A Q&A with Dr. Régine Sitruk-Ware
Clinical research in contraceptive care has led to several new treatment options in recent years, but with many needs still unaddressed, researchers continue to seek alternative solutions. Dr. Régine Sitruk-Ware of the Population Council’s Center for Biomedical Research, recently named one of the 50 most influential people in health care in 2018 by TIME for her innovative work in female and male contraception, shared insights on how contraceptive care is evolving.
What recent advancements in the field of contraception are you most excited about?
A number of new methods for women have been approved in the past few years, including methods that give women more control and require less reliance on or visits to a healthcare provider. Excitingly, in August the FDA approved Annovera™, a single vaginal system providing one full year of birth control that can be inserted and removed by the user. As a first-of-its-kind option that gives women greater control of their contraceptive care, it marks an important step forward.
While the options available to women have increased, male contraceptive methods remain limited – mainly condoms, withdrawal and vasectomy. Expanding options for men will positively impact sexual health for everyone, so I’m pleased to see more studies focused on male users. For example, the Population Council and The Eunice Kennedy Shriver National Institute of Child Health and Human Development along with other research partners are currently recruiting for clinical trials of a gel contraceptive for men. Female partners of men in the study will not need additional contraception. The transdermal gel, Nestorone®/testosterone (NES/T), closely resembles natural hormones and offers a non-invasive, non-oral delivery system, which may minimize safety risks. Similar to Annovera for the woman, it gives the man more administrative control. I’m optimistic about the impact it could have. If approved, NES/T would expand contraceptive options for men and make family planning more of a shared responsibility between both sexes.
“We are seeing a shift in how couples are approaching responsibilities when it comes to contraceptive care. More and more, men – particularly those in committed relationships – are looking for ways to have an active role in family planning, and couples are deciding on solutions together based on their lifestyle needs.”
How do men and women view contraceptive care? What are they looking for in treatment options?
We are seeing a shift in how couples are approaching responsibilities when it comes to contraceptive care. More and more, men – particularly those in committed relationships – are looking for ways to have an active role in family planning, and couples are deciding on solutions together based on their lifestyle needs. While numerous studies have helped define the needs and desires of women, we don’t have the same understanding of male users. However, survey results confirm there is interest in hormonal contraception for men, particularly options that come in oral, injectable and gel form. Familiarity with female options seems to influence what men consider to be acceptable methods of delivery.
We also know that both men and women are most interested in finding an effective option that does not induce side-effects. However, in my experience women are more willing to accept minor side effects such as acne or headaches to avoid pregnancy. Men are less willing to accept inconveniences – they want options that come with zero side effects. The decision-making process is also impacted by cost and access to care, which varies greatly around the world.
Can you elaborate on challenges impacting user access to contraceptive care?
Access to contraceptive methods, particularly modern methods, is subject to several factors. Sometimes it’s an issue with supply – a couple finds a method that works for them, but the next month it’s not available at the local pharmacy. Cultural and religious beliefs also create barriers that limit access and impact willingness to use a particular method, but impacting cultural norms is a difficult and slow process. However, we can alleviate some access challenges by investing in research that leads to new options. For example, increasing the availability of user-controlled methods that require less frequent office visits can improve access and reduce the strain on the health system in markets where access to healthcare providers is limited.
What excites you most when you review ongoing studies?
We have an opportunity to help simplify contraceptive care and address user needs through innovation. I’m excited to see new non-invasive methods and more user-controlled options, such as gels as opposed to injections, which I think will have a positive impact on user willingness to use contraception. Clinical studies are also looking at the health benefits that new molecules and approaches can offer beyond contraceptive care, adding to the therapeutic value and likely increasing willingness of a couple to use a particular method and for a provider to prescribe it.
We continue to see improvements in contraceptive care and investment in finding new solutions, particularly from governmental organizations such as the NICHD and non-governmental, non-profit organizations like the Population Council. As we discover and develop new methods, we increase awareness of the contraceptive field and new research opportunities overall, which I hope will drive the pharmaceutical industry to invest in new research initiatives.