt want to wait not want more children for sev- most of her life, causing her to she can’t continue taking her a year or two before having eral years. She is used to taking suffer particularly during men- usual birth control pills while their first child. Neither part- birth control pills but often struation. Her doctor has rec- she is breastfeeding. She has ner feels comfortable with the has to visit several pharmacies ommended a hysterectomy to heard that breastfeeding it- idea of taking pills or having a each month to find one with prevent the loss of blood dur- self offers some contraceptive device implanted or inserted. her brand in stock. With two ing menstruation, but this protection, but she wants a But buying, using, and dispos- infants and a full-time job, she solution is unacceptable to her more reliable method in ing of condoms is more cum- finds it difficult to get her pills. because she still wants to have which she can have full bersome than they would like. children one day. confidence. THE SOLUTION Women THE SOLUTION When who want to delay pregnancy THE SOLUTION Mirena®, THE SOLUTION The applied to the skin, Nestorone®, for several years can use an IUD a Council-developed intrauter- Council’s progesterone vagi- a Council-developed synthetic or subdermal implant to provide ine system (IUS), provides up nal ring provides contracep- progestin, may provide safe, five to ten years of completely to five years of contraception tion during breastfeeding. reversible suppression of ovu- reversible contraception, with- with a low dose of hormone Vaginal rings require no day- lation. The Council is working out the need to take a daily and has the added benefit of to-day maintenance and, with a small pharmaceutical pill. The Council has developed greatly reducing menstrual unlike some other hormones, company to test whether a three IUDs and two generations bleeding, sometimes by up to progesterone is safe to use daily application of a Nestorone- of implants, Norplant® and 90 percent. while lactating. based gel can prevent ovula- Jadelle®, to give women more tion and pregnancy. options for long-term, low- maintenance contraception. PHOTOS (L to R): © JACK FIELDS/CORBIS; POPULATION COUNCIL; © JEREMY HORNER/CORBIS; POPULATION COUNCIL
6 7 Creating more contraceptive options for men
PROVIDING MEN WITH CONTRACEPTIVE CHOICES IS AN important but neglected approach to reducing unwanted pregnancy. Although men in both developed and developing countries have indicated they would like more choices for contraception, the Council is one of very few organizations committed to male contraceptive development.
PHOTO: POPULATION COUNCIL
THE PROBLEM Surveys indi- hormonal compound derived from trials that test dosages and combi- Additional basic research focus- cate a demand for more contracep- an anti-cancer drug. Adjudin has a nations of MENT with other hor- es on how sperm develop the ability tive choices for men, yet very few demonstrated, reversible ability to mones. Because it is ten times to fertilize eggs, what critical factors companies or organizations are stop sperm maturation in animals. more potent than testosterone, affect sperm production and mobili- researching new methods. The Safety studies are needed before MENT can be administered in ty, and the genetic mechanisms of only two choices for men today large-scale studies in humans begin. small doses, making it a candidate action of male sex hormones. are a vasectomy, which is expen- for use in a long-acting implant sive and permanent, and condoms, The Council is also conducting that might be inserted under the THE SOLUTION Men can which are not widely used promising research with a synthetic skin of the upper arm. (The Council help reduce unwanted pregnancy if consistently. male hormone called MENT®, has already developed similar they are provided with easy-to-use, which suppresses testosterone implants for women.) One trial reversible contraception. With addi- THE PROGRESS Council and sperm production while simul- using MENT implants showed a tional investment in research, MENT researchers are investigating several taneously maintaining male sex significantly reduced sperm count and Adjudin could become the new promising male contraceptive characteristics such as sex drive in male volunteers. Sperm counts long- and short-term choices for options. One substance that shows and muscle mass. Council re- returned to normal after the men who want to share the respon- great potential is Adjudin, a non- searchers are conducting clinical implants were removed. sibility for family planning. 8 9 PROFILE IN CONTRACEPTIVE RESEARCH Seeking a winning A conversation with combination Dr. Renshan Ge
The Council is developing a single product to prevent two of the biggest global health problems: unintended PHOTO: KAREN TWEEDY-HOLMES / POPULATION COUNCIL pregnancy and HIV. TELL US ABOUT A PROBLEM side effects, like hypertension. I came YOU ARE STUDYING. to the Population Council from China One promising project is our research 13 years ago to study these side effects on stem Leydig cells. These are excit- and find ways to prevent them. ing cells, as they are the precursors to fully formed Leydig cells, which pro- DID YOU ALWAYS WANT TO BE A PHOTO: POPULATION COUNCIL duce testosterone. Population Council SCIENTIST? scientists were the first to discover I guess I knew I was good at science THE PROBLEM Unintended oping both contraceptives and these stem cells, and we are working when I was 16 and I won first place pregnancy is not the only health microbicides, which are products hard to understand exactly how they in a national competition for math risk for sexually active people today. intended to prevent the transmission become fully functioning Leydig cells. and science back in China. HIV and other sexually transmitted of HIV. Combining a microbicide Knowing exactly how a stem cell infections threaten the lives of mil- with a contraceptive in one product changes into a Leydig cell would ARE YOU ABLE TO VISIT CHINA lions of people around the world. such as a gel, implant, or vaginal open new possibilities in controlling VERY OFTEN? Condoms are currently the only ring would provide reliable treat- male fertility and also provide better I visit China every year to see my option women have to protect ment for two of today’s biggest sex- treatment for men and boys with parents and to help train new scien- themselves from both HIV and ual health concerns. inadequate hormone levels and oth- tists in the field. When appropriate, I unwanted pregnancy. However, con- ers with decreased fertility. I am try to bring these new minds here to dom use is notoriously inconsistent THE SOLUTION For women proud to be a part of this research. work at the Council’s Center for and, in some societies, the decision who wish to prevent pregnancy and Biomedical Research. They add their about whether to use a condom is protect against HIV transmission, a WHY ARE YOU INTERESTED IN own perspective to the research and out of the woman’s control. product that offers both benefits MALE CONTRACEPTION? often return to enrich the field in could provide a cost-effective solu- I don’t think it’s fair for women to be China. We look to many other coun- THE PROGRESS The Council is tion that helps achieve both goals. the only ones worrying about contra- tries to enhance our staff. That’s one investigating a single product that For people with limited contact with ception. The burden of contraception of my favorite things about working would prevent both pregnancy and health care professionals and little needs to be shared. That’s why I start- here—the philosophy of collabora- HIV transmission. We are uniquely money, dual-use products might ed working on gossypol in 1988. Gos- tion. We work with many other labs positioned to conduct this research make the difference between illness sypol was the first chemical used for and universities to share knowledge because of our leadership in devel- and health. male contraception, but it had serious and to further the field.
