Expanding the Contraceptive Armamentarium

This post originally appeared on the Gates’ Foundation’s blog, Impatient Optimists, here. Reposted with permission.

By Laneta Dorflinger, Kate Rademacher, Markus Steiner, FHI 360

Armamentarium. It’s a big word. It’s what we in the U.S. like to call a fifty-cent word. An armamentarium refers to the full range of resources that are available to tackle a problem, often in the arena of health care.

Today, we have an unequivocal need to expand the contraceptive armamentarium for women around the world.

In some cases, this means expanding access to existing, underutilized family planning methods. In too many settings, women do not have adequate access to a full range of options, including long-acting and permanent contraceptive methods. Barriers to access include frequent stock-outs of commodities; a lack of adequate health care facilities or trained staff to administer contraceptives, especially in rural areas; prohibitively expensive client fees; a lack of comprehensive, accurate information for clients; a provider bias against the provision of long-acting methods to some women; and opposition from family members or community institutions.

This week, over 3,000 program implementers, health care providers, researchers, faith-based leaders, donors and policymakers gather in Addis Ababa, Ethiopia for the third International Conference on Family Planning. The theme of the week-long event is “Full Access, Full Choice.” The organizers explain that this is more than just a conference; it is part of a movement to garner commitments globally to implement evidence-based solutions targeting the persistent barriers to access that women and men face every day.

In addition to identifying effective service delivery and policy approaches to increase access to existing methods, we must also take advantage of this moment in Addis to make a long-term commitment to expand the contraceptive armamentarium to include new, innovative methods. The basket of family planning methods available has remained largely unchanged for several decades. There are gaps in the method mix that, if filled, could result not only in increased uptake of contraceptives by women, but also in improved continuation rates by better meeting individuals’ needs and desires.

With funding from the Bill & Melinda Gates Foundation, FHI 360 has recently launched a new Contraceptive Technology Innovation Initiative to develop new, highly effective, long-acting contraceptives for those most in need in low-resource settings. This initiative will build on work that is already under way to develop a longer-acting injectable contraceptive, which would have the advantage of requiring less frequent reinjections, thus reducing the burden on women, providers and health systems. The project will also build on research funded by the U.S. Agency for International Development to develop a biodegradable implant that would not require removal services — a significant barrier in some low-resource settings.

As work continues to make new and existing methods more accessible, affordability is a critical issue. Through an initiative also funded by the Gates Foundation, FHI 360 has worked with a consortium of partners to support the global introduction of http://www.fhi360.org/projects/sino-implant-ii, a low-cost, highly effective, two-rod contraceptive implant. Sino-implant (II) has contributed to increasing access to more affordable implants by being the first to market with a lower cost product (it is available for approximately US$8 per unit). Over 1 million units of Sino-implant (II) have been distributed in countries supported under the Gates-funded project since 2009, which translates into US$10.5 million in commodity cost-savings (assuming the alternative would have been to buy more expensive implants during this time period).

We must apply lessons learned from family planning and other fields to continue to increase the number of affordable alternatives to high-cost products. For example, the hormone-releasing intrauterine system (known as the Mirena®) is enormously popular in the U.S. and Europe but is available only on a limited basis in developing countries, largely due to its high price. This inequity must be addressed, and work is under way to develop a lower-cost version of the Mirena®. Women around the world deserve to have this highly effective, long-acting method available as part of their armamentarium.

People sometimes say that you shouldn’t use a fifty-cent word when a five-cent word will do the job. We disagree. When it comes to women’s reproductive health, using the biggest, most powerful words is appropriate to convey the magnitude of the unmet need and the critical importance of filling those gaps. At the same time, it’s true that big words and big talk won’t solve problems. But big ideas and big commitments will. Since the landmark London Summit on Family Planning that took place last year, 69 countries have committed to the collective goal of reaching an additional 120 million individuals with family planning services by 2020. This week’s conference in Addis provides an opportunity to reflect on initial successes, identify innovative approaches for moving forward, and reaffirm that commitment so that all women and men around the world can have access to the full range of contraceptive choices they need and deserve.