Developing New Contraceptives Obstacles and Opportunities (1990) / Chapter Skim
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2 The Need for New Contraceptives
2 The Need for New Contraceptives
Pages 11-29
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From page 11... ...
Contraceptives, however, differ from most products in important ways. Government policies have limited the number and variety of contraceptive products available to consumers as well as the rate of 11
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From page 12... ...
The vast majority of less developed countries support national family planning programs to increase contraceptive use in order to reduce population growth or to improve health by enabling women to avoid high-risk and unwanted pregnancies (Lapham and Mauldin, 1987~. The committee believes the lack of an adequate array of contraceptives has adverse consequences for both individuals and for society as a whole.
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From page 13... ...
In addition to the benefit of reducing unwanted pregnancies and their consequences, contraceptives also have noncontraceptive health benefits. But since most people assume that contraceptive users typically are healthy at the time they contracept, these benefits involving prevention not only of unwanted pregnancy, but of health risks associated with pregnancy have not been sufficiently taken into account in the development of public policy.
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From page 14... ...
Before describing the potential advantages of new contraceptive methods, it is useful to review currently available contraceptives. Table 2.1 provides an overview of contraceptive methods available in the United States; the table includes information on prevalence of use and failure rates as well as a brief account of the methods' major advantages and disadvantages.
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From page 15... ...
Population-based studies have had the highest rates up to 23 percent (Ryder, 1973; Schirm et al., 1982~. The diaphragm offers some protection against sexually transmitted diseases and pelvic inflammatory disease and possibly cervical cancer.
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From page 18... ...
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From page 20... ...
Although a variety of contraceptive methods exists, the committee believes that substantial gaps remain in the array of methods available for particular groups. The importance that couples in the United States give to effective contraception and the problems they encounter with existing methods are illustrated by the large proportion of couples who are surgically sterilized.
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From page 21... ...
. In developing countries, contraceptive practice ranges from only 1 percent of currently married couples in some African countries to over 60 percent in such Asian and Latin American countries as Thailand, South Korea, Panama, and Costa Rica (Mauldin and Segal, 1986~.
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From page 22... ...
, there would be over 500,000 accidental pregnancies in the United States each year because of the low effectiveness of the condom in actual use. Using data from the 1987 Ortho survey of married and unmarried women currently protected by venous contraceptive methods and several estimates of methodspecif~c contraceptive failure, we estimate that between 1.2 and 3.0 million accidental pregnancies occurred in 1987 as a result of contraceptive failure (Forrest and Fordyce, 1988~.
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From page 23... ...
Increased contraceptive use and more effective contraceptive practice could help reduce unsafe abortions and the complications and deaths associated with them (Viel, 1985~. One recent analysis of the potential impact of improved contraception in six European countries concluded that a reduction in contraceptive failures would result in a 5- to 10-percent reduction in pregnancies.
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From page 24... ...
If new methods help to reduce births in high-risk categories of maternal age or birth order or among women with short birth intervals, then infant and childhood mortality might decline as the new contraceptives become more popular (Hobcraft, 1987; Trussell and Pebley, 1984; National Research Council, 1989~. Reducing the Problems Associated With Existing Methods Although the risks of currently approved contraceptive methods are on balance lower than those of pregnancy, in a small fraction of users the health consequences of some current contraceptives are serious.
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From page 25... ...
The health hazards of existing contraceptive methods are usually due to a mismatch between the method and the user. Cardiovascular complications of oral contraceptives, for example, are not a significant risk for young nonsmokers.
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From page 26... ...
But it is also true that the limitations of then-existing contraceptive methods were so extensive that many government leaders were discouraged from undertaking family planning programs. Bernard Berelson noted the importance of the introduction of the IUD for family planning programs in the 1960s: "By giving national programs some hope of success .
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From page 27... ...
However, until more information on the long-term follow-up is available, the potential risk of synthetic hormone transfer to the baby is a cause of concern regarding the use of these methods. THE IMPORTANCE OF CONTRACEPI IVE DELIVERY Accounts of the large number of people in need of family planning services warrant the question of whether and to what extent this unmet need could best be served by better delivery of existing contraceptive methods.
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From page 28... ...
Nevertheless, the contribution of new contraceptive methods to an improvement in the coverage and impact of family planning programs is likely to be particularly important in the less developed world. In a large and growing number of countries, access to family planning services is considered a basic human right, similar to good health or literacy.
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From page 29... ...
We must work to improve the technology used by couples to plan their families. New methods are needed to help reduce the level of unwanted pregnancy, the use of abortion, and the health risks of childbearing.
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