Govt will biggest challenge for reproductive health

What percentage of the debate about reproductive health, relate to men? There is nothing new in the market in terms of contraceptive for men. There is research being done on male contraceptives. One of the leaders in that space is the Population Council – a research institute based in New York. They have for a […]

What percentage of the debate about reproductive health, relate to men?

There is nothing new in the market in terms of contraceptive for men. There is research being done on male contraceptives. One of the leaders in that space is the Population Council – a research institute based in New York. They have for a number of years now been working on male contraceptives and hormonal methods. It’s still very much experimental. There are hormonal patches which are in use. They come with various side effects in the initial trials that have been done. Right now there are only condoms and then vasectomy.

Why is it still difficult to get contraception for men, 50 years after it first came into the market?

There is interest and it is this interest that is playing out in groups like the Centre for Biomedical Research. I think that if you really look at the development of contraceptive technologies, there hasn’t been even among women, huge generation of new technologies, really. There have been improvements, modifications but still when you look at it, we’re still dealing with injectables, pills which have been around for decades. There are patches which is a relatively new technology. But by and large what is actually out there and being used are variations of methods that have existed since the 1970s and maybe even further back. I think there are a lot of reasons for that. The reality is contraceptives are not huge moneymakers. I don’t think there is necessarily the interest on the part of the manufacturing and pharmaceutical industry to spend huge amounts of money on new technologies. So it has been a hesitation, broadly speaking. Why it is less with male, my understanding is that in the case of male contraception it is more complicated because you are actually controlling the production of sperm which in my understanding is a bit more complicated when it comes to the use of hormones to deal with it as opposed to ovulation and other mechanisms of action for female contraceptives.

I think there is also concern, maybe even in the marketing, where the majority of women if they were in a situation of having unprotected sex feel comfortable trusting the male partner is using the method. If you really want to make sure you are not getting pregnant, you take matters into your own hands maybe within the context of partnership or a marriage, it’s a slightly different situation.

What is the motivation for the reproductive health campaign to be more inclusive of the younger generation?

I think what we’ve seen is a very unusual sort of trajectory in the growth of this space. When I became involved in this field in the 1980s that was a point when there were many people in my generation who were getting involved in family planning. It was being spoken of, funds were going into it. In the 1990s, there was a huge shift from family planning. There was a conservative government where reproductive health became a bad word. There was a lot of investment going into HIV/AIDs and many of the people who may have got their start in family planning in the early 90s were being sucked into this new area. So most people in this space left and began working on HIV. The vacuum was never filled. We carried on but the people coming in were often in other areas. The last eight years have been very good for the family planning community. We’ve seen a lot of support for family planning from a lot of western governments. I think as a result, we have seen an increase in the number of young people who are getting involved. With people of my generation getting to leave, it is important to make it clear that we need to move forward in this, to ensure that our positions are being filled by many of those who are coming into this space. When I spoke about young people getting involved in this, I was speaking less about their being the beneficiaries of the knowledge that comes out of family planning awareness and more about the responsibility we bare to ensure that those who are involved in family planning programs give way to younger generation of people who do the stuff that we do right now.

When you look at the language of the old, it is way different from that of the young. What do you think of them taking charge in advancing their knowledge and their take of family planning?

It is a different space than it was when we were there and I think we are increasingly seeing more and more people getting involved. The power brokers still remain, by and large an older generation. Gradually we are seeing the increasing role that is being played by young people. I think it is something that we are certainly behind.

Sustainability is a major issue and funding streams stop at some point. What are advice do you have for developing countries in terms of sustaining today’s efforts for the future?

We increasingly see that the vast majority of supplies being bought are being bought through the private sector. Public sector commodities financed by donor money makes up far less than half of all of the commodities. The reality is that it will probably stay this way. I think we’re going to see shrinking donor resources, we may see growing country government support for contraceptive procurement but I think by and large the tendency would be for the private sector to grow and out of pocket expenditures represent huge proportion of expenditures now.

There are lots of challenges identified by different groups in this space. What would you consider the singular biggest challenge of getting the help women need across to them?

To me, the biggest challenge is will and on the part of those in authority. I’m most familiar as of late in this space, particularly in the procurement area – we see many instances of national governments when they procure commodities absolutely convinced that all women want is one method, maybe two and that’s all they buy. But that’s not the case. Our research shows that you need to have a choice. If women are not using a method that meets their needs, discontinuation rates are high. That willingness to accept that there is breadth of needs I key and it is incumbent upon governments to recognise that. Otherwise we will still end up with this skewed method mix. There are other aspects to will. We in RHSC began an initiative called take stock. It is designed to help put in place programs to address the plague of stock outs of commodities. One of the things we have seen in many countries is almost to sort of in a way a kind of complacency that takes over. In the years we were in Nairobi we experienced stock outs with things like milk and sugar. For a lot of people the argument is why should contraceptives be any different? It’s a pin, it’s a nuisance but that’s part of life and I think that’s sort of the outrage that you need to say enough is enough. We need to really focus on dealing with this issue and we need to focus by putting the right money in place and making the systems are in place to ensure the commodities flow until the day comes when it becomes a priority and the will is there to move it. It’s not just a matter of throwing money at the problem. The solution depends on groups deciding that it is not just acceptable and we need to work together to address it.

PHOTO: Megan Christofield