The best chance for better contraceptives comes from the developing world

Waiting for better choices.
Waiting for better choices.
Image: Reuters/Erik De Castro
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There can be no gender equality without reproductive rights, and there can be no reproductive rights without access to contraception.

When oral contraceptives—which quickly became known simply as “the pill”—were introduced in 1960, they caused a revolution. They allowed women to avoid unwanted pregnancies and marriages, giving them the opportunity to pursue careers outside the home, and get on their way to financial emancipation.

More than 60 years later, family planning remains the most important area of investment for global gender equality, and one that has suffered significant setbacks during the pandemic. In the past year, due to a combination of reduced funding and logistical restrictions, over 12 million women in poor countries (primarily in West and Central Africa) lost access to contraception, which resulted in 1.4 million unwanted pregnancies, says Anita Zaidi the president of the Gates Foundation’s gender equality division.

To help make up for these losses, the Gates Foundation is going to invest $2.1 billion in initiatives for gender equality over the next five years. Of the funds, $1.4 billion is dedicated to advancing reproductive health, including $480 million for the research and development of new contraceptive technologies.

Good contraceptive products are the enemy of perfect ones

Women around the world don’t just need better access to existing contraceptives—they need better contraceptives.

Hormonal contraceptives—from the monthly pill to subcutaneous injections that last from three months to five years—are the most common and accessible, but their side effects can be so severe that many women tend to stop using them, says Rebecca Callahan, who works on product development at FHI 360, a research nonprofit working on reproductive health technologies. 

Research focusing on alternatives doesn’t have much funding, however. Only about $64 million a year are invested globally toward the development of alternative methods of contraception, including non-hormonal methods that could greatly reduce the side effects, or male contraceptives. The Gates Foundation donation will more than double the current budget.

Globally, the vast majority of the funds for contraceptive research come from development organizations and agencies; the Gates Foundation, prior to the latest commitment, was the biggest donor with $24 million a year, followed by the US government health and aid agencies. Meanwhile, big pharma hardly does any research in contraception, because available products, while imperfect, work well—too well, in fact.

“There are a lot of good products out there, and if used perfectly—the key is “perfectly”—they are very effective, and [big pharma] would weigh that against the cost of research and development,” says, Gregory Kopf, the director of research and development for contraceptive technology innovation at FHI360. 

Developing new contraceptives is a costly endeavor. First, the new technologies need to be more effective than current ones, and just as safe: Contraceptives are given to healthy young people, so the tolerance for risks is even lower than it would be for other drugs. Further, long-term contraceptive solutions require long studies, and eventually need to be sold at low prices in order to compete with existing products on the market.

“The bar is just very high,” says Kopf, who used to work for Wyeth, the drug company that introduced the contraceptive pill, before it shut down its contraceptive research operation ahead of its acquisition by Pfizer in 2000. Big pharma, however, would likely license any new competitive products developed through research funded publicly and through foundations to manufacture and distribute it, which is what has happened in the past with the pill, and many other drugs.

Better contraceptives for all

If big pharma doesn’t have much interest in new contraceptives, women in the rich countries they serve sure do.

For them, just like for women in poor countries, the hope that better contraceptives might eventually be available is tied to investments in solutions for poor countries. The investment made in contraceptive development right now primarily comes from organizations whose missions are to provide inexpensive innovative products to lower- and middle-income countries. But any solution that they develop will by necessity need to become available in rich country markets, too. To produce contraceptives at a low cost for poor countries, manufacturers will need to sell them at higher prices elsewhere. Whatever is developed through development grants needs to be a viable, competitive product all over the world.