This post is part of a monthly blog series profiling viewpoints from leaders in reproductive health who are members of the Bellagio Group on Long-Acting Reversible Contraception. The Bellagio Group is a coalition of experts who convene annually to discuss practices for expanding contraceptive choice and accelerating progress toward the Millennium Development Goal of universal access to reproductive health services. This post represents the views of the author and is not a representation of the Population Council or the Bellagio Group. Please direct any questions to the author at firstname.lastname@example.org.
Two weeks ago, I observed a focus group in Lusaka, Zambia, where a moderator from a South African marketing agency spoke with eight young women about their views on contraception. Joined by a local researcher, a program manager, and marketers, I watched the session next door through a live television feed. Our goal was to get a head start on the development of marketing strategies for new contraceptive products—a project funded by USAID. In that small room in the Lusaka office building, we huddled around the television listening to these women’s opinions about different contraceptive options, hoping to understand how they make decisions about which methods to use and how the public health community can better meet their needs.
To my surprise, these savvy urban young women said that they were sexually active but did not use a modern method of contraception, preferring the withdrawal method. For differing reasons, they were not enthusiastic about the methods typically available to them—including, but not limited to, condoms, pills, and injectables—and did not even mention long-acting reversible contraceptives (LARCs), such as IUDs and implants, as an option.
They are not alone in their decision not to access modern methods: More than 100 million women globally* cite method-related reasons for nonuse of modern contraceptives. Of these women, 34 million want methods that do not cause side effects; 31 million need methods that are appropriate for infrequent sex; 25 million need methods suitable for use while breastfeeding; and 14 million require discreet methods or ones that they can use despite partner opposition. We are falling short in our efforts to provide these 100 million women with a full range of choices that work for them and meet their individual preferences and needs over time.
At WomanCare Global (WCG) our motto has long been, “No matter who she is or where she lives, every woman should have access to contraceptives.” Determining whether or when to have children is a woman’s basic human right, and our job is to give her the means to make those decisions. The single most important intervention that WCG undertakes is to implement a sustainable approach to the “contraceptive value chain” from the product developer to the manufacturer to the central warehouse to the service delivery outlet and, ultimately, to the client.
To improve access, we focus on quality products, reliable manufacturing, in-country registration, and prices that women can afford. Our key message is a simple one: Access means the right product in the right place at the right price.
While the supply chain is the linchpin of contraceptive access, it is not enough to deliver large quantities of male condoms or hormonal pills and declare victory. Instead we must really listen to women, such as those in the Lusaka focus group, and give them what they want, including acceptable alternatives to withdrawal. “Contraceptive access” means supplying products and services that women desire and will use.
With support from USAID, WCG leads the EECO consortium: Expanding Effective Contraceptive Options. Under this program, our team will introduce five new contraceptive methods in Zambia, Malawi, and India. The methods, which have been under intensive development, are designed to address gaps in the method mix. They are all woman-initiated, vaginal methods—meaning that a woman does not need to visit a healthcare provider or to rely on her partner for contraception.
Two contraceptive vaginal rings from the Population Council are the one-year investigational Nestorone® and ethinyl estradiol contraceptive vaginal ring, and the three-month progesterone contraceptive vaginal ring that is approved in eight Latin American countries for use by breastfeeding women. Additionally, PATH’s redesigned SILCS diaphragm and Woman’s Condom will offer barrier methods that women can control themselves. And Evofem’s Amphora contraceptive gel will provide a safe and easy-to-use alternative to hormones. It is our belief that access to more choices will empower more women to use modern contraception and will appeal to those who have discontinued previous methods because they were unsatisfied.
In places such as Zambia, public health practitioners have made strides in recent years to increase the uptake of LARCs, such as IUDs and implants. Now, we must address the larger issue of access. When we provide more user-initiated contraceptive solutions, when we listen to women such as those in the Lusaka focus group discuss their choices, we will empower them to make contraceptive decisions that give them greater control over their sexual and reproductive health.
* Darroch, Jacqueline E., Gilda Sedgh, and Haley Ball. 2011. “Contraceptive Technologies: Responding to Women’s Needs.” New York, NY: Guttmacher Institute.