How increasing male contraceptive options can change the world, and reminds us of Kevin Bacon.
Are you looking to truly make a global impact on health, the environment, gender equity, education, or any other number of issues we currently face as a global community? If so, improving contraception generally and increasing male contraceptive options specifically is an effective way to achieve that goal.
After spending more than a decade working in the field of contraception and reproductive health, I can say, without exaggeration, that I think contraception can play a role in addressing just about any issue. I often joke about this in a “6-degrees of contraception” manner, betting that I can relate contraception to any global issue in less than six steps à la the Kevin Bacon game (really, I can probably do it in three but I like to give myself some wiggle room). The thing is, I really, REALLY believe this to be true.
It is for this reason, that I find myself perplexed that in a modern philanthropic age with philosophies focused on strategic giving, impact investing, and effective altruism, that there isn’t a greater focus on supporting contraceptive research and development. Maybe it is because some believe that there are already enough contraceptive methods available, which would be easy to imagine at first blush; however, even the slightest bit of digging will make it clear that many of the existing methods for women are fraught with side-effects that often make using them difficult. Then there are the male methods of contraception – you know, both of them – so, there’s certainly room for improvement there.
So why has it been so difficult to generate the much needed support for contraception generally and male contraception specifically? How can we clearly articulate the need and immediate impact that improving contraceptive options can have, and the tremendous opportunity for impact that improved contraceptive uptake and adherence can have on many other global issues?
The Sustainable Development Goals (SDGs)
The first step in understanding problems of great magnitude is to develop a common nomenclature and strategy for addressing the challenges at hand. This is exactly what the Millennium Development Goals (MDGs) set out to do. Established as part of the United Nations Millennium Declaration signed in 2000, the MDGs consisted of eight target areas that formed “…a blueprint agreed to by all the world’s countries and all the world’s leading development institutions” to address the most critical needs of the world’s poorest populations by 2015. While we made progress towards the MDGs, some areas fared better than others and there is still work to be done. So, with an eye toward 2030, the Sustainable Development Goals (SDGs) were introduced; a refinement and expansion of the MDGs that includes nine additional goals with a greater focus on environmental strategies as “…a shared blueprint for peace and prosperity for people and the planet, now and into the future”.
Figure 2: The Sustainable Development Goals
Source: UN Sustainable Development Goals
Can investment in contraceptive R&D impact this even wider swath of global goals? Absolutely. Are we even close to being on-track to realize the true potential that such investments could have? Absolutely not.
While experts are already communicating the cross-sector impact that increased family planning use can have on the SDGs (fig 3), these assumptions are based on increased access and uptake of existing methods, which we know do not fully meet the needs of many women around the world.
Figure 3. Impacts associated with increased use of family planning
A review of the most recent DHS data reflects an unmet need for family planning across 77 countries that ranges from 10-38 per cent (fig 4). While some of this unmet need can be addressed through increased access to existing methods there are two key factors to consider in these data:
Figure 4. Unmet need for family planning (married or in union women)
Source: The DHS Program STATcompilerSo how can we deliver on the promise of global impact that contraceptive R&D has to offer? There is no big pharma strategy for expanding contraceptive options – nearly all of the already limited funding that supports contraception is provided by public funds or support from foundations. These funds are shared across programmatic, operations research, and research & development. Moreover, those funds are almost exclusively focused on women’s contraception. While incremental improvements on existing female contraceptive methods are underway, few will move beyond using hormonal active ingredients that have the potential for dissuasive side-effects. Similarly, the male contraceptive products that are furthest along in development also use hormone-based active ingredients.
What is glaringly absent in the calculus around contraceptive impact is non-hormonal male contraception. While there are many potential leads in the development pipeline for such methods, the paucity of funding in the contraceptive space has resulted in only slight progress. Yet, after meeting many of the researchers working in this space over the past eight months, we need these methods!!