During one of Duke’s wellness days, Kate Rademacher and Rebecca Callahan from FHI 360 presented the work being done at FHI 360 related to contraceptive development and accessibility/ acceptability in low- to middle- income countries (LMIC). As a part of FHI 360’s Contraceptive Technology Innovation Team and a public health scientist, Rebecca Callahan researches new contraceptive methods and product availability; As a technical director for the LEAP Initiative for FHI 360, Kate Rademacher supports the development of long-active contraceptives for low resources settings.

At the start of the panel, Dr. Callahan introduced the research being done in FHI 360, exploring different forms of existing contraceptives and how they differ in use world-wide. Notably, she focuses on contraceptive usage in LMIC and discusses how for contraceptives to be properly received by these populations, they must have qualities like “safe and effective”, “discreet”, “low cost”, etc. Because contraceptive development is not as profitable for larger pharmaceutical companies, FHI 360 engages research for the regulation, development, and acceptability of contraceptive globally as a NGO through funding from sources like the US government. Recently, the  Contraceptive Technology Innovation Team has been working on a longer-acting injectable that lacks for 6 months through subcutaneous injection, and, most challengingly, has a predictable return to fertility. They’ve also been working on a biodegradable implant that has a 18-24 month of efficacy, easy administration, and a zero-order release profile. Lastly, they’ve been researching microneedle patches for contraception that would target contraceptive steroid hormones to the dermal versus the subcutaneous space and that could be self-administered. Across all of these contraceptive products, the team engages in their acceptability to ensure their use upon product development completion.

Next, Kate Rademacher explores how the levonorgestrel-releasing intrauterine system (a hormonal IUS) is not as widely available in LMIC. She notes how despite its popularity in the United States, there are dramatic research and acceptability gaps and a global level. To approach this problem, multiple NGOs and research organizations have come together in the Global Learning Agenda to collaborate in exploring acceptability and acceptability of the hormonal IUS. Rademacher notes how an important element of introducing hormonal IUS is counseling menstrual changes as normal, and can even be perceived as a health benefit. Across this discussion on the barriers to hormonal IUS usage in LMIC, she emphasizes how it is so important to have initiatives that focus on translating research to real-life application and making it practical and applicable to a larger population.

During the question section, the panelists discuss how COVID has changed not only contraceptive method choice but also provider training, creating a problem for family planning and reproductive health. They also explore how their work seeks to increase interest from pharmaceutical companies to develop these contraceptive methods and also reflect on the ways that this pipeline can result in global disparities in acceptability, as demonstrated by Rademacher’s presentation.

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