Population Council Presents New Research
at the International Conference on Family Planning
ADDIS ABABA (15 November 2013) — This week, the Population Council presented findings from more than 40 research studies at the International Conference on Family Planning (ICFP) in Addis Ababa, Ethiopia. Council experts showcased new research during panel sessions, oral presentations, roundtable discussions, a press conference, and poster presentations.
Population Council presentations highlighted the Council’s strengths, including: opportunities for developing and introducing new contraceptive and multipurpose prevention technologies; expanding access to family planning through innovative financing mechanisms; and promoting gender equity by encouraging male involvement in family planning.
"The International Conference on Family Planning provided an important venue for exchanging knowledge about the benefits of family planning for women, their partners, and families," said Peter J. Donaldson, PhD, President, Population Council. "More people are gaining access to family planning, thanks to growing political leadership and financial commitments. These commitments are essential for building stronger and healthier communities around the world."
Selected presentations are summarized below.
Developing and Increasing Access to New Technology
Panel Session: From Bench to Bedside: Public, Private, Regional, and Donor Perspectives on the Challenges and Opportunities for Introducing New Contraceptives (Ruth Merkatz, PhD, Director, Clinical Development of the Council's Reproductive Health Program)
Council President Peter J. Donaldson, PhD, moderated a panel session on the importance of collaboration between funding agencies, developers, and in-country networks to manage the process of delivering new contraceptives to areas with the greatest need. Speakers included Dr. Judy Manning (US Agency for International Development [USAID]), Dr. Frans van Birgelen (Merck Sharp & Dohme), Dr. Elizabeth Anne Bukusi (Kenya Medical Research Institute [KEMRI], Nairobi, Kenya), and Dr. Ruth Merkatz (Population Council).
- Panelists emphasized the importance of accelerating contraceptive development to address unmet family planning needs, reduce the consequences of unintended pregnancy, address maternal and newborn health issues, and improve quality of care. The importance of integrating family planning into the care of women with HIV was also emphasized, along with challenges and approaches for scaling up and introducing new contraceptive methods.
- Partner presentations also reviewed the collaborative process of the interagency Contraceptive Technology Donor Working Group to align institutional priorities for contraceptive research and development.
- In a presentation titled "Development of the Nestorone®/ethinyl estradiol contraceptive vaginal ring (NES/EE CVR): Challenges, opportunities, and obligations of the public sector," Dr. Ruth Merkatz and colleagues from the Council discussed the requirements for successful "bench to bedside" development of a new contraceptive option. Researchers emphasized that products must be safe, effective, acceptable, cost-effective, easily accessible, and well differentiated from existing methods. In addition, planning for market introduction early in the development process requires ongoing support from donors and alignment on shared goals.
- The Council also reported on the completion of preclinical and clinical studies that will be included in a New Drug Application to be filed with the US Food and Drug Administration for the investigational one-year ring. Data from clinical trials support the safety and efficacy of the one-year ring and show it is associated with favorable bleeding patterns, and is highly acceptable to women and their partners.
"Maintaining a clear focus on unmet family planning needs, an understanding of health systems, and relentless efforts to lower costs and improve quality are essential components of successful contraceptive development," said Ruth Merkatz, PhD, clinical director the Population Council's Reproductive Health program. "Ongoing research underscores the true value of a cross-collaborative approach, which is essential as we work toward expanding access to novel methods in low-resource settings."
Presentation during the “Best in Class: Top Scientific Research” Special Session: Developing a Model of Acceptability for a New Long-Acting Contraceptive Vaginal Ring (Ruth Merkatz, PhD, Director, Clinical Development of the Council’s Reproductive Health Program)
The Council is the leading developer of long-acting reversible contraceptives (LARCs), and more than 120 million women worldwide have used a Council-developed method. The Council leads contraceptive development from start to finish through a "bench to bedside" approach—whereby scientists identify and develop drugs and delivery systems based on needs in the field, conduct preclinical studies and human clinical trials, and work with regulatory authorities to bring new technologies to the market.
The Council developed a one-year contraceptive vaginal ring that contains ethinyl estradiol, an approved, marketed synthetic estrogen, and Nestorone®, an investigational progestin that is a new chemical entity. If approved by regulatory authorities, the one-year ring will offer a unique option for those seeking a long-acting, reversible contraceptive that is under the woman's control, is effective for one full year, and does not require insertion by a health care professional. The one-year ring is intended to not require refrigeration, a feature that is important in low-resource settings.
- During a special session, Dr. Ruth Merkatz presented findings from a study with more than 1,000 women that evaluated their acceptance of the one-year ring. Because women's satisfaction with contraceptives has been correlated with outcomes such as continuation rates, the Council studied patient satisfaction and continuation through 13 cycles of use.
- Responses revealed that the vast majority of women liked this method, would recommend it to others, and would use it again. Women who reported being satisfied with the one-year ring were significantly more likely to continue using the ring for the full year.
"Significant barriers may prevent women in developing countries from accessing a range of contraceptives to meet their needs—and a woman's acceptance of a new method is important to ensure continued use," said Dr. Ruth Merkatz. "These findings support our growing understanding about women's experiences using the one-year ring. We look forward to continued evaluation of our acceptability data and the submission of a New Drug Application to the US Food and Drug Administration."
Panel Presentation: Constructing a Socio-Behavioral Framework for Multipurpose Prevention Technologies: Lessons Learned from Family Planning (Martha Brady, Senior Associate at the Population Council)
Multipurpose prevention technologies (MPTs) are products that seek to provide simultaneous protection against pregnancy and sexually-transmitted infections, including HIV. A number of MPTs are currently under development.
- The objective of this presentation was to review lessons from the introduction of a range of family planning methods to inform the development and introduction of MPTs, with particular attention on the socio-behavioral factors and acceptability considerations related to these products.
