Ideas with Impact

Developing Highly Effective, Long-Acting, and Reversible Contraceptives

As a senior medical advisor for Planned Parenthood Federation of America and a professor of obstetrics and gynecology at Columbia University, I know well the power that family planning can provide for women and couples. With effective contraception that meets their needs and lifestyles, women have the ability to freely decide whether to have children and, if so, when and how many.

A recent article in The New York Times reported on one of the largest-ever experiments with long-acting, reversible contraceptives (LARCs) in Colorado and highlighted its “startling” success. The program offers free IUDs and implants to teenagers and poor women. As a result, the rate of unintended pregnancy among teenagers—and the abortion rate—plummeted by 40 percent.

Closer to home, I participate in a program at Columbia that provides health care in high schools. Recently, five high-school seniors came to the clinic to get their first IUDs. It was a rite of passage for them: five girlfriends going off to college, and each wanted to protect herself from pregnancy. They knew they wanted to pursue their education and prevent unintended pregnancy with a highly effective, reversible family planning method. They had the information they needed to make this decision and knew how to get effective contraception. I was tremendously proud of them.

The young women in Colorado and New York probably didn’t realize the vital role the Population Council has played for more than 60 years in allowing women—young and not so young—to plan their families and chart their futures by preventing unintended pregnancies and planning and spacing planned pregnancies.

For decades, the Council has been at the vanguard of researching, developing, and facilitating access to LARCs including IUDs and implants. The Council invested deeply in contraceptive research and development at a time when the pharmaceutical industry wasn’t doing so. And based on the success of the Council’s efforts in the 1970s, ’80s, and ’90s, pharmaceutical companies began to step up their efforts to develop and increase access to LARCs.

It was the Council who, in the early 1970s, developed the first copper intrauterine device. The Copper T IUD (ParaGard®) has become a popular option for women around the world because it is safe, highly effective, long-acting (it can be used for up to 10 years), very cost-effective, and once inserted doesn’t require any follow-up—women get 10 years of protection from just “one act”; they don’t need to remember to take a pill every day or get a contraceptive injection every few months.

The Council also developed the levonorgestrel-releasing Mirena® intrauterine system, which in addition to all the benefits of ParaGard also reduces heavy menstrual bleeding and anemia.

Currently, 170 million women worldwide are using a highly effective contraceptive developed by the Council or based on the Council’s technologies, including ParaGard and Mirena, the implants Norplant® and Jadelle®, and Progering®, a contraceptive vaginal ring for breastfeeding women.

The Council has worked with ministries of health, international organizations, and health care providers in many developing countries to facilitate the introduction of ParaGard into family planning programs and to develop guidelines for safe provision of and counseling for the product. And through partnerships with Bayer (the pharmaceutical company that licenses Mirena), Mirena has been distributed at no cost to more than 100,000 low-income women globally.

However, there are still an estimated 225 million women in developing countries who want to avoid pregnancy but are not using modern forms of contraception. These women face many barriers to obtaining effective contraception, including a lack of trained providers, supply shortages, resistance from families or communities, and misperceptions about side effects.

Today, the Council is still at the cutting edge of contraceptive research and development, and will shortly be submitting an application to the US Food and Drug Administration for the approval of a one-year contraceptive vaginal ring, a promising advance in family planning. I was a principal investigator on the Phase 3 efficacy trial of the ring. It is safe, effective, controlled by the woman, and does not require daily attention. Nor does it need refrigeration prior to distribution or during periods of non-use. The ring contains Nestorone® (an investigational new chemical entity) and ethinyl estradiol (an approved, marketed hormonal product). It is left in place for 21 days and removed for 7 days. Once a woman inserts it, the ring prevents ovulation—and, therefore, pregnancy—by continuously releasing a low dose of hormones. In addition to the one-year ring, the Council’s product pipeline includes contraceptive gels and contraceptives for men.

With its groundbreaking history of innovation and focus on the future of contraceptive technologies, the Population Council continues to lead the way to ensure that people, particularly in low-resource settings, have access to high quality, effective, and affordable methods of contraception that will allow them to achieve their reproductive intentions. I’m proud of the Council’s accomplishments, and eager to see what the future holds. 

Dr. Carolyn Westhoff serves as senior medical advisor for Planned Parenthood Federation of America. She is the Sarah Billinghurst Solomon Professor of Reproductive Health; Director, Division of Family Planning and Preventive Services; and a professor in the Department of Obstetrics and Gynecology at Columbia University Medical Center. She is also a professor of epidemiology and population and family health at the Mailman School of Public Health at Columbia University. She serves as editor-in-chief of the international health journal Contraception, a monthly publication for the advancement of reproductive health.

Dr. Westhoff’s clinical and research focus is on contraception, the development of new contraceptive technology, and the evaluation of current methods. She has published over 200 scientific articles, as well as many abstracts, relating to safety and effectiveness of contraception and abortion.

Dr. Westhoff is a member of the Institute of Medicine of the National Academy of Sciences. In 2010, the Society of Family Planning recognized her accomplishments by honoring her with a Lifetime Achievement Award.


Previous entry: Delivering Ideas, Evidence, and Solutions to Improve Lives, by Julia Bunting

Next entry: Pursuing Evidence to Uphold Girls’ Rights, by Kate Gilmore