New contraception review article redistributes reproductive responsibility
- FHS Communication
Contraception has transformed women’s lives for more than fifty years. Yet despite its unquestionable impact, unplanned pregnancies are rising, with half of all pregnancies worldwide being unintended.
Researchers of the review article Biomedical innovations in contraception: gaps, obstacles, and solutions for sexual and reproductive health, published in The Lancet, have identified systemic failures in global contraception. The article also presents promising scientific solutions and advocates for change that will enable these innovations to improve people’s lives and advance reproductive rights.
91¿´Æ¬Íø' contributing researcher and Director of Clinical Trials at 91¿´Æ¬Íø RHI, Professor Thesla Palanee-Phillips, says that prioritising innovations in contraception is necessary because gaps in existing methods remain inadequately addressed. Although innovation alone cannot be the solution, it is a critical pathway for expanding autonomy and improving reproductive outcomes. “We prioritised innovations because the science is advancing in ways that can directly address longstanding gaps, improving acceptability, expanding choice, and shifting burdens to enable greater equity and reproductive autonomy,” she explains.
The social cost of limited options
Some 259 million women who are avoiding pregnancy choose not to use contraception due to concerns about hormonal side effects and the high cost of alternative methods. Up to half of women discontinue oral contraceptives within a year.
She explains that such systemic failures highlight the urgent need for acceptable, accessible, and user‑centred technologies. However, she stresses that designing methods that are not only clinically effective but also affordable, easy to use, and culturally acceptable takes time and extensive user‑experience research.
Despite rapid scientific advances, the translation of non‑hormonal contraceptives into accessible products and investments is often delayed. This is partly because hormonal methods were historically prioritised, a legacy that continues to reinforce structural barriers. Other factors, such as misinformation and inequitable healthcare, have also stalled uptake and rollout.
“There are several interconnected reasons why accessible non‑hormonal contraceptive methods have been slow to reach users, despite the clear demand and scientific progress underway,” she says.
Limited investment and slow translation of science into products have left many non‑hormonal options stuck in early development due to a lack of funding, regulatory work, and manufacturing capacity before they can be delivered at scale.
She adds, “When health systems themselves are constrained by stigma, low funding, or political resistance, new contraceptive options, particularly those that shift traditional gender roles, face delayed adoption.”
Global unmet needs
Access to contraception is shaped by gender norms, cultural expectations, religious beliefs, restrictive laws, misinformation, and inequities in healthcare. In some parts of the world, unintended pregnancy rates are significantly higher, ranging from 36 per 1 000 women in Western Europe to 283 per 1 000 in Central Africa.
These figures reflect deep social inequities that innovation alone cannot resolve. For example, anti‑abortion and anti‑contraception policies in many countries continue to restrict access, funding, and education. The impact ripples through society, driving increases in unplanned pregnancies, unsafe abortions, and maternal mortality.
“These constraints drive persistent gaps in contraceptive use across regions and populations by limiting access, shaping demand, and reducing people’s ability to make informed choices,” she says.
Transformative contraception
There is now a growing selection of male contraception innovations. “This could redistribute reproductive responsibility and provide meaningful choices to groups historically excluded from contraceptive development, including men, young people, and transgender individuals,” says Professor Palanee-Phillips.
New hormonal combinations such as the NES/T gel have shown the ability to suppress sperm levels by 88 to 89 per cent in trial participants, without serious side effects.
Other non‑hormonal methods are also making rapid progress. Studies show that soluble adenylyl cyclase (sAC) is a viable option for on‑demand contraception. This has the potential to reverse the burden imposed by gender norms by creating opportunities for couples to negotiate shared responsibility and giving men greater agency over their reproductive choices.