There is controversy about which African country contains the “true” birthplace of humankind. I’ve recently returned from Kenya, where the citizens take pride in this distinction and their country. I was part of the invitation-only “Contraception Innovation Lab: Kenya” sponsored by the Bill and Melinda Gates Foundation (BMGF) and organized by FHI360. The organizers brought together healthcare providers, researchers, design experts, advocates, artists and experts in human sexuality for a “hackathon” style workshop to completely rethink contraception. Using a human centered design process, facilitated by the design group Quicksand from India, the goal was to completely rethink contraception rather than just trying to make minor changes around the edges to make existing methods better.
Globally there are 225 million women who want to prevent a pregnancy for at least 2 years but aren’t using a form of modern contraception. In the public health world, we can that an “unmet need” for family planning. We often assume this is because women don’t know about contraception or can’t access health facilities or due to frequent documented stock-outs of contraceptives in developing countries. While these factors contribute to this unmet need, the most common reasons cited for not using contraceptives include fear of side effects, infrequent sex, post-partum or breastfeeding and partner opposition. All of these issues could be addressed with better options for contraception.
Even in the US, where (as of now) we have fairly good access to and awareness of contraceptives, there are 3.4 million unplanned pregnancies every year. In my clinical practice, I see women everyday who have tried multiple forms of birth control and have not been happy with any of them. And efforts to develop male contraceptives have been stymied by men's unwillingness to accept the side effects that women deal with everyday. Big pharma companies have stepped away from innovation in contraception (and women’s health more broadly) preferring to focus on high profit markets like diabetes, cancer or Alzheimer’s. This leaves a handful of scrappy biotech companies and the critical support of a few donors like the BMGF to support this innovation.
BMGF has identified three high risk target groups for whom existing contraceptive methods aren’t acceptable:
Women who have achieved their desired family size and who therefore need a highly effective and long acting (or permanent) method
Women who are concerned about side effects with current (particularly hormonal) methods – either because they’ve had side effects or have fears of side effects
Young women 15-19 who need discretion and easy access to methods
Over the course of the workshop, the “ideators” (as we were called) were taken through a human centered design process that included visits to the local community and reviewing field research done by the organizers prior to the workshop and multiple ideation sessions based on the information we learned. The goals articulated by BMGF were to come up with ideas that would exponentially increase update of contraceptive methods, dramatically improve the experience of women using the methods and would be technically feasible to develop.
The group ultimately came up with 115 (!) unique ideas for new contraceptive methods which were narrowed down to the best 14 ideas on the final day. I am hopeful that one of more of these ideas will be developed with funding from BMGF and other donors interested in ensuring more women have access to a contraceptive method that works for them.
For more information about the range of contraceptive methods available in the US – including the pros and cons of each, check out bedsider.org.