Language and Measurement of Contraceptive Need and Making These Indicators More Meaningful for Measuring Fertility Intentions of Women and Girls

In GHSP’s February 2022 commentary “Language and Measurement of Contraceptive Need and Making These Indicators More Meaningful for Measuring Fertility Intentions of Women and Girls,” the authors issue a call to action from the Performance, Monitoring and Evidence Working Group (PME-WG) to the broader Family Planning (FP) community (e.g., survey researchers, governments, donors, policy advocates, and program managers) to work toward (1) developing better metrics to improve analysis, policy, and program planning at the country level and (2) testing novel metrics and sharing findings widely. A noticeable omission from the targeted group of stakeholders is manufacturers. These manufacturers include big and small pharmaceutical companies, biotech companies, app developers, companies that currently manufacture contraceptives and devices as well as those who may be interested in contraceptive pharmaceutical and device manufacturing in the future.