Contraceptive Choice: Having Some Options is Good, but Having More Options is Better

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It’s no secret that there are a wealth of contraceptive methods that exist today, including methods like the birth control pill, the hormonal or non-hormonal IUD, the implant, the patch, and many more! Still, there are people around the world whose contraception needs are simply not being met. Julia Bunting with the Population Council sits down with us to discuss the need to continue the development of innovative contraceptive methods, and how her organization is leading the charge.

The Population Council has been a leading developer of contraceptive methods for more than sixty years, and Population Council’s scientists developed what we now know as long-acting reversible contraceptives (LARCs) in the 1950s. LARCs include methods like IUDs (Paraguard and Mirena) and the implant (Jadelle and Norplant). It is estimated that today, more than 170 million women in the world, which is between 20-25% of all women, are using modern methods of contraceptives, many of which are developed by the Population Council.

Different women need different contraception methods at different points, seeing as many women use contraceptives for up to thirty years of their lives. While there may be a slew of options to choose from, there are new methods of contraception (with added health benefits and fewer side effects) that are emerging to meet those needs. The newest FDA-approved vaginal ring, Annovera, provides a full year of protection against unintended pregnancy but can be inserted and removed by someone on their own. Unlike other vaginal rings, Annovera does not require refrigeration and can be used by women around the world, including rural settings. Annovera will hopefully be available to women in the United States by the end of this year, or early next year.

There have been whispers about male contraceptive methods for years, but no actual results. Preventing the production of one egg versus billions of sperm creates a biological challenge, societal roadblocks that prevent the welcoming of men adopting a contraceptive method creates a social challenge, and the enormous amount of time it takes to actually develop the method itself creates a logistical challenge. There are also very few people that are interested in investing in male contraceptive methods. Unfortunately, a lack of male contraceptive methods can undermine the idea that men also want to make choices about and have control over their sexual and reproductive lives and futures.

In the U.S. and around the world, reproductive health and rights, including access to contraception, is under attack. The development of contraception methods is a long game, and has taken place over constantly shifting political and funding environments. Population Council continues to develop contraceptive methods and listen to the needs and wants of people around the world when it comes to contraception.

links from this episode

Population Council
Population Council on Facebook
Population Council on Twitter 
Annovera FDA Press Release

Transcript

Jennie Wetter: Welcome to rePROs Fight Back a podcast on all things repro. I'm your host Jenny Wetter. In each episode, I'll be taking you to the front lines of the escalating fight over our sexual and reproductive health and rights at home and abroad. Each episode, I will be speaking with leaders who are fighting to protect our reproductive health and rights to ensure that no one's reproductive health depends on where they live. It's time for repros to fight that.

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Jennie Wetter: Hi everybody and welcome to a special bonus episode of rePROs Fight Back. I'm your host Jennie Wetter. So over the next couple of weeks we're going to be having our regular episodes that'll be every other week along with a special bonus episodes that I recorded while I was in Vancouver for the Women Deliver conference, which is a maternal and reproductive health conference. I was lucky enough to conduct four special interviews while I was there and so we're going to air them, um, every other week against our weekly schedule. So for the next eight weeks are going to be, we're going to go weekly. And this week's bonus episode, I talked to Julia Bunting with the population council and we talk about contraception right now. There are a lot of different methods of contraception available on the market, some long acting, some less so. And it's really important to find the right one that works for you. There are a lot of different benefits and side effects to different methods and so it's really important to find the one that is the one that fits best in your life at the time. So I talked to Julia about some of the methods that they have already helped create and some of the methods that they are working to create for the future, including multipurpose prevention technologies, which um, can prevent both STDs and pregnancy. So enjoy this conversation where we talk about things that you can be expecting coming up soon in the world of contraception.

Jennie Wetter: There are a wealth of contraceptive options available today, the pill, the IUD, the implant, but there are still many women and men whose contraceptive needs are not being met. That's why I'm excited to speak with Julia Bunting, the president of the Population Council, about the need to continue developing innovative contraceptive methods and how her organization is leading the charge.

