The power to save millions of lives

In this guest post, Dr. Judy Manning from the US Agency for International Development (USAID) and Dr. Zeda Rosenberg from the International Partnership for Microbicides (IPM) discuss the need for new and improved contraceptive options for women worldwide. The post was written to mark World Contraception Day. The picture could not be clearer: A woman's health and livelihood are threatened when modern family planning methods are out of her reach. On World Contraception Day (September 26), we are reminded that unintended pregnancy is a major contributor to maternal and infant death and disability around the world, and a recognized obstacle to global development. Forty percent of pregnancies worldwide are unintended, but that number is not so surprising when you consider that 222 million women have an unmet need for modern contraceptive methods. Access to such methods would enable women to plan and space their pregnancies, leading to improved health, educational, and economic outcomes for themselves and their families. New sexual and reproductive health innovations have the potential to revolutionize women's options by diversifying delivery forms, varying product duration, and targeting multiple health risks simultaneously. Photo: PATH. According to the Guttmacher Institute, 70 percent of the unmet need stems from method-related concerns. These include concerns about the safety and potential side effects of hormonal methods; appropriate options for women who have infrequent sex, or who are postpartum or breastfeeding; and opposition from their partners to specific approaches. Geography and access to health services are also barriers to modern contraception. Last year at the London Summit on Family Planning, the global community made an unprecedented pledge to reach 120 million more women with contraception by 2020. The upcoming International Conference on Family Planning in Ethiopia will map out additional steps required to make contraception available for all women. Efforts will focus on expanding access to existing methods as well as prioritizing the development of new innovative technologies. New sexual and reproductive health innovations have the potential to revolutionize women's options by diversifying delivery forms, varying product duration, and targeting multiple health risks simultaneously. Unfortunately, there is no magic bullet. When it comes to sexual and reproductive health, women face obstacles that are unique to their circumstances. But experience has taught us that if women have a range of affordable and appropriate products to pick from, they may use them more consistently, which in turn will allow them to better protect their health. We are excited about a number of cutting-edge technologies now in development. For instance, USAID is investing in the early-stage development of a biodegradable contraceptive implant that does not require removal. This product from FHI 360 could fill a critical gap in low-resource settings where women may not have access to trained health workers. Alongside contraceptive-only products, multipurpose prevention technologies (MPTs) can help address women's overlapping health needs in a single product. For example, women in areas with high rates of HIV often have the greatest unmet need for family planning, creating a double burden of risk. With support from USAID and other funders, IPM is developing a 60-day MPT ring to offer dual protection against HIV and unintended pregnancy that women could use discreetly. The self-initiated ring is being designed to provide sustained release of an antiretroviral (ARV) drug called dapivirine along with the contraceptive hormone levonorgestrel. USAID and other funders also recognize that, in many regions of the world, sexually transmitted infections (STIs) such as herpes simplex virus, human papillomavirus, and bacterial vaginosis are of greater public health concern than HIV. As a result, USAID is supporting CONRAD (in partnership with PATH) to develop an MPT that combines the new one-size-fits-most SILCS diaphragm with tenofovir gel—the first ARV drug shown to help prevent both HIV and herpes (a confirmatory trial of tenofovir's effectiveness is under way). This could provide women with a non-hormonal product that could be used "on demand," appealing to women who would like a product that is used at the time of sex. MPTs could result in significant health gains for women by broadly addressing their sexual and reproductive health needs, and reducing rates of maternal and newborn death associated with both unintended pregnancy as well as STIs. In fact, there is reason to believe that MPTs may have another added benefit: Combining two or more products into one may make protection more appealing and acceptable to women, and therefore increase its use. To fully realize the immense promise of up-and-coming innovations, we need continued investment in the development pipeline and in full access to the final products. No single product will address every woman's sexual and reproductive health needs, so it will take a portfolio of methods to ensure that women have options to choose from that are appropriate for their individual circumstances. New tools are not developed overnight—they take time, effort, and dedicated resources. But it is an investment that will help make modern contraception a reality for the 222 million women whose lives, health, and development depend on it. Originally posted by the Policy Innovations blog, a publication of Carnegie Council.

This week, many GHTC members will be in New York for the sixty-eighth session of the United Nations’ General Assembly (UNGA), where, among other topics, progress toward meeting the Millennium Development Goals (MDGs) will be addressed. Especially relevant this year will be discussions around the post-2015 development agenda. As we close in on the year 2015, and thus the deadline for the MDGs, there is a great deal of speculation about what set of goals, targets, and indicators will drive our development work for the next period. We’ve seen hints through reports released by a High-Level Panel on the Post-2015 Development Agenda, and by the Secretary General himself. But much of the work remains to be done, and as of yet there is still a great deal of uncertainty about what the agenda will look like in its final form. We should know more after this week. Previous investments in research to develop new vaccines, drugs, diagnostics, and other tools have led to some of the greatest advances in global health to date. Credit: PATH. Although it was good to see achievements brought about by health science and technology noted in both reports, there is a strong need for greater recognition about the need for new medical innovations to carry us through this next period—as well as the commitments and leadership that will get us there. Previous investments in research to develop new vaccines, drugs, diagnostics, and other tools have led to some of the greatest advances in global health to date, saving countless lives and resulting in billions of dollars in cost savings. With sustained investment and support, further gains are achievable: from the eradication of polio, to the elimination of malaria; from controlling and ending the AIDS and TB epidemics, to effectively diagnosing and treating neglected tropical diseases. The post-2015 development agenda must prioritize innovation for health, and I’ll be listening and talking with development leaders this week to discuss how this can be achieved. Excitingly, innovation seems to be featured in a number of side events that will take place this week—including the MDG Innovation Forum. Through these events, global health and development partners intend to highlight the role that innovation, research and development, and public-private partnerships play in helping us to achieve our development goals. Research and development for new, innovative health tools will be essential to achieve any international development goals and enable more equitable and sustainable improvements across health services and health outcomes. I hope that global health innovation is strongly supported by leaders during this week’s UNGA and that the discussions held this week will result in concrete support for global health research and product development as a key component of the post-2015 development agenda.