1. For FIGO Faculty Use Only. DO NOT COPY OR DISTRIBUTE.
At and Beyond the Horizon: New Technologies to Increase Choice and Address Unmet Need Panel on Unmet Need and Method Mix International Conference on Family Planning Addis Ababa, Ethiopia November 15, 2013
Jeff Spieler
Senior Technical Advisor for
Science and Technology
Office of Population and RH
Bureau for Global Health
USAID/Washington

2. For FIGO Faculty Use Only. DO NOT COPY OR DISTRIBUTE.
Topics in this presentation
Rationale for improved and new methods
At the horizon: Improved contraceptive technologies
LNG-IUS
Sayana Press (Depo subQ in Uniject)
SILCS Diaphragm
Woman’s Condom
Beyond the horizon: New technologies
NES/EE Contraceptive Vaginal Ring (CVR)
Biodegradable Contraceptive Implants/Pellets
Multi-Purpose Prevention Technologies (MTPs)
New contraceptive methods Still Needed
Future challenges

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Client-level reasons for non-use, women with unmet need for FP, 3 regions
Perceived subfecund, 2%
Unaware of methods, 4%
Health/side effects, 23%
No access/high cost, 8%
Infrequent sex, 21%
Postpartum/breastfeeding, 17%
Source: Darroch et al, Guttmacher Institute, 2011.

4. At the horizon (within 5 years): Improved contraceptive technologies
LNG-IUS
Sayana Press (Depo subQ in Uniject)
SILCS Diaphragm
Woman’s Condom

5. For FIGO Faculty Use Only. DO NOT COPY OR DISTRIBUTE.
The LNG-IUS: The best of both worlds
Highly effective/(when used correctly and consistently)
Reduction of menstrual loss
Reduction of pelvic inflammatory disease (PID)
Highly effective
No daily motivation
Long-acting (up to 5 yrs)
Estrogen-free
Rapidly reversible
Programs can apply to the International Contraceptive Access Foundation
for free donations of the LNG-IUS at see

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Change in hemoglobin during 5 years of use

7. Hormonal Intrauterine Contraceptive System

8. For FIGO Faculty Use Only. DO NOT COPY OR DISTRIBUTE.
New formulation of Depo-Provera: Sayana Press (Depo-subQ in Uniject)
Depo-subQ Provera 104:
New formulation for subQ injection
New name
30% lower dose (104 mg vs. 150 mg)
Rapid onset of action
Same effectiveness, same length of protection (>3 months)
Approved by USFDA (2005) and EMA/UK
Uniject:
Single dose, single package
Prefilled, sterile, non-reusable
Short needles for subQ injection – allows easier use by non-clinical personnel/CHWs
Compact; easy to use and store
Potential for home- and self-injection
Approved by EMA and LDC registration forthcoming
Available for roll-out in 2014; PK study on-going for injection in arm; acceptability studies completed 2013
Potential “home run” 8

9. Two new female barrier methods: SILCS Diaphragm and Woman's Condom
Image Credit: PATH/Patrick McKern.
Woman’s Condom
Image Credit: PATH/Patrick McKern.

10. Beyond the Horizon (5-15 years): New Contraceptive Technologies
New Technologies
NES/EE Contraceptive Vaginal Ring (CVR)
Biodegradable Contraceptive Implants/Pellets
Multi-Purpose Prevention Technologies (MTPs)
New contraceptive methods still needed

11. Nestorone® / Ethinyl Estradiol 1-Year Ring (Core Technology)
NES/EE Contraceptive Vaginal Ring (CVR):
First long-acting method that is user-controlled
Nestorone® / Ethinyl Estradiol 1-Year Ring (Core Technology)
NES Core
*Delivers NES/EE 150/15µg /day, cycles of 3 weeks on followed by 1 week off
FDA approval expected in 2015
Developed by the Population Council
Sponsored by USAID, NICHD, WHO
NES / EE Core
8.4 mm (3/8”) in cross section
58 mm (2 1/4”) in diameter

12. Biodegradable Contraceptive Implant/Pellet
Biodegradable Contraceptive Implant Pellets
Effective contraceptive placed under the skin
Similar to, but much smaller than, an implant
Easy to insert
Biodegradability would eliminate the need for removal at the end of one year BUT can be removed
Landscape analysis of manufacturers underway (FHI360)

13. Priorities for first-generation MPTs
“On demand” products:
Used at the time of intercourse
Appropriate for women who have intermittent sex, or who would like more direct control over their own protection
Sustained release products:
User-initiated, but do not require daily action
Should increase adherence, and therefore overall effectiveness

14. New Contraceptive Methods Needed
Some additional methods would likely have immediate application if they were of low cost:
Non-hormonal, non-steroidal and/or non-estrogen containing OCs, or novel progestin-only OCs
Non-surgical methods of male and female sterilization
A highly effective and safe vaginal spermicide
Post-testicular methods for men

15. For FIGO Faculty Use Only. DO NOT COPY OR DISTRIBUTE.
Future Challenges
Short Term – Improve programs and access, and help women successfully use current methods
Medium Term - Improve current methods to address reasons for non-use, e,g., reduce side effects and make methods easier to use, including confidentially and during breastfeeding
Long Term - Develop totally new methods to offer new approaches to contraception that address women’s reasons for unmet need and discontinuation