The introduction of the contraceptive Depo-Provera in Uniject is suitable for delivery by community health workers and even for self-injection. Photo Credit:PATH/Patrick McKern

It is well-documented that contraception has multiple individual, national and global health and development benefits, including reductions in maternal and child mortality and maternal to child transmission of HIV, and increased opportunities for women in the workforce and global economy.  World Contraception Day, commemorated every year on September 26, highlights the growing need for improved access and awareness of modern contraception.

Seven out of 10 women in Sub-Saharan Africa, South Central Asia and Southeast Asia who want to avoid pregnancy but are not using modern contraceptives report the  major reasons they don’t use contraception include: concerns about health risks and side effects (23%), infrequent sex (21%), being  postpartum or breastfeeding (17%), and opposition of their partner (10%).  In other words, the currently available methods do not, necessarily, meet their needs.  It is imperative that we continue to work to develop innovative technologies, both adaptive technologies that improve current methods and totally new methods to ensure women and men use and have access to a wide range of modern contraceptive methods.

With USAID funds and technical input, the Population Council developed a new contraceptive vaginal ring that is effective for one year and should be approved by the FDA in 2013. This novel ring is the first-ever long-acting method of contraception that is completely under the control of women to start, continue and discontinue using without requiring a trained health provider.  Also with support from USAID, the biomedical research organization, CONRAD, is developing a vaginal ring that could provide protection against both unplanned pregnancy and HIV infection, through the combination of a progestin hormone and the anti-retroviral drug, tenofovir.

Injectable contraceptives have rapidly become the most popular contraceptive method in many developing countries, including in sub-Saharan Africa.  The inclusion of the most popular injectable, Depo-Provera, delivered in its sub-cutaneous formulation in the single use, pre-filled  Uniject® device is a potentially game-changing product being developed by Pfizer in collaboration with Bectin-Dickenson, USAID, and PATH.  The all in one, single dose packaging and sub-cutaneous formulation that uses a very short needle make it suitable for delivery by community health workers and even for in-home or self-injection.  Although roll-out of this innovative contraceptive should occur in 2013, we are concerned that unless an acceptable price can be agreed upon there may be very limited use of this product.

Improved and totally new contraceptive methods alone will not overcome all reasons for nonuse – poor access and availability, provider biases, the general quality of contraceptive counseling and services, and the need for health system strengthening must also be addressed.  Engaging men to actually use contraceptives and/or support use by their wives/partners would both enhance gender equality and increase the likelihood of correct and consistent use of current and new products.