Contraception

Overview

Access to modern contraception is recognised as a fundamental human right, vital for safeguarding women’s health, well-being, autonomy, and equality. Despite the availability of various contraceptives, 218 million women have an unmet need for contraception globally, contributing to 111 million unintended pregnancies each year. Meeting women’s and men’s need for modern contraception would lead to a dramatic drop in unintended pregnancies, to 35 million, with 21 million fewer unplanned births and 26 million fewer unsafe abortions annually. Reasons for non-use of contraception vary, but include limited availability, real or perceived concerns about side effects, provider bias, and entrenched cultural and religious opposition and gender inequalities. While most of the unmet need is felt in LMICs, these issues – particularly concerns about side-effects – contribute to non-use in most markets:  even when available, current methods are losing appeal, leaving women vulnerable to unplanned and unwanted pregnancies. Male options also remain limited to condoms and vasectomy, with the burden of responsibility continuing to fall on women.

Unmet needs

While existing contraceptive options such as oral contraceptive pills, intrauterine devices, injectables, and implants have improved contraception uptake globally, significant challenges persist. Many currently available options have limitations, including side effects (since many are hormonal), the need for administration by a skilled health professional, short shelf lives, and contraindications in certain women (such as users with a history of cardiovascular disease). This is exacerbated by high costs and lack of accessibility, particularly in LMICs. There is increasing demand globally for user-controlled, on-demand, non-hormonal options, as well as innovative contraceptives for men. Innovations such as longer-acting contraceptive injectables, next-generation vaginal rings, biodegradable implants, fast dissolving inserts, gels and microneedle array patches show promise in offering suitable alternatives.

Funding

Funding for contraception R&D dropped to its lowest ever level in 2023, down $20m (-16%) to $107m, having fallen every year since 2019. It is now down a total of $51m, or almost a third, from its 2019 peak.

The 2023 drop was mostly due to a $17m (-25%) reduction in funding from the Gates Foundation, which returned to roughly its normal levels after spiking by $14m in 2022. The longer-term reduction, though, is largely the result of decreased funding from industry (which is down $38m, -69% from its 2019 peak).

Almost all of the 2023 decline fell on long-acting reversible contraception (LARC, down $19m, 47% to $21m), which has likewise borne the brunt of the longer-term decline (down $45m, -68% since 2019). Falling LARC R&D reflects ongoing reductions in industry funding (now down by 84%), alongside the return of Gates LARC funding to around normal levels in 2023 after two years of increased spending in 2021/22 focused on supporting Dare Bioscience’s early-stage development of a novel long-acting, user-controlled hormonal contraceptive implant. These falls have taken the share of contraceptive R&D funding going to LARC from 42% in 2019 to less than 20% in 2023.

This shift away from long-acting contraceptive research has been accompanied by an apparent move towards user-controlled technology. Looking only at products which specify a locus of control, the share of funding for user-controlled products has risen every year, from 26% in 2018 to 70% in 2023. Partly, this is just the effect of the same decline in industry funding that drove the reduction in LARC funding, since industry’s spending was mostly on long-acting, non-user-controlled devices. But even excluding industry, user-controlled funding has risen from a little over half the 2018 total to 80% in 2023, suggesting a meaningful shift towards user-centred design of products in line with increasing recognition of autonomy and convenience as key to their successful adoption. The growing category of user-controlled product development includes a record $1.9m in funding from the Male Contraceptive Initiative for a range of projects, including $0.5m for the YourChoice male contraceptive pill, which recently progressed to Phase I trials.

Despite some growth in male contraceptive R&D, contraceptives targeting female end users continued to dominate, accounting for almost three-quarters of total funding. R&D targeting male end users did rise, to a record 17% of the total in 2023, up from just 9% in 2018. These mostly focused on short-acting methods (two-thirds of total male contraceptive funding), including multiple late-stage grants from the NIH for the evaluation of NES/T gel – a combination of Nestorone and testosterone.

The proportion of contraceptive investment going to hormonal products fell to a record low of 47%, down from 68% in 2018, with focus shifting to non-hormonal methods. Meanwhile, overall investment in contraceptive R&D was concentrated on drugs in 2023 ($64m, 60%), as funding has shifted away from device/drug and combinations and towards straight drug R&D.

Funding for contraception

Product landscape & pipeline

Calliope – available here – provides an interactive database of the R&D pipeline for contraceptives. It is coordinated by FHI 360 as part of the Contraceptive Technology Innovation (CTI) Exchange.