Contraceptive Research and Development Looking to the Future (1996) / Chapter Skim
Currently Skimming:
2 The Need and Demand for New Contraceptive Methods
2 The Need and Demand for New Contraceptive Methods
Pages 29-46
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From page 29... ...
The "contraceptive revolution" which began in the 1950s changed that picture with the invention of oral contraceptives and the reintroduction2 of intrauterine devices, innovations which, for the first time, separated reversible contraception from the act of coitus (Rockefeller Foundation 1993)
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From page 30... ...
. Use of the technologies emerging from the first contraceptive revolution accounted for the great preponderance of that increase: Despite significant regional differences, as of 1995 most of the world's women who use any contraception are selecting modern contraceptive methods (Guttmacher Institute 1995a)
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From page 31... ...
Fourth, there remain large subpopulations whose contraceptive requirements remain insufficiently addressed, significantly those of males in general, to whom the first contraceptive revolution brought no new reversible contraceptive options, as well as the requirements of special times and circumstances across the female life span, notably adolescence, lactation, and the perimenopausal period.3 Fifth, there is the virtually undisputed reality that no existing contraceptive method can meet the requirements, intentions, and preferences of all individuals in all circumstances over entire reproductive lifetimes. Nor can any method be totally without side effects, risks, or trade-offs in terms of safety, efficacy, convenience, usability, and appropriateness (Fathalla 1994)
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From page 32... ...
. The principal reason for this dynamic is that family planning approaches that are "woman centered," dedicated to quality of care, provision of a full range of contraceptive options and the informational basis for making informed choices among them, and generally satisfying clients are simply more effective in terms of adoption and continuation (Bongaarts and Bruce 1995; Bonnie et al.
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From page 33... ...
CONTRACEPTION AND SEXUALLY TRANSMITTED DISEASE A question raised before this committee was the appropriateness of including the sexually transmitted diseases (STDs) 5 in a study of the current scientific prospects for contraceptive technology.
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From page 34... ...
Unfortunately, those contraceptives that best prevent pregnancy provide minimal protection against STDs. In all instances, there are many unanswered questions which jointly affect the fields of sexually transmitted disease and family planning and involve questions of safety, contraceptive use, and the nature of the need for new contraceptive methods (Antrobus et al.
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From page 35... ...
were significant developments, but they were not significant breakthroughs from the perspective of fundamental science. Because development of new contraceptive technologies typically takes 10 to 20 years, contraceptive products that are now emerging from the pipeline tend to fit the earlier demographically driven paradigm and respond only in a limited way to newer thinking (Brown 1995)
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From page 36... ...
. In general, the analysis concluded, the pharmaceutical industry does not seem to perceive either sufficiently enticing new product ideas or an adequately large, interested, and financially rewarding market that would justify the sizable investments required for development of fundamentally new contraceptive methods.
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From page 37... ...
International and Domestic Perspectives This report is admittedly uneven in incorporating both the international and domestic dimensions of contraceptive research and development. We have done so in Chapter 2 in the contexts of unintended pregnancy, abortion, maternal mortality, the public health dimensions of sexually transmitted diseases, and male involvement in contraception.
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From page 38... ...
They reviewed published data and analyses and canvassed the field of science; talked informally, during committee meetings and at other times, with experts on the various topics under study; held five meetings of the full committee over a 13-month period (August 1994 through July 1995) ; surveyed 170 biotechnology companies to ascertain their involvement and interest in contraceptive research and development; conducted smaller, informal surveys of scientists to refine priorities for potential research leads; canvassed a small sample of pharmaceutical companies concerning their experience with litigation concerning contraceptive methods; and developed a mini-case study as the basis for a follow-on workshop at the end of the study.
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From page 39... ...
The third had to do with initiation of special studies of drug regulatory requirements for vaginal microbicides/spermicides, public-sector pricing structure, and comparative analysis of product liability experiences and solutions. The final recommendation was a proposal for initiating a program of collaborative effort between the public sector and private industry in the early stages of development, when product viability is still in doubt and investment is still seen as high risk, with the rationale that risk-sharing in those stages might tip the balance in industry investment.
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From page 40... ...
However, not all persons can find a family planning method that suits them and the range of choices available to men is more limited than that available to women. The growing incidence of sexually transmitted diseases, including HIV/AIDS, demands substantially higher in vestments in new methods of prevention, diagnosis and treatment.
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From page 41... ...
Testing and introduction of all new technologies should be continually monitored to avoid potential abuse. Specifically, areas that need increased attention should include barrier methods, both male and female, for fertility control and the prevention of sexually transmitted diseases, including HIV/AIDS, as well as microbicides and virucides, which may or may not prevent pregnancy.
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From page 42... ...
Sexually transmitted diseases: Current and future dimensions of the prob lem in the Third World. IN Reproductive Tract Infections: Global Impact and Priorities for Women's Reproductive Health.
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From page 43... ...
Reproductive Health and Dignity: Choices by Third World Women. Technical back ground paper prepared for the International Conference on Better Health for Women and Chil dren Through Family Planning, Nairobi, Kenya, October 1987.
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From page 44... ...
Challenges in Reproductive Health Research: Biennial Report 1992–1993. Geneva: World Health Organization, Special Programme of Research, De velopment and Research Training in Human Reproduction.
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From page 45... ...
have been broadly defined to include sexually transmitted infections and infections that are nonsexually transmitted, and comprise three types of infection: (1) sexually transmitted diseases (STDs)
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From page 46... ...
8. Public sector participants came from WHO's Special Programme in Human Reproduction and Training, the Population Council's Center for Biomedical Research, the U.S.
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