Research to Improve
Fertility Control Technology
Information and Technology
In addition to creating the climate for fertility decline, as
described in a previous section, it is essential to provide safe and
effective techniques for controlling fertility.
There are two main elements in this task: (a) improving the
effectiveness of the existing means of fertility control and
developing new ones; and (b) developing low-cost systems for the
delivery of family planning technologies, information and related
services to the 85% of LDC populations not now reached.
Legislation and policies affecting what the U.S. Government does
relative to abortion in the above areas is discussed at the end of
The effort to reduce population growth requires a variety of
birth control methods which are safe, effective, inexpensive and
attractive to both men and women. The developing countries in
particular need methods which do not require physicians and which
are suitable for use in primitive, remote rural areas or urban slums
by people with relatively low motivation. Experiences in family
planning have clearly demonstrated the crucial impact of improved
technology on fertility control.
None of the currently available methods of fertility control is
completely effective and free of adverse reactions and objectionable
characteristics. The ideal of a contraceptive, perfect in all these
respects, may never be realized. A great deal of effort and money
will be necessary to improve fertility control methods. The research
to achieve this aim can be divided into two categories:
1. Short-term approaches: These include applied and developmental
work which is required to perfect further and evaluate the safety
and role of methods demonstrated to be effective in family planning
programs in the developing countries.
Other work is directed toward new methods based on well
established knowledge about the physiology of reproduction. Although
short term pay-offs are possible, successful development of some
methods may take 5 years and up to $15 million for a single
2. Long-term approaches: The limited state of- fundamental
knowledge of many reproductive processes requires that a strong
research effort of a more basic nature be maintained to elucidate
these processes and provide leads for contraceptive development
research. For example, new knowledge of male reproductive processes
is needed before research to develop a male "pill" can come to
fruition. Costs and duration of the required research are high and
difficult to quantify.
With expenditures of about $30 million annually, a broad program
of basic and applied big-medical research on human reproduction and
contraceptive development is carried out by the Center for
Population Research of the National Institute of Child Health and
Human Development. The Agency for International Development annually
funds about $5 million of principally applied research on new means
of fertility control suitable for use in developing countries.
Smaller sums are spent by other agencies of the U.S. Government.
Coordination of the federal research effort is facilitated by the
activities of the Interagency Committee on Population Research. This
committee prepares an annual listing and analyses of all government
supported population research programs. The listing is published in
the Inventory of Federal Population Research.
A variety of studies have been undertaken by non-governmental
experts including the U.S. Commission on Population Growth and the
American Future. Most of these studies indicate that the United
States effort in population research is insufficient. Opinions
differ on how much more can be spent wisely and effectively but an
additional $25-50 million annually for bio-medical research
constitutes a conservative estimate.
A stepwise increase over the next 3 years to a total of about
$100 million annually for fertility and contraceptive research is
recommended. This is an increase of $60 million over the current $40
million expended annually by the major Federal Agencies for
biomedical research. Of this increase $40 million would be spent on
short-term, goal directed research. The current expenditure of $20
million in long-term approaches consisting largely of basic
biomedical research would be doubled. This increased effort would
require significantly increased staffing of the federal agencies
which support this work. Areas recommended for further research
1. Short-term approaches: These approaches include improvement
and field testing of existing technology and development of new
technology. It is expected that some of these approaches would be
ready for use within five years. Specific short term approaches
worthy of increased effort are as follows:
a. Oral contraceptives have become popular and widely used; yet
the optimal steroid hormone combinations and doses for LDC
populations need further definition. Field studies in several
settings are required. Approx. Increased Cost: $3 million
b. Intra-uterine devices of differing size, shape, and
bioactivity should be developed and tested to determine the optimum
levels of effectiveness, safety, and acceptability. Approx.
Increased Cost: $3 million annually.
c. Improved methods for ovulation prediction will be important to
those couples who wish to practice rhythm with more assurance of
effectiveness than they now have. Approx. Increased Cost: $3 million
d. Sterilization of men and women has received wide-spread
acceptance in several areas when a simple, quick, and safe procedure
is readily available. Female sterilization has been improved by
technical advances with laparoscopes, culdoscopes, and greatly
simplifies abdominal surgical techniques. Further improvements by
the use of tubal clips, trans-cervical approaches, and simpler
techniques can be developed. For men several current techniques hold
promise but require more refinement and evaluation. Approx.
Increased Cost $6 million annually.
e. Injectable contraceptives for women which are effective for
three months or more and are administered by pare-professionals
undoubtedly will be a significant improvement. Currently available
methods of this type are limited by their side effects and potential
hazards. There are reasons to believe that these problems can be
overcome with additional research. Approx. Increased Cost: $5
f. Leuteolytic and anto-progesterone approaches to fertility
control including use of prostaglandins are theoretically attractive
but considerable work remains to be done. Approx. Increased Cost: $7
g. Non-Clinical Methods. Additional research on non-clinical
methods including foams, creams, and condoms is needed. These
methods can be used without medical supervision. Approx. Increased
Cost; $5 million annually.
h. Field studies. Clinical trials of new methods in use settings
are essential to test their worth in developing countries and to
select the best of several possible methods in a given setting.
Approx. Increased Cost: $8 million annually.
2. Long-term approaches: Increased research toward better
understanding of human reproductive physiology will lead to better
methods of fertility control for use in five to fifteen years. A
great deal has yet to be learned about basic aspects of male and
female fertility and how regulation can be effected. For example, an
-effective and safe male contraceptive is needed, in particular an
injection which will be effective for specified periods of time.
Fundamental research must be done but there are reasons to believe
that the development of an injectable male contraceptive is
feasible. Another method which should be developed is an injection
which will assure a woman of regular periods. The drug would be
given by pare-professionals once a month or as needed to regularize
the menstrual cycle. Recent scientific advances indicate that this
method can be developed. Approx. Increased Cost: $20 million