Better contraceptives are coming

September 26, 2023 update: This article from November 2022 has great, accurate information about new contraceptives methods for women in development. Updated data on contraceptive research and development funding can be found in the 2023 Policy Cures Research G-Finder report. The most recent data on unmet family planning needs can be found in this 2023 Countdown2030 report.

In my field of contraceptive research, there’s a widely cited statistic that delivers an emotional punch no matter how many times I hear it: About 40% of pregnancies are unintended.

That’s 121 million unplanned pregnancies each year. For some, an unintended pregnancy is a miracle; for others, it can be devastating. But we know that, on a global level, the consequences are profound: Families without enough resources for their children. Women seeking unsafe abortions. Babies at risk of serious health issues because their mothers were unable to safely space their pregnancies. Adolescent mothers who don’t finish school.

In my career, I’ve seen way too many of these things.

We know that modern contraceptives are highly effective at preventing pregnancy. So why aren’t more women using them? And what can we do to help women globally to better achieve their family planning goals?

Family planning and women’s reproductive health are underfunded, understudied, and compartmentalized. And yet, family planning is one of the smartest investments leaders can make to unlock opportunity for millions of women and their families, especially those living in low- and middle-income countries. Investing in this kind of health care benefits everyone. Neglecting maternal, infant, and child health holds women and children back.

I work on the foundation team that supports research and development on contraceptive technology. It’s a long game because developing new products that meet women’s needs takes time. But the investment is worthwhile because these promising technologies bring us closer to a world where every pregnancy can be planned and women and girls everywhere can make decisions about their future.

Why so many women stop using contraception

Many people are satisfied with their contraceptive methods, and more people are using them. That’s great news. In my work, though, the goal is to consider those who aren’t. About 40% of women in low- and middle-income countries who use a contraceptive method stop within the first year of use, and many of them say it’s because they’re dissatisfied with the method. Breakthrough uterine bleeding and spotting causes worry. A busy mother finds it challenging to take an oral contraceptive pill every day. A woman can’t travel far away to a clinic every three months for a new prescription.

It’s clear that current contraception options aren’t working for many women. And yet, contraception technology hasn’t seen innovation in decades. It’s common for women today to be using the same contraceptive methods as their mothers, or even their grandmothers.

While R&D for many global health issues is underfunded, the dearth of funding for contraceptive development stands out. Investment in health technology for effective contraception use in low- and middle-income countries—where the unmet need is greatest—was just US$64 million in 2018. (Investment in R&D for HIV/AIDS in those countries during the same period exceeded US$1.4 billion.) Research shows that 218 million women and adolescents in low- and middle-income countries—nearly one-fourth of the population in that age group—have an unmet need for contraception.

In the pipeline now: New forms of birth control that meet women’s needs

For some women, the issue is affordability or access. That must be addressed. But there are other issues that require different solutions. Our foundation has committed US$280 million per year from 2021 to 2030 to develop new and improved contraceptive technologies, support family planning programs that reflect the preferences of local communities, and enable women and girls to be in control of their own contraceptive care—where, when, and how they want it.

Through numerous surveys, we’ve learned that some women want longer-acting options. They want safe and reliable contraceptives that don’t require a medical visit or procedure to initiate or use. They want options they can control themselves. And many women also want a method that’s discreet because family planning is not always accepted by their communities, or even their partners.

Here are a few exciting contraceptive technologies that researchers are working on right now:

• A once-a-month pill.
  • This update to the hormonal contraceptive pill addresses one of its current shortcomings: that it must be taken every day to be effective. Making a new form of birth control that only needs to be taken once a month is trickier than it might sound, so researchers are working on new ways to ensure that the hormones are released over time.
• The micro-array patch.
  • This new contraceptive method is an entirely new kind. Picture something like a Band-Aid that a woman can stick onto her skin, but with micro-sized projections that go into the skin’s layers. The sticky part is removed, leaving the projections to dissolve and release hormones over several months. This method would be designed to be simple and safe to use at home, as well as discreet, since no patch remains on the skin.
• A six-month injectable.
  • Many women in low- and middle-income countries like injectable contraceptives, and studies have shown that women can successfully inject themselves at home. But many women find it problematic that the injections are effective for only three months and would prefer a longer duration. Researchers are working on injectable contraceptive for women that would last six months, halving the number of injections each year.

I’m excited about all of these new product development ideas, but hurdles remain. For one thing, none of these new methods of contraception for women has reached the clinical trial stage, so we don’t know which products, if any, will reach the market. At best, they are eight to 10 years away. And all of these are hormonal contraceptive technogies, which raises a different set of challenges.

Nonhormonal contraceptives for women could be a game-changer

While hormonal contraceptives have allowed generations of women to plan their families, they aren’t right for everyone. Side effects such as unpredictable uterine bleeding, mood changes, and headaches can be annoying at best and in the worst cases debilitating. Nearly all of the products on the market involve hormones, so women are faced with a terrible choice: Endure the side effects? Or risk unintended and unwanted pregnancy?

Developing other options for those women makes sense, but historically investments in nonhormonal contraceptives have been nearly nonexistent.

Our foundation is funding partners and grantees who are working to change that through a growing consortium that’s working on drug discovery for nonhormonal contraception. This is uncharted territory, and, like any R&D effort, it will take almost two decades before these methods are fully developed and have been proven to be safe and effective contraceptives. The U.S. National Institutes of Health and USAID are also funding research on nonhormonal contraceptive technologies, including some designed for men.

Giving women new contraceptive product options has never been so important

Investing in women’s health is often a low priority or is viewed as a tradeoff. This is especially true during crises such as the COVID-19 pandemic. In fact, major global cutbacks have already led to serious funding shortfalls for family planning work.

But according to the best projections, investing in sexual and reproductive health in low- and middle-income countries in places like Africa and East Asia, including family planning, would avert 76 million unintended pregnancies, 21 million unplanned births, 26 million unsafe abortions, and 186,000 maternal deaths. The Guttmacher Institute calculated that every additional dollar invested in contraceptive services would save $3 in health care costs for pregnant women and newborns.

When women and girls have access to contraceptives and quality family planning services, we unlock a cycle of empowerment and prosperity that benefits everyone.

There’s no time to waste.