Population Briefs

Advancing Long-Acting Reversible Contraception

The Population Council developed the copper T IUD, one of the most effective and cost-effective contraceptive methods available today.

The Landscape

The first modern IUDs were developed in the early 1900s, but had many shortcomings. Women who used them experienced pain and heavy bleeding, and the devices were often expelled from the uterus. The Population Council began contraceptive research in 1956 and was the first organization to recognize the potential of the IUD to be a better, more effective contraceptive method. The Council invested significantly in new research and product development to achieve that potential.

The Paradigm Shift

In the mid-1960s, Population Council biomedical researcher Howard Tatum determined that a common weakness of existing IUDs was the incompatibility of their shape and size with the dimensions of the uterus. Taking into account the musculature of the uterus, in 1967 Tatum produced the first “Tatum-T” plastic IUD. The Tatum-T produced only one-fifth the incidence of pain and bleeding and half the expulsions as another commonly available IUD. However, the Tatum-T was not an effective contraceptive until Tatum’s colleague Jaime Zipper of the World Health Organization added copper to it, significantly improving its effectiveness.

In 1976, the U.S. Food and Drug Administration (FDA) approved the Copper T200 IUD, the first-ever New Drug Application sponsored by a nonprofit research organization. And in 1984, the FDA approved a longer-lasting Council product with more copper, the Copper T 380A IUD, now known as ParaGard®. The modern copper T IUD is one of the most effective and cost-effective contraceptive methods available; it lasts 12 years and its contraceptive effect is reversed as soon as it is removed.

The Tatum-T was also used as the foundation for a hormonal IUD, developed with Council funding by a team led by University of Helsinki scientist Tapani Luukkainen, a member of the Council’s International Committee for Contraception Research (ICCR). With the addition of a progestin, Luukkainen and the Council sought to decrease menstrual bleeding and prevent anemia. From this initial design evolved Mirena®, a levonorgestrel-releasing intrauterine system (IUS), approved by the FDA in 2000 for contraception and later for the treatment of heavy menstrual bleeding.

The Lasting Impact

The Council is a recognized international leader in the development of safe, highly effective, reversible contraceptive methods. To date, more than 120 million women have used a Council-developed contraceptive, including ParaGard and Mirena; implants like Norplant® and Jadelle®; and Progering®, the contraceptive vaginal ring for breastfeeding women. Today the Council is developing a new contraceptive vaginal ring that will be effective for one year.

The Council has worked with ministries of health, international organizations, and health care providers in many developing countries to facilitate the introduction of the Copper T 380A IUD into family planning programs and to develop guidelines for safe provision of and counseling for the product. And, through partnerships with the pharmaceutical company that licenses Mirena, the IUS has been distributed at no cost to more than 65,000 low-income women in the U.S. and to around 46,000 women in developing countries.

Speaking of the Council’s contraceptive development, Dr. Laragh Gollogly, then a senior editor at The Lancet, wrote, “Most nongovernmental organizations claim to promote change for the better; the Population Council actually has hard evidence of having changed the lives and expectations of hundreds of millions of people.”


Sources

Tatum, Howard J. 1972. “Intrauterine contraception,” American Journal of Obstetrics and Gynecology 112(7): 1000–1023.

Nilsson, C.G., E.D.B. Johansson, and T. Luukkainen. 1976. “A D-norgestrel-releasing IUD,” Contraception 13(4): 503–514.

Funding

Ford Foundation and Swedish Medical Research Council