10 11 DONOR PROFILE
KATY STOKES: WHY I GIVE TO THE COUNCIL
After I finished law school, I tioned but THE POPULATION COUNCIL spent six months in Kenya doing came to the CONDUCTS VITAL RESEARCH research on battered women. I country with AND DEVELOPMENT IN THE was astounded by how many preconceived FIELD OF CONTRACEPTION women had lost at least one of ideas about their children and were still over- what should burdened with more children than work instead KARENPHOTO: / POPULATION TWEEDY-HOLMES COUNCIL they could support. How could it of listening to people on the ground. be that these conditions exist in This is a big difference about the 21st century? the Population Council. The PHOTO: POPULATION COUNCIL Although I live in America, Council listens to people and pro- THE COUNCIL IS A LEADER IN THE FIELD OF NEW CONTRACEPTIVE as a woman, a mother, and some- vides scientifically tested answers technologies. This issue of Momentum highlights just a few of our achieve- one with my own aspirations and tailored to local situations. ments and new developments. With your support, we can do even more. Few dreams, I identify with the women Council researchers under- organizations, public or private, are willing to invest in new contraceptive in Kenya. stand that the challenges facing development. We are one of the few, and that is why your donation is critical- women in poverty are ly important to enable us to continue to develop more contraceptive options complex. Best of all, gov- for both men and women. My trip to Kenya opened my eyes ernments and other large to the overwhelming heartbreak of We hope you will join us in our effort to provide women and men with organizations implement the choices they need to plan their families. Your donation will help us work mothers and children who die programs developed and toward a day when no woman will feel powerless to protect herself from a because women have no say in how tested by the Council, pregnancy she does not want or cannot support. Few decisions are more per- many children they want. The multiplying the impact of sonal or important than choosing when and how many children to have. With Population Council is known for my donation. To me, that your help, we are working toward the day when every man and woman can research that finds solutions to these is a smart investment for choose a birth control method that gives them control over that decision. tragic and complex problems. high-quality research that empowers women www.popcouncil.org/supporting everywhere. www.popcouncil.org/publications/momentum I quickly found many exam- I give because I want to send a ples of why we cannot just throw message to those women in Kenya SOURCES FROM INSIDE FRONT COVER: 1,2 Singh, S., J.E. Darroch, M. Vlassoff, and J. Nadeau. 2003. Adding It Up: The Benefits of Investing in Sexual and Reproductive Health Care. New York: Alan Guttmacher Institute (AGI) and money at the problem: boxes of that they are not alone, that some- United Nations Population Fund (UNFPA). Pp. 18–19. 3 Population Reference Bureau (PRB). 2008. Family donations that were never opened Planning Worldwide: 2008 Data Sheet. Washington, DC: PRB. P. 4. 4 The Alan Guttmacher Institute (AGI). 1999. one else cares. I give to the Popu- Sharing Responsibility: Women, Society and Abortion Worldwide. New York: AGI. P. 25. 5 Daulaire, N., P. Leidl, L. and shells of buildings that were lation Council because its research Mackin, et al. 2002. “Promises to Keep: The Toll of Unintended Pregnancies on Women’s Lives in the Developing World.” Washington, DC: Global Health Council. P. 11. 6 Frost, J.J., S. Singh, and L.B. Finer. 2007. “U.S. women’s never used or maintained. I saw leads to huge impact with every one-year contraceptive use patterns, 2004.” Perspectives on Sexual and Reproductive Health 39(1): 51. 7 Glasier, A.F., charities that were well inten- dollar. R. Anakwe, D. Everington, et al. 2000. “Would women trust their partners to use a male pill?” Human Reproduction 15(3): 646–649. 8 Greene, M.E. and A.E. Biddlecom. 2000. “Absent and problematic men: Demographic accounts of male reproductive roles.” Population and Development Review 26(1): 94. 9 Population Council. 2008. “Building on decades of success: Pioneering contraceptive research and products.” Fact sheet.