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From "The New York Times"

Birth Control Over Baldness

By Nicholas D. Kristof

Over the next decade, some astonishing new technologies will spread to fight global poverty. They’re called contraceptives.

This is a high-tech revolution that will affect more people in a more intimate way than almost any other technological stride. The next generation of family planning products will be cheaper, more effective and easier to use — they could be to today’s condoms and diaphragms what a smartphone is to the bricklike cellphones of 20 years ago.

Contraception dates back to ancient Egypt, where amorous couples relied on condoms made of linen. Yet after three millennia, although we can now intercept a missile in outer space, we’re often still outwitted by wandering sperm.

Largely, that’s because research on contraception is pitifully underfunded; if only family planning were treated as seriously as baldness! Contraception research just hasn’t received the resources it deserves, so we have state-of-the-art digital cameras and decades-old family planning methods.

The situation is particularly dire in poor countries, where some 215 million women don’t want to get pregnant yet can’t get their hands on modern contraceptives, according to United Nations figures. One result is continued impoverishment and instability for these countries: it’s impossible to fight poverty effectively when birthrates are sky high.

Yet impressive new contraceptive technologies are in trials and should address this problem. These new products are expected to hit the market in the coming years, in the United States as well as in the developing world.

One is a vaginal ring that releases hormones. There is already such a ring on the market, but it lasts only one month. The new one lasts a year and is being developed by the Population Council, an international nonprofit that researches reproductive health.

This new ring has completed phase III trials on more than 2,200 women in the United States and abroad, and is highly effective, according to Ruth Merkatz, who directs clinical development of the ring for the Population Council. She said that women found it easy to insert the ring themselves, which is crucial in poor countries where there are few health workers. The women’s sexual partners were often unaware of the ring in the trials, and if aware they were untroubled by it, Ms. Merkatz said.

Just as important for accessibility, the rings are likely to be cheap. John Townsend, director of the reproductive health program at the Population Council, estimated that the cost in developing countries would eventually be $5 to $10 for a year of contraception.

Researchers are also beginning to test the rings with other medications. For example, adding a microbicide to the rings may help prevent the spread of H.I.V. and other sexually transmitted infections. Also, researchers are testing whether adding a slow-release compound to a vaginal ring could reduce the risk of certain cancers. Population Council researchers are experimenting with one compound that they say seems to protect breast tissue from cancer.

Another new contraceptive that could have far-reaching impact is the Sino-implant (II), a tiny pair of rods inserted just under the skin (typically in the arm) to release hormones. Other implants are widely used, but one great advantage of the Sino-implant is that it can last four or five years and costs $3 a year or less.

This implant is already on the market in China and Indonesia — 100,000 units were distributed last year — with no safety issues so far. The only drawback is that it requires a trained health worker to insert and remove the implant.

My hunch is that at this point, female readers are seething and muttering something like: Where’s the progress if a woman still has to pump herself full of hormones to avoid pregnancy? Where’s the burden-sharing with men?

That’s a fair point, for the pharmaceuticals developed for men in the reproductive health arena are less about responsibility and more like ...Viagra.

Still, I’m happy to report that there are some nifty new technologies in the works for men. One from India is a reversible sterilization. It’s an injection that hardens to create a plug in the duct carrying sperm. To reverse it, a health worker injects a solvent that dissolves the plug. The plan is to introduce this on a broad scale in the next few years.

Meanwhile, researchers in France are developing special male underclothing to raise the testes snug against the body and elevate their temperature, in effect cooking the sperm so that they are infertile. A report for the Bill and Melinda Gates Foundation says that these “suspensories” provided “long-acting, reliable contraception in multiyear clinical trials, with no impact on testosterone.”

Family planning has long been a missing — and underfunded — link in the effort to overcome global poverty. Half a century after the pill, it’s time to make it a priority and treat it as a basic human right for men and women alike around the world.

September 25, 2010


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