The "contraceptive revolution" of the 1960s and 1970s introduced totally new contraceptive options and launched an era of research and product development. Yet by the late 1980s, conditions had changed and improvements in contraceptive products, while very important in relation to improved oral contraceptives, IUDs, implants, and injectables, had become primarily incremental. Is it time for a second contraceptive revolution and how might it happen?

Contraceptive Research and Development explores the frontiers of science where the contraceptives of the future are likely to be found and lays out criteria for deciding where to make the next R&D investments.

The book comprehensively examines today's contraceptive needs, identifies "niches" in those needs that seem most readily translatable into market terms, and scrutinizes issues that shape the market: method side effects and contraceptive failure, the challenge of HIV/AIDS and other sexually transmitted diseases, and the implications of the "women's agenda."

Contraceptive Research and Development analyzes the response of the pharmaceutical industry to current dynamics in regulation, liability, public opinion, and the economics of the health sector and offers an integrated set of recommendations for public- and private-sector action to meet a whole new generation of demand.

Contents

• Committee On Contraceptive Research And Development
• Acknowledgments
• Summary
  • The Existence of Need and Some Fundamental Concepts
  • The Prospects Of The Science
  • Translating Unmet Need into Market Demand
  • Toward a More Temperate Climate
  • Closing Comment
• Introduction
  • The First Contraceptive Revolution
  • The Changing Structure of Contraceptive Needs
  • New Concepts: Reproductive Health And The "Woman-Centered Agenda"
  • Contraception and Sexually Transmitted Disease
  • The Need for a Second Contraceptive Revolution
  • The Environment for Contraceptive Research and Development and the Objectives of this Study
  • Study Methodology
  • Report Organization
  • References
• 2. The Need and Demand for New Contraceptive Methods
  • Issues of Terminology
  • Market Demand
  • Calculating the Unmet Need for Contraceptives
  • Reproductive Preferences
  • Third-Party and Public Health Perspectives
  • A Life Span Perspective
  • Preferences and Intentions
  • The Consequences of Unintended Pregnancy
  • Involvement of Males in Contraception
  • Concluding Comment
  • References
• 3. Contraceptive Technology and the State of the Science: Current and Near-future Methods
  • Introduction
  • Current Options
  • Contraceptive Options For The Next Decade, 1995-2005
  • Concluding Comment
  • References
• 4. Contraceptive Technology and the State of the Science: New Horizons
  • A Strategy for Basic Research on Contraception
  • Approaches to New Contraceptives for Females
  • Approaches to New Contraceptives for Males
  • Approaches to Immunocontraception for Males and Females
  • Concluding Comment
  • References
• 5. The Market for New Contraceptives: Translating Unmet Need into Market Demand
  • Current Contraceptive Use
  • Specific Needs and Market Opportunities: The Limitations of Available Contraceptives
  • Consumer Perspectives
  • The Dimensions of the Market for Contraceptives
  • The Cost-Effectiveness of Contraception
  • Concluding Comment
  • References
• 6. The Translators: Sectoral Roles in Contraceptive Research and Development
  • The Role of Industry in Contraceptive Research and Development
  • Roles of the Public and Nonprofit Sectors in Contraceptive Research and Development
  • Concluding Comment
  • References
• 7. Issues of Law, Regulation, Information, and the Environment for Contraceptive Research and Development
  • Regulatory Influences on Contraceptive Research and Development
  • Legal Influences on Contraceptive Research and Development
  • The Role of Information
  • The Environment
  • Concluding Comment
  • References
• 8. Recommendations
  • The Prospects of the Science
  • Advancing the Science and Translating Unmet Need into Market Demand
  • Closing Comment
• Appendixes
  • A Female Methods
  • B Male Methods
  • C Immunocontraceptive Approaches
  • D Barrier Methods and Mucosal Immunologic Approaches
  • E Agendas and Participants in Committee Workshops
  • F Committee Biographies
• Glossary

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

This project was funded by the Contraceptive Research and Development (CONRAD) Program, the Andrew W. Mellon Foundation, the National Institute of Child Health and Human Development of the National Institutes of Health, the Rockefeller Foundation, and the United States Agency for International Development. USAID does not take responsibility for statements or views expressed in this report.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.