diminished; and what does that suggest, if anything, in the way of recommendations for action?

The first section of this chapter examines changes in the regulatory climate since 1990; the second section examines changes in the legal climate since that year, in each instance from the perspective of how those affect—or might affect—contraceptive research and development. The chapter then turns to an area where law, culture, politics, scientific research, medicine, and the thoughts and needs of contraceptive users intersect: the area of information. The chapter closes with a scan of those aspects of the environment that are most critical in generating the controversy that so often attends the development and use of modern contraceptive technologies.

The emphasis in this chapter is primarily on the United States. Even though we know that regulatory structures and legal frameworks differ significantly in many other countries in ways that could be illuminating, resources limited what the committee could deal with adequately. It may also be, at least at present, that breakthroughs in contraceptive research and development are not likely to occur without full-fledged U.S. participation. Finally, regulatory, legal, and political and legal decisions that are made in the United States continue to produce repercussions for other countries, particularly developing countries; examples include the controversy around Depo-Provera¹ and the persistent controversy in the United States around the abortion issue.

This is not to say that no other nation is present on the international contraceptive research and development stage. As perhaps the most prominent examples, Organon of The Netherlands and Schering AG of Germany are leading industrial players; until recently, French scientists at INSERM (Institute National de la Santé et de Recherche Médicale) were actively involved in the development of antiprogestins; India and China both have major research endeavors, and China is also a major producer of contraceptives; and The Wellcome Trust of the United Kingdom has recently committed £50 million to priorities in population and contraceptive research and development.

There are also informative similarities between the United States and other countries. Many European countries and the United Kingdom have experienced some of the same controversy around contraceptives for postcoital use that has been experienced in the United States in connection with RU 486 (Hughes 1995). Still, no nation is as litigious as the United States, although this may be changing (Steyer 1995), and few have a health system as driven by the market (Hutton et al. 1994). Each of these characteristics affect contraceptive research and development and the availability of contraceptive services.