- Experience from a range of products was reviewed to identify product characteristics and service delivery platforms that may have been associated with differing levels of product acceptance and successful use.
- It was concluded that successful introduction of MPTs will require a nuanced understanding of socio-behavioral dimensions of these products, demand generation, effective integration into health delivery systems, and active engagement of both public and private sectors. Specific product characteristics and their socio-behavioral correlates should be taken into account early in the development process.
This presentation formed part of a panel session titled "Multipurpose Prevention Technologies for Family Planning/Reproductive Health: Using Family Planning to Inform the Next Great Wave in Protection for Women and Girls," which was co-chaired by Dr. Judy Manning (USAID) and Dr. Elizabeth Anne Bukusi (KEMRI). Speakers also reviewed trends in sexual and reproductive health epidemiological and demographic data; input from providers and users on product attributes of MPTs; and donor coordination related to the development of MPTs that build upon a common platform of family planning.
"Multipurpose prevention technologies represent a major step forward in the R&D landscape, and have the potential to improve the sexual and reproductive health of women and girls globally," said Martha Brady, Senior Associate, Population Council. "We hope the lessons learned here will inform the development and introduction of MPTs as we advance these critical research efforts."
Novel Strategies for Expanding Access
Oral Presentation: Organizing the Evidence on Family Planning Voucher Programs: A Taxonomy of Program Implementation and Studies (Benjamin Bellows, PhD, Associate with the Population Council's Reproductive Health Program in Nairobi, Kenya)
Vouchers are an innovative strategy for governments seeking to expand access to family planning methods for individuals who, in the absence of supportive funding, would not likely be able to afford family planning services.
- The Council conducted a literature review to document family planning voucher programs in low- and middle-income countries, identify successful characteristics of contraceptive use, help inform governments interested in launching or expanding voucher programs, and recommend focused program designs to achieve supply and demand goals.
- Key features include effective and inexpensive poverty-based targeting of demand subsidies, prompt and efficient payment to contracted providers, and transparent information systems to facilitate performance monitoring and service verification.
- Researchers concluded that scaling up voucher programs requires keeping management costs low, maintaining quality of care, focusing on effective targeting, and coordinating family planning voucher subsidies through multiple service delivery channels to meet demand.
"Results from our research indicate that family planning vouchers can improve equity by effectively reaching poor populations who want but cannot afford their preferred method without a subsidy," said Ben Bellows, PhD, Associate, Population Council.
Oral Presentation: The Effect of a Voucher Program on the Uptake of Long-Acting and Permanent Methods of Contraception in Kenya (Benjamin Bellows, PhD, Associate, Population Council, on behalf of Sam Wangila Wafula, lead author and former Bixby postdoctoral fellow at the Population Council, Kenya)
While long-acting and permanent methods (LAPMs) (e.g., intrauterine devices, implants, and sterilization) can help women avoid unintended pregnancies, existing research showed that only 8.3 percent of Kenyan women of reproductive age were using LAPMs by 2009. Though government health facilities widely offer short-term contraceptives, use of LAPMs is very low given high out-of-pocket costs and limited provider knowledge about insertion.
- A Council study sought to determine whether vouchers could increase use of LAPMs in Kenya. Following a survey of nearly 3,000 women ages 15–49 years, researchers evaluated the effect of a government-instituted voucher program on the uptake of LAPMs.
- Researchers documented a significant increase in LAPMs among poor women in villages exposed to the voucher program, compared to villages without access to voucher services (6 percent net increase—difference in difference—over 20 months; p<0.05). Researchers recommended that future programs incorporate routine performance measures to facilitate regular assessment of the impact of voucher programs on LAPM usage.
"Until now, there have been no controlled studies evaluating the effect of a voucher program on the uptake of LAPMs in Kenya," said Ben Bellows. "This study gives us new insights on the ability of a family planning voucher program to positively influence a woman's use of LAPMs in low-resource areas with high unmet needs."
Interventions to Promote Gender Equity
Oral Presentation: Re-Invigorating Male Involvement in Family Planning: An Assessment in Southern Ghana (Nsorma Gertrude Nyaaba, Program Officer for Research, Population Council, Ghana)
New Council research evaluated men's attitudes toward family planning and demonstrated the positive impact of programs that strengthen gender equity.
- Results from a previous Council study recommended encouraging male involvement as a way to increase access to family planning in Ghana. Results from this additional study indicated that while both men and women are aware of contraceptive methods, most men may not support family planning.
- Contributing factors include perceived loss of social prestige, loss of control in the household, misinformation, fear of side effects, and concerns related to religion and cost. In scenarios where men do not consent to using contraception, most women seek these services secretly, which often leads to marital conflicts and divorce.
- In this new study, researchers recommended strengthening the focus of programs so they actively encourage men to take active part in family planning. Recommended methods for achieving this goal include engaging men through group discussions; helping sensitize men by educating and encouraging them to be supportive of their partners’ contraception needs; using social media to reach men at the workplace and at home; and increasing visibility of male role models to counter the perception that family planning is a female responsibility.
- Researchers concluded that men who understand the need for contraceptive use are more likely to support their partners by helping them to monitor their use of contraceptives and/or help pay for the cost.
"This study showed us that when men are engaged using methods such as joint counseling and interactions with male associations, uptake and support of family planning services increases," said Nsorma Gertrude Nyaaba, Program Officer for Research, Population Council. "Understanding the factors that help influence men's positive involvement will help us influence policies and programs that break down barriers and encourage greater adoption of voluntary family planning services."
About the Population Council
The Population Council confronts critical health and development issues—from stopping the spread of HIV to improving reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world. Established in 1952 and headquartered in New York, the Council is a nongovernmental, nonprofit organization governed by an international board of trustees.
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