Jennie Wetter: Hi Julia. Thank you so much for being here.

Julia Bunting: Thanks for having me.

Jennie Wetter: So not everybody knows this, but the Population Council has been a leading developer of contraceptive methods for a long time. Why don't you tell us a little bit about what methods you developed and why?

Julia Bunting: Well that's exactly right. The scientists at the Population Council Center for Biomedical Research have been developing innovative contraceptive methods now for more than 60 years. So it was all scientists who back in the 1950s before the birth control pill was even available to women here in the US, let alone around the world, developed what we now call the field of long acting reversible contraception. As I'd like to say, we conceived the field of long acting reversible contraception. So our scientists develop things like the Inter uterine device Paragard. We went on to develop the hormonal inter uterine system, Mirena, used by many of us, uh, and also the contraceptive implant technologies. And so we estimate today that some 170 million women in the world, that's between 20 and 25% of all women using modern methods of contracepting are using products that were developed by the Population Council or based on our technologies.

Jennie Wetter: That's amazing.

Julia Bunting: Incredible. And nobody knows.

Jennie Wetter: So, um, there are a lot of methods available to women in the US but I think there's often people who are not happy with what they have. So can you tell us a little bit of why we need more?

Julia Bunting: So we know that different women need different methods at different points in their life. And we know that for women around the world, including here in the US that we are contracepting for possibly three decades, for 30 years of our lives. And so we know that we need different methods to meet those needs. Some women don't want hormonal methods, some women want short acting, some women want barrier methods. So we need to develop a range of different methods to meet the needs of different women.

Jennie Wetter: There are a lot of choices. And you mentioned that women often you need to have different needs over the course of their lives and you know, you may be unhappy with one. So are there new methods that are coming in the near future?

Julia Bunting: Absolutely. One of the things that we're most excited about is just last summer the US Food and Drug Administration approved a new contraceptive vaginal ring that we've developed. It's a ring called Annaovera. And what's exciting is that it provides women with more choice, more convenience and more control. What's exciting about Annovera is that it provides a full year of protection against unintended pregnancy. But a woman can remove that and insert it of her own as he doesn't need to go to a doctor to get it inserted. She doesn't need to go to a pharmacist to get a resupply every month. And we think it's a really needed method that will give women, as I said this, the choice, the convenience and the control that we know that women want.

Jennie Wetter: That's a big big change cause like the rings right now are only for a month. And wearing my advocate hat. So thinking in the developing context, do they need to be refrigerated?

Julia Bunting: No, and that's again, the methods that we develop are really aimed at women around the world. Uh, and we obviously get the approved by the US Food and Drug Administration. They are made available here to women in the US but we also develop it with the mindset of we need to make this available to as many women around the world as possible. So what's exciting about Annovera compared to other vaginal rings that are on the market is that it doesn't require refrigeration, doesn't require cold chain. So it's particularly helpful in low resource settings.

Jennie Wetter: That's wonderful. I know, um, that's something that's really needed right now. And um, you have a lot of women in developing countries who don't have a lot of method mix that they are able to use. And so it's exciting to have some new ones that might be really useful.

Julia Bunting: Yeah, I mean we're, we're excited about getting the existing products that we have available to women around the world. Continuing to adapt those and to make them more usable, more accessible, and also to develop new technologies that meet the needs that we know women have today.

Jennie Wetter: Yeah, I think that's really important. As we've talked about, like often people need different ones over the course of their lives and being able to go to the doctor or the clinic and being able to get the one that's right for you. Um, in so many places, that's not the case. You get what is in stock. Um, particularly when you're thinking of developing countries. Like they might not have a full range of contraceptives. So one getting the ones that already exist there and stocked, but also having new options that are useful for women is really cool.

