populations and the costs of that failure are high, for societies, for families, and for individuals.

Throughout its work, the committee sought to frame the issues around contraceptive research and development in a way that might offer a fresh outlook on the subject. Four concepts seemed to merit integration into such a framework: the idea of a "woman-centered agenda," the challenges of unintended pregnancy, consideration of contraceptives from both the perspective of need and market demand, and new possibilities for collaboration between the sectors.

The Idea of a "Woman-centered Agenda"

For many years, women's health groups and advocates, as well as some researchers, have called for more safe and effective contraceptives that would better meet the needs of both women and men. In 1989, Carl Djerassi, a major figure in the development of the first contraceptive pill, suggested a list of priorities for new contraceptives. In order of descending priority, they were: (1) a new spermicide with antiviral properties, (2) a "once-a-month" pill effective as a menses-inducer, (3) a reliable ovulation predictor, (4) easily reversible and reliable sterilization for males, (5) a contraceptive pill for males, and (6) an antifertility vaccine for males or females or both.

Over the half-decade since then, a construct referred to as a "woman-centered agenda" has evolved, its source an expanding dialogue within a number of national and international women's groups, and between some of those groups and scientists working in reproductive and contraceptive research. The agenda reflects a more expansive view of contraception that attempts to integrate concerns for contraceptive efficacy into concerns for the overall reproductive health and general well-being of the primary users of contraceptives, that is, women. The notion of a woman-centered agenda for contraceptive research and development does not imply that there is some "universal woman" or some necessary, unitary view of women's preferences; it is simply that the field should refocus itself toward approaches in areas where the needs of women are still unmet by existing methods.

At the top of that agenda are three types of methods that were included in that 1989 agenda. Slightly restated, these are contraceptives that are also protective against sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV); menses-inducers and monthly methods targeted at different points in the menstrual cycle; and contraceptive methods for males that would both expand their range of contraceptive choice and their sharing of the responsibility for contraception.

There is also a subtext for the agenda that has two themes: One is women's concern for control over their own bodies, including control over the occurrence and timing of pregnancy; the other concern is for equity in terms of physical safety and well-being. The basic message from research around these topics is



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