Roadblock:
In recent decades, there have been tremendous improvements in the reproductive health of men and women in the developing world. Nonetheless, many do not have access to health supplies and services that enable planning the number and timing of pregnancies, safe delivery of children, and management and treatment of sexually transmitted infections. It is estimated that 200 million women in developing countries have an unmet need for effective contraception even while family planning is one of the most cost effective ways to reduce maternal, infant and child mortality (Vlassoff, M., Singh, S., Darroch, J.E., Carbone, E., Bernstein, S. 2004. “Assessing costs and benefits of sexual and reproductive health interventions.” Occasional Report. New York: The Alan Guttmacher Institute, No. 11).
Sub-Saharan Africa and South Asia have the highest maternal and infant mortality and lowest use of contraception. Early marriage and childbearing before age 18 is also a serious public health problem in many countries, leading to increased maternal and newborn death and disability. Women, and even young girls, often have little choice in decisions related to sexual activity and any overt contraception is often unaccepted. Meeting this need is hindered in the current context of declining funding for family planning programs and for global R&D in new contraceptive technologies, both in the public and private sectors. The current pipeline of new methods in development is heavily weighted towards hormonal methods. This presents the opportunity to explore non-hormonal methods, which might provide new benefits for uptake among women who find hormonal methods less than satisfactory. This also presents opportunities for new technologies that limit the side effects of hormonal methods, decrease the cost of existing methods or increase the deliverability of existing methods.
Barriers to Uptake:
Many in the developing world do not use contraception because current methods do not meet their needs and those needs can be markedly different in different populations. For those whose income is less than $2 per day, cost is an especially important issue. Intermenstrual bleeding, a side effect that can occur with hormonal contraceptives, is not acceptable in certain cultural contexts. Skilled health care workers are often unavailable in resource poor settings so self administration or options that allow for non-medical staff -- such as community health volunteers -- can increase access to new methods. Additional barriers for women arise from differing contraceptive needs depending on stage of life and childbearing desire, the need for a covert contraceptive and the need to easily reverse effects of the contraceptive. For men, the current modern forms of contraceptive are the condom and vasectomy, which are not accepted in many contexts. Overall, increasing contraceptive uptake will not only require increased supply in the developing world but a larger range of choices for women and men so that their specific needs can be met in an appropriate, safe, culturally sensitive and cost-effective manner.
What We Are Looking For:
The goal of this topic is to solicit novel and innovative approaches to preventing unintended pregnancy. We seek proposals that are "off the beaten track," daring in premise, and clearly different from the approaches currently being developed or employed. Technologies or approaches should enhance uptake, acceptability and provide for sustained use; enable or provide for low-cost solutions; promote effective delivery and administration of new solutions; and ensure or enhance safety.
Highly desirable attributes include:
- Methods that prevent unintended pregnancy in addition to acquisition of HIV and other sexually transmitted infections;
- Self-administration methods or methods that do not require medical workers to administer;
- Discreet use methods for women;
- New concepts that translate into lower cost, affordability and ease of logistics in the management of contraceptive procurement and distribution;
- Simple adaptation of existing technologies with characteristics important to meeting unmet needs;
- Technologies that can be translated quickly into approved products;
- Contraceptive methods that inherently include other health or personal benefits that would increase their uptake and desirability.
A few of the many specific examples to be considered include:
- New delivery mechanisms for short and long acting methods;
- Methods to limit side effects associated with systemic exposure to hormonal contraceptives;
- Technologies that markedly improve the cost, acceptability, and deliverability of contraceptives;
- Approaches to lengthen the duration of injectables and implants;
- Methods that work after ovulation;
- Methods that interfere with sperm delivery or function in the male or in the female genital tract or both;
- Non-hormonal contraceptive agents (as an alternative option to hormonal formulations).
We will not consider funding for:
- Solutions that are not applicable to the developing world setting;
- Exclusively non-technological, social intervention;
- Contraceptive methods that are already mature in development, unless the proposed work would develop new technical improvements to that method which address a clearly identified unmet need.
Grants will be selected on ability to create impact in the context of our existing global health priorities.
For more information on Foundation priorities in the area of family planning click here.
For information on The Bill & Melinda Gates Foundation’s priority global health conditions, please click here.