In 2012, 85 million women on this planet became pregnant when they did not intend to. Unintended pregnancy reflects barriers to contraceptive access and use as well as dissatisfaction with currently available contraceptive options. Despite the family planning revolution that began with the contraceptive pill half a century ago, an estimated 222 million women have unmet need for modern contraception in the developing world . To meet this need, a range of contraceptive products must be widely available at low or no cost.
Gynuity’s work in this area encompasses research and as well as novel approaches to contraceptive technology development. We also aim to further the dialogue about the interconnectedness of contraception and abortion. Both options allow women to limit or control fertility, yet they are often seen as completely separate. Exploration of the common pathways to use of abortion and contraception can be useful to women’s health advocates.
Contraception after Medical Abortion
Since many women do not return for follow-up visits after medical abortion, the surest or even the only opportunity to initiate clinic provided contraception may be when the abortion pills are provided. However, administration of contraceptives containing progestin hormones could, in theory, reduce the efficacy of the abortifacient drug mifepristone, which is an antiprogestin – or the antiprogestin could decrease the efficacy of the contraceptive. To address these concerns, Gynuity Health Projects conducted two clinical trials each comparing immediate to post-abortion initiation of a progestin-based contraceptive one used etonogestrel implants and the other study depot medroxyprogesterone acetate. The trials were conducted in Mexico and the United States.
Neither trial found an appreciable increase in risk of surgical intervention in women who received the contraceptive with the mifepristone, although immediate injection of DMPA did slightly increase the ongoing pregnancy rate. Timing of contraceptive initiation did not significantly reduce pregnancy rates at six months after the abortion in either trial. Women in both trials strongly preferred immediate contraceptive administration. Based on these results, standard protocols at both Planned Parenthood Federation of America and the Mexican Ministry of Health now allow administration of both methods at the initial medical abortion visit with appropriate counseling.
Exploring Innovative Uses and Delivery of Existing Contraceptive Technologies
Gynuity looks for innovative ways to shorten or even bypass the long clinical development and regulatory pathway which is required for all new pharmaceutical products by adapting the use of already approved and established products.
In collaboration with PATH, the Reproductive Health Technologies Project, WHO, and other partners, Gynuity assessed options for bringing an “on-demand” oral contraceptive pill to market. Data indicate that such a method – a pill that is taken before or after sex to prevent pregnancy – is appealing to women in many settings who are not adequately served by currently available methods. Our project concluded that the Article 58 pathway of the European Medicines Agency would likely be the most efficient regulatory pathway to approval of such a method in developing countries. Additional clinical data would be needed to establish safety and efficacy. A “real life study” that assesses the risks as well as the benefits of introducing the method into selected target settings would be extremely useful in informing decisions about whether and how to develop this method further.
Training and Technical Assistance
Two Gynuity staff members sit on the Steering Committee of the Oral Contraceptives Over-the-Counter (OCsOTC) Working Group, which seeks to explore the potential of over-the-counter access to oral contraceptives to reduce disparities in reproductive health care access and outcomes, and to increase opportunities for women to access a safe, effective method of contraception, free of unnecessary control, as part of a healthy sexual and reproductive life.