Julia Bunting: Absolutely. And I think that's what's so exciting about having developed the field of long acting reversible contraceptives is that once you have that method, you don't have to worry about the resupply. And so what we see around the world is women who have chosen to take a method who have had a method and then when they go back to the pharmacy or to the health care provider that method stocked out. And the consequence of not having that available the next time you need it is that you find yourself unintentionally pregnant. And so the field of long acting reversible contraception has really been a game changer that you don't need to keep visiting the health provider. You don't need to risk stock out, but also you're not spending time and a lot of time walking into clinics, waiting in clinics to get that method. And I think Annovera as a, as this one year contraceptive vaginal ring really provides an alternative method that gives that same freedom, that same control but fully under a woman's control.

Jennie Wetter: Yeah. And I think that's also a really important way. And like we think in our lives, like the pharmacy, like right now we're sitting in a hotel room, there's pharmacy like literally right across the street. And so people don't necessarily, um, it doesn't occur to them that it, particularly in a developing country context, like women are having to walk a long way or travel a long way to get to a clinic. And so not having what she wants when she goes is a huge problem because she might not be able to go back anytime soon.

Julia Bunting: And it's not just in the developing world. I actually wrote a piece for Ms. Magazine, uh, last year, uh, as a, as a European, as a Brit. Um, I've been used to begin to have these methods available when I want them and to have the numbers of methods and the availability that I've needed. And what shocked me when I first arrived in the US and I needed to use birth control pills for a short period of time is that I was only being given one month at a time. And so having to, even myself living in midtown Manhattan, the pharmacy was one block away. Having to go in my lunch time and queue and then to be told that I couldn't help them because I hadn't finished my existing cycle was an absolute shock. I wasn't used to that. So it's not just in the developing world, we know that those issues are also constrained here in the United States.

Jennie Wetter: Absolutely. And also sometimes by distance as well. You know, I grew up in rural Wisconsin, so the closest pharmacy was not down the block. It was having to go 15 minutes into town. And while that's, you know, a scale different, there are places that are much further away than where I grew up that had that really have to travel even within the US.

Julia Bunting: Absolutely.

Jennie Wetter: So long acting methods can really be a game changer for a lot of women. Okay. So when can women start getting Annovera? Julia Bunting: So our hope is that it will be available here in the United States, uh, towards the end of this year or early next year.

Jennie Wetter: That's exciting!

Julia Bunting: It is, is we can't wait.

Jennie Wetter: So now we're going to talk about what I often refer to is the great white whale. I feel like it's one of those things that I always hear is five years away. We are five years out, there's going to be a new male method in five years. And it's been since I started working at Populations Institute when I've been paying attention to this. That's 11 years now. So five years has not happened.

Julia Bunting: And its still at least five years out.

Jennie Wetter: So what has held us back from having another effective contraceptive method for men and can we expect one in the near future or in the future?

Julia Bunting: So I think there are many reasons why we don't yet have an effective male contraceptive. I mean, we do have methods, of course we have condom and we have the vasectomy and we have withdrawal and we have abstinence, which are not great options of course. Um, but I think there are, there are many reasons. There's obviously the biological reasons women and men's reproductive biology is very different. The challenges of preventing the production of one egg versus billions of sperm are very different. There's also the sort of societal challenges about whether men would want a method where the women would want men to use a method and then there are just the sort of the timeline that it takes to develop this. We've been in this game for more than 60 years. We know it takes an enormous amount of time and investment to deliver and develop products. Uh, so it's all of those things and, and there's just not the funding to do it. I mean, I think that's one of the biggest constraints that we see. There are very few people who are investing in the research and development of new contraceptive technologies for women or for men.

Jennie Wetter: It is one of those things that you hear it and like there's like excitement that builds that there's going to be a new male method and then it, you just, it, you don't hear anything about it again for a couple of years and then it's like five more years.

