Combining health and social protection measures to reach the ultra ...

Research resourcesPartnerships offer promise indeveloping systemic methodsof male fertility regulationArticle by Kirsten M Vogelsong (pictured), Henry L Gabelnick and Eberhard NieschlagIn response to the Programme of Action approved by 179countries at the International Conference on Population andDevelopment (ICPD) held in Cairo in 1994, an increasingemphasis is being placed on free reproductive choice, genderequity and greater male participation in sexual and reproductivehealth and family planning programmes worldwide. Onemeans by which to promote partnerships with men in familyplanning is through increasing options by the development ofsafe, effective and acceptable methods of contraception formen to use.Men around the world, in a variety of countries and settings,are aware of the existence and use of methods of familyplanning; many support their sexual partners in using thefamily planning methods of their choice. On a global level, ofthe more than one billion married women of reproductive age,approximately 60% are using any method of family planning.Most of these women report using methods that theythemselves initiate, with fewer couples relying on the use ofcondoms (about 5%) or vasectomy (about 3.5%) to planwhether and when to have children. However, these numberspresent a limited view of male participation in contraceptivebehaviour, since traditional methods like rhythm andwithdrawal (each relied upon by approximately 3% of marriedwomen of reproductive age) also require the male partner’scooperation. Significant country and regional differences in therates of use of these methods do exist, with vasectomy,condoms and withdrawal all used by a higher proportion ofcouples in more developed regions of the world 1 .At least 120 million couples around the world do not use anymethod of family planning, despite a desire to avoid apregnancy. This unmet need for family planning is especiallyapparent in the developing world and is probably symptomaticof a variety of shortcomings in the available health care systems(lack of knowledge about contraception, lack of services ortrained medical personnel, limited supplies) as well as thelimitations of the methods themselves including real orperceived health effects, and personal and cultural objections tothe use of existing contraceptive technologies.In early 2007, the All Party Parliamentary Group onPopulation, Development and Reproductive Health of theUnited Kingdom launched its report Return of the PopulationGrowth Factor – Its Impact Upon the Millennium DevelopmentGoals. The evidence gathered and reported by this groupdemonstrates that it is essential to address and meet theincreasing needs for family planning worldwide, in order toachieve these international goals. The recommendationsinclude promotion of gender equality and sustained provision ofcontraceptive commodities 2 .The World Bank, too, has recently presented updatedevidence linking population and development and has againcommitted to working with government, country and UnitedNations partners to address family planning issues at thehighest levels of country policy-setting 3 .Traditionally, women have assumed the responsibility forfamily planning. However, many women do not have access tothe most effective methods, find their side-effects intolerable, orwould simply prefer to share this role with a partner. For theirpart, a significant proportion of men report a willingness to usea method to regulate their own fertility in repeated surveys invarious countries and settings, with the most recent researchconducted in Europe, the USA, Latin America and Indonesia 4and the UK, China and South Africa 5 . The Programme ofAction from the ICPD calls for increased research to developmale methods, in order to better meet individuals’ needs andrights in reproductive health 6 .For more than three decades, the public sector has beenworking in collaboration with major pharmaceuticalcompanies, small independently-owned companies, not-forprofitorganizations and academic scientists on a researchagenda geared towards the development of safe, effective andacceptable methods to regulate male fertility. Since familyplanning programmes that offer a wider variety of methods aremore successful in meeting the contraceptive needs of couples,making a method available for men to use could address theneeds of a significant number of couples who are not using anymethod, or who are unsatisfied with the methods available.Successfully regulating male fertility can be achieved byexploiting one or more of several aspects of male reproduction,as long as sperm are prevented from reaching an egg in awoman’s reproductive tract. Following the resurgence incondom promotion associated with the public healthemergency of the HIV/AIDS pandemic, improved condomshave been developed, using innovative designs and alternativematerials, with the goal of increasing acceptability and,therefore, use 7,8 .In addition, researchers and small companies have128 ✜ Global Forum Update on Research for Health Volume 4