Global Pulse Blog

Today, the second annual International Conference on Family Planning (ICFP)  in Dakar, Senegal began. This conference is co-hosted by The Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health and the Ministry of Health and Prevention in Senegal to bring together participants to share research, best practices, and progress on national strategies to deliver family planning services, with the ultimate goal of universal access to family planning.

Currently, over 215 million women worldwide want but do not have access to family planning tools. “We’ve made a lot of progress in putting maternal health on the global agenda; now we must call on leaders to put family planning on their to-do list. Every individual deserves this – women, men, and young people,” said Jill Sheffield, President and Founder of Women Deliver.

These speakers reinforced the importance of the demographic dividend – the concept that health and social development, enabled by full access to contraception, are inextricably linked with strong economic growth. They provide examples of success in Asia, where declining fertility, spurred by rising contraceptive use, have led to increased education, improved health, and market-driven economic policies which have allowed for significant income growth.  With an expanded world population of over seven billion, “Now is the time to prioritize family planning – as a strategy to reduce maternal mortality, to improve the lives of women and their families, and ultimately, to enable broad and enduring economic development,” said Dr. Amy Tsui, Director of the Gates Institute for Population and Reproductive Health, Professor at Johns Hopkins Bloomberg School of Public Health, and a lead conference organizer.

To proceed into the future, investments must be made in the health sector maintaining adequate numbers of midwives, OB/GYNs, facilities, etc. and examining past successes around the globe. As Hon. Stephen O’Brien stated, “having a child should bring joy” not dying in childbirth and women must be able to plan for the future. Family planning is smart and cost-effective. As Dr. Osotimehin stated, we must empower young people to take control of their futures along with the future of their countries and make sure that economic and social justice drives this process. Issues of family planning are issues of human rights.

According to Judy Manning from USAID, their priorities include: 1) Improve existing methods to make them more acceptable, easier to use and more affordable like injectable forms of contraceptives. 2) Develop new contraceptives to fill gaps such as duration of effectiveness between 3 month injectables and 5 year inserted rings. 3) Develop technologies that simultaneously prevent pregnancy, HIV & other STDs like the silk diaphragm which delivers tenofovir.

Clearly there is an immense need for family planning access, affordability, and effectiveness. Fortunately, there are also attainable solutions. Meetings such as ICFP brings together a wealth of scientific knowledge, family planning experience, and critical discussions to help ensure that universal access to family planning becomes a reality.

Figure 1.

For the first time in the 15 year-long search for an HIV prevention method that women can control, a vaginal microbicide gel called Viread has been shown to decrease the risk of HIV infection by as much as 54%.  Even though the microbicide does not prevent transmission in every woman who uses it, this is the first promising tool that women are able to use without the cooperation of the male partner.  This is an important consideration most of the new HIV infections in women living in Africa were acquired through forced sex with infected men who refuse to wear condoms. Women and girls represent 60 percent of the 22 million people infected with HIV living in Africa.

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Britain’s Medical Research Council (MRC) announced that the Pro 2000, a vaginal microbicide gel, was ineffective in preventing the spread of HIV infection in a trial conducted in four African counties. PRO 2000 works by inhibiting the entry of HIV into cells .The trial was sponsored by the Microbicides Development Program (MDP), a not-for-profit partnership of 16 African and European research institutions took place between September 2005 and September 2009, involved 9,385 women .

Sheena McCormack, who led the trial, was disappointed in the results because a smaller trial held earlier, indicated that that the results for the current larger trial would be different from what they were. The smaller trial included more than 3,099 women and was funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH. The sites include 6 countries in sub-Saharan Africa and one site in the United States. The results of the smaller trial were presented at the Conference on Retroviruses and Opportunistic Infections in Montreal, Canada in February. These results indicted that the Pro 2000 gel would reduce transmission rated by 30 %. Earliers this year, ENDO Pharmaceuticals purchased the PRO 2000 from Indevus Pharmaceuticals.

Currently, women make up half of all people worldwide living with HIV and in sub-Saharan Africa, women represent nearly 60 percent of adults living with HIV.

In most cases, women become infected with HIV through sexual intercourse with an infected male partner. Manufacturers were hoping that this microbicide would be a potential solution for hose whose partners refuse to use condoms and could have empowered women with a prevention method they could initiate. Even though this microbicide failed to prevent the spread of HIV, scientists have not given up hope, as here are currently dozens of microbicides being tested. A previous post on the Global Pulse Blog discusses the debates that have taken place about the role of microbicides on HIV prevention.

A recently published article in the Economist reveals an experimental new technique to combating malaria.  The problem with many existing pesticides aimed at reducing the number of mosquitoes is that they quickly evolve resistance.  To circumvent this problem researchers are testing a fungus which takes 10-12 days to kill infected anopheles mosquitoes.  Because the fungus kills its host after it has had time to reproduce, there is far less evolutionary pressure to develop resistance.  The plasmodium parasites require several days to infect mosquitoes (they are not present in the mosquito at birth, but must be acquired by biting an infected person) and grow to maturity.  The fungal insecticide aims to kill adult mosquitoes before the plasmodium protozoans can mature, but after the reproductive cycle of the mosquito.  If it works, researchers estimate that it could reduce infectious bites by up to 95%.

There has been a recent renewed focus on HIV prevention methods, especially in developing nations. One such method which, like the female condom (see Global Pulse Blog March 18th), microbicides are a potential method of empowering women to help prevent the spread of the HIV virus.

A March 12th discussion on US National Public Radio explores the continuing debate over the roll of microbicides in the fight against HIV.

In one recent study, presented at the Conference on Retroviruses and Opportunistic Infections in Montreal found results that, while not statistically significant, are believed to be promising especially when the microbicide gel was used consistently. The gel worked to prevent HIV in 30 percent of the women who tried it in this study.

Be sure to check out the entire discussion over this controversial HIV prevention method.