Julia Bunting: But of course, as you know, I mean we, we launched a clinical trial, a phase two B clinical trial just at the end of last year here in the United States and in several other countries around the world through this year, which is testing and novel new contraceptive gel for men. This is a really exciting development, um, that combine anestarhone, which is the chemical entity actually in the content of vaginal ring that contributes to sperm suppression. And we've combined it with testosterone, which will deal with some of the side effects that have derailed previous attempts to develop a male contraceptive. So we're currently enrolling 400 couples around the world in this clinical trial, which is the test of safety and efficacy of this new contraceptive gel. And it's developed and generated enormous amount of interest and conversation, um, both within the community but also just in, in the general public as these trials have been launching. I say initially here in the US and and earlier this year in the United Kingdom and in other countries, it's generating a lot of discussion and a lot of conversation, which is important. I think in hoping to create the market and the excitement for the fact that we do need more methods for women and for men.

Jennie Wetter: Yeah. And I think that's a good point too is the market right, is how is whether there's going to be a big um, increase in men who are interested in using it and women who want their partner to use it.

Julia Bunting: And I think it's both and certainly from the Population Council's perspective, we see it very much as, as one way in which we can truly start to address gender equality. If the responsibility, the contracepting is seen as something that is a woman's responsibility, I think we're always going to find gender equality being challenged. But I also think, and we know that men also want to control their own reproductive life. Men don't always want to become fathers and so they also had their own reproductive needs, often separate from a woman's needs. But the ability for men and women to be able to share that responsibility for parenthood, I think is something that we're really excited about. And again, to give men their own control but also to give women other options where they don't have to take that responsibility all for themselves.

Jennie Wetter: And I think that's such an important shift in the conversation because it has been the woman's responsibility for so long. And it's often really, um, I think back to my sex ed and you know, uh, was, was very much abstinence-only based, but um, you know, it's, it's on her, right? It's on your responsibility to say no and I think that has really kind of carried for a very long time. Um, so it would be really an important change in the conversation about men also taking control of their reproductive future

Julia Bunting: And men want to have that control. We've seen from the social science research that we've done that there are millions of men around the world who, who want to have their own control for this.

Jennie Wetter: Is there any chance we're going to see a product on the market anytime soon?

Julia Bunting: So the trial that we've just started, as I said, is a phase two B clinical trial that we're doing with partners. It's supported by NIH CD a so it's going to be at least 2022 before we see results from that trial. And then obviously we got further trials to do after that. So we're probably still five to 10 years away from actually having a product in the marketplace, assuming that this trial continues in the way that we hope that it will.

Jennie Wetter: So it's nice to hear things are being tested and it's moving forward. Um, even if it is still ubiquitous five years. And so right now keep looking at everything that's happening in the US but also globally, it's really kind of an uncertain time around reproductive health. And so what do you see that meaning for the future of contraceptive care?

Julia Bunting: So I'm an optimist by heart and I think when we look at the development of contraceptive of biomedical research and development, this is a long game. I mean the the development of Annoversa took us 20 years from the idea through to having a product approved and hopefully available in the market place later this year. So we very much play the long game and we know that the politics changes. We know that the funding environment changes and we know what's needed. And so we continue to do science, we continue to use evidence, we continue to ask people about what they want and what they need and we continue to develop products to meet those needs because we know no matter what the politics is saying, women, men and young people want the ability and deserve the right to be able to control their own reproductive health.

Jennie Wetter: It's interesting and maybe a little bit of a sidetrack we can go down. Um, so what have you been seeing that people are saying they want?

Julia Bunting: We know that women, men and young people want to, I mean a range of different methods. As we said earlier, different women in particular need different methods at different point in their lives. And I think it's both about developing not only sort of individual contraceptive products, but work that we're also doing that I'm really excited about in developing what we call multipurpose prevention.

Jennie Wetter: Ah, you read my mind. I was actually just going to ask you about that. I think that's one of the things you don't hear about in the, in a US context as much as part of the conversation. But I know it's something we talk about a lot in the global side. So can we talk a little bit about what do we mean when we talk about multipurpose prevention technology?

Julia Bunting: So multipurpose prevention technology is a concept that describes a single product that addresses, as we say, more than one indication. So the kind of holy grail of, of an NPT as we call it, would be a product that prevents unintended pregnancy, also against HIV would prevent something like human papilloma virus, the virus that causes the VICRYL cancer and things like herpes simplex virus. So it's about having the drugs that you need in a delivery system, whether it's in a vaginal ring or a, a micro-ray patch or a fast dissolving insert that can provide protection against two or more of those indications. And we're excited about some of the work that we're currently doing to develop what will hopefully be the first, uh, multipurpose prevention technology on the market, which is combining an existing oral contraceptive pill with an existing, uh, oral pre-exposure prophylaxis that would prevent against HIV. So we're doing some work at the moment. It was just announced, uh, at the International Conference on Family Planning in Kigali in Rwanda at the end of the last year that the Children's Investment Fund Foundation in the UK is supporting us to do the development of this product.

Jennie Wetter: That's great news and for some reason I think I did not hear that. So that's extra exciting.

Julia Bunting: Well we're happy to share information about that because it is a really and a much needed development and we're doing this in this way with, see the sort of two oral pills in order to be able to create a market and test the demand for it. But ultimately we can imagine that you would want to provide those drugs in, in different formulations and through different delivery systems. I say through a vaginal ring or through an implant or fast dissolving inserts. And I think it's a really exciting opportunity to provide a single product that meets a that meets the needs of women in a single way. I mean, I think we, we see too often that our, our roles and our needs are divided and we've heard a lot about that this week here at Women Deliver is, is women's lives aren't siloed. We don't want HIV prevention on Monday and contraception on Tuesday and other things on Wednesday. We, we need those things to live our real lives. And so the chance to develop products that meet women's real lives is, is a really exciting opportunity.

Jennie Wetter: Yeah. And it's so important because we do often talk about it in a siloed way. We talk about, you know, HIV as its own thing and you start, there's the integration conversation is happening better than than it has in a very long time. But there are complications as well with um, things like the global gag rule that are preventing how it's being delivered on the ground. So it's great to see projects that are moving forward to try and come up with these multipurpose prevention technologies that are coming, and bringing everyone's lived experience together in one place so that you can not only prevent pregnancy but also maybe prevent, um, HIV.

Julia Bunting: Absolutely.

Jennie Wetter: OK. So we always looked to and our conversations in a place of hope, but you know what, this conversation was actually one of the more hopeful conversations I've had because normally we were talking about terrible policy or restrictions or all these other things that are happening. So talking about new methods is actually a really positive and really exciting conversation. So I think that's really important. So let's take a minute for hopeful positive conversations in the chaos. But also we always love to talk about what can listeners do. So what can listeners do? What action can they take to help to help you guys?

Julia Bunting: I think the most important thing people can do is to share their views on, on what they want a, as funding decisions are made about what to invest in and what not to invest in. We need to hear voices from people who are using these products. We actually have a survey that we've been uh, out on the website for about the last year or so that's literally asking women, what do you want, what methods do you want, what different needs need to be met. So I'd love to be able to share that with you and maybe have you put a link out for us so that we can hear real people's real voices about what they want and then we can use that to advocate for meeting those needs.

Jennie Wetter: Absolutely. We'll make sure to share the link on social, but we also put it in our show notes so that way all of our listeners can let you know what they want. Fantastic. Well that's what we need hear. Great. Well Julia, thank you so much for doing this. This is when a lot of fun.

Julia Bunting: Thanks Jenny. It's been a pleasure.

Jennie Wetter: For more information including show notes from this episode and previous episodes, please visit our website reprosfightback.com. You can also find us on Facebook and Twitter at rePROs Fight Back. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening!

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