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Below, EngenderHealth experts weigh in on what it will really take to forge the missing link in making contraceptive technologies – old and new alike – available to the 215 million women who don’t have access to a modern method of birth control:
Innovation is Just Half the Equation
Family planning indeed has a direct link to alleviating poverty. Moreover, its cost effectiveness is irrefutable: In addition to saving lives, each dollar spent on voluntary family planning can save governments $31 in health care, water, education, housing, and more.
Developing new contraceptive options is critical. But no matter how many technologies come to market, a major challenge remains: ensuring that those who need contraceptives the most—poor women and couples often living in remote communities—can get them. Strengthening health care systems, including training local providers, must be part of the solution.
We’ve learned from our own experience on the ground that all the technology in the world won’t work without trained providers to offer counseling, information, and quality care for family planning and reproductive health. Innovation is just half the equation. Access and delivery is the other half. Only when you have both will new contraceptives break through.
— Pam Barnes, President and CEO
“Software” v. “Hardware”
New technologies are important, but so many of the access issues in poorer countries relate to “software”. These include knowing about available methods and where to go to get them; human resources, such as the scarcity of trained providers; a competing disease burden (such as HIV and AIDS); and traditional gender norms and other sociocultural barriers. The “hardware” issues of not having sufficient technology to meet demand are still secondary in many places.
— Dr. Roy Jacobstein, Medical Director
To make vaginal rings – or any contraceptive technology - available to those women who currently don’t have access to modern birth control methods is quite simply going to require more than the technology itself. There is a complex set of interconnections among what women and men need, the technologies that can address those needs, the services that can provide those technologies, and the resources available to sustain supply and services.
— Karen Beattie, Director, Fistula Care
Investment, Policy, and Accountability
New contraceptive technology is only part of the solution. Training health providers at every level – community health workers, nurses, midwives, physician’s assistants, as well as doctors – and positive changes in health systems are needed. But more than that, donors need to invest more in finding innovative solutions. For instance, supplies like condoms, IUDs, and contraceptive pills, don’t always get to where they are needed when they are needed. Without solving what ought to be simple distribution problems (but are actually quite complicated), the vaginal ring will just be one more supply that is stuck in a warehouse and takes weeks if not months to get to rural clinics.
There needs to be local policy commitment, and investment of local resources and accountability. If we look at success stories, like Thailand, Mexico, and Colombia, where use of modern contraception has greatly expanded (and contraceptive prevalence rates are 70.9%, 71.5% and 78.2%, respectively), it’s because there was political support and investment in improving health systems and making contraceptives available.
— Terry Jezowski, Vice President, External Relations
Technology and Stronger Health Systems – We Need Both
New contraceptive technologies always hold the promise of better options for women and couples. But options don’t de facto equal access. Addressing the health care worker crisis and improving commodity security (e.g. getting needed supplies to clinics and pharmacies so customers can get them when they want them) would go a long way towards helping women access modern family planning methods.
The cost-effectiveness of family planning is paramount. I was curious that Kristof reports Sino-Implant costs only $3, when the cost typically cited is $8. Both prices make it a less expensive option than Jadelle®, yet in the countries where women most need better access to modern methods, health ministries still don’t have (or allocate) enough money to procure commodities.
Nonetheless, there are some interesting additional contraceptive technologies on the horizon that Kristof did not mention:
- Essure is a form of non-surgical female sterilization that is tremendously quick and less invasive than tubal ligation.
- Mirena® is an IUD that also delivers a minuscule dose of progesterone, which reduces menstrual bleeding – a side effect that women in the U.S. and Europe have warmly welcomed!
- Sub-Q Depo has the potential of clients self-injecting at home.
— Erin McGinn, Senior Technical Advisor for Family Planning