Bill & Melinda Gates Foundation

A Pill of Choice

February 20, 2013

The Oral Contraceptive has indeed come a long way since its first application way back in the sixties.  It totally transformed the landscape of sexual health and rights for the past six decades. We were involved back in the day with its invention with our Member Association, Planned Parenthood Federation America funding valuable research into its viability in the 1950s.  One of our brave founding mothers worked closely with Dr Gregory Pincus and Katherine McCormick to develop the first effective hormonal contraceptive. So, the advent of oral contraception in the ‘60s, in the form of The Pill, did indeed herald the ‘sexual revolution’.

So, why is the Pill so revolutionary?  Well, we know that the oral contraception is recognised as one of the most important medical advances of the 20th century, even though the quest for reliable contraception has been around through time and memorial.  The Pill enables women to control their reproductive cycles and separate sexual activity from child bearing. As a result they can realize the most basic human right, to choose the size and timing of their family. This empowers women to plan their families, their lives and to make choices that, all other things remaining equal, will make them happier.  For some women this could be making sure the kids go to school, or enable them to participate fully in educational and economic life which in turn keeps them above the poverty line.

 Women need a variety of oral contraceptives to choose from, as the health implications and suitability differs for each individual. So why should the range be limited because they live in a certain country?

The Pill sounds great, right? The Pill is a reliable method that empowers women and gives them the choices to define not only their own lives, but of their whole family. After all, family planning is the basic human right to decide freely and responsibly the number and spacing of ones’ children. So, this means that we have to put people first in any approach to family planning and this means taking their situation into context. But, this isn’t just about women being given a prescription or a packet of tablets to tick boxes. There has to be meaningful counselling and consultation about what method responds to her needs and what support she will need in order to make the method effective. We have a wealth of expertise in providing independent and unbiased, evidence based counselling to ensure that women are given the means to make responsible decisions about childbearing and about their sexual and reproductive health. In order, to be truly effective, family planning has to be rights-based, consistently available, appropriate, affordable and not forgetting accountable all who need it.

Despite impressive global gains, the uptake and usage of the oral contraceptive is uneven between global regions, between countries and even between socio-economic groups within countries. In short, we know that the oral contraceptive is wanted and needed but is all too often unavailable.

Securing access for the Pill should also reflect the populations it should serve.  Over half of the world’s population are young people living in the developing world, but many are unable to get the services to meet their needs. Young people need access to a range of different methods too. Many are concerned about stigma from service providers or a breach of confidentiality, preferring to visit a pharmacy, traditional healer or to buy from a shop. Temporary methods often then become the preferred option of choice in these circumstances. Social norms, provider attitudes and legal implications can inhibit young people’s ability to make informed choices. Laws on the age of consent to sex, requirements of parental or spousal consent to treatment and care for legal minors, present significant obstacles and create uncertainty among sexually active people. Take for example, Tanzania and Uganda where providers state that they will not serve anyone under the age of 18 even though there are no set laws that enforce this. This blocks empowerment in the most extreme way.  We need more advocacy to help remove legislative, policy, regulatory, cultural, economic and social barriers to enable young people to make informative choices free from fear.

Now let’s tackle the affordable and accountable. Technology developments now offer a range of family planning options, but while implants, intrauterine devices and monthly injectables have become the contraceptive choice for many women, oral contraceptives are the principle commodity of interest for the private sector.  The Pill accounts for 50 per cent of contraceptive sales globally. But, the pool of manufacturers is shrinking. How do we fix this?

One position could be to get manufacturers and governments to build the in-country capacity to manufacture generic contraceptives which pass quality control tests such as the World Health Organization’s pre- qualification programme or other stringent regulatory authorities’ quality control tests.   Locally produced generic contraceptives that have gone through an internationally recognised quality control process would open up local markets and meet local demand.  More support for generic manufacturers to pass the WHOs pre-qualification process needs to be addressed urgently.  But there has to be a strong political will to back this change. We need to work with governments to build the capacity of national regulatory authorities, so that they too get international recognition as Stringent Regulatory Authorities. This would be hugely beneficial, saving shipping time and costs as well as making savings for the person who needs the pill the most. There is so much potential to make this a reality in countries like Brazil, China, India and South Africa already. Just look at this from a choice perspective. Women need a variety of oral contraceptives to choose from, as the health implications and suitability differs for each individual. So why should the range be limited because they live in a certain country?

Oral contraceptives open up opportunities for women. Challenges relating to cost, bottlenecks in supply, tired health services, funding or training prohibit access, and as these issues relate to all contraceptive methods, they prohibit choice. Prohibiting access and choice undermines efforts for poverty eradication, health improvement and human rights and development. No one should be denied the same benefits that the developed world takes for granted.

As a community we are working towards the FP2020 target, of reaching  120 million women worldwide and meet their unmet need for contraception by 2020,  What the foregoing indicates is that we will achieve this (and it is achievable) one consultation at a time.  This means we need to work effectively, personally, on the ground, in a way which is culturally sensitive and understands the particular nuances of need.

IPPF has something special to offer when it comes to addressing that “one consultation at a time” construct, with Member Associations working in over 170 countries, through 65,000 outlets. Each Member Association knows the particular challenges that country and its people face. It knows how best to meet those challenges, it knows what resources are needed, when and where and why. Quite simply, it knows what works.

This knowledge is invaluable. It’s what will enable all of us – all the agencies involved in this great enterprise - to deliver more services, more efficiently and more effectively.  Critically, it’s knowledge which enables all of us to advocate authoritatively as we bring together civil society to drive forward the London Summit on Family Planning’s agenda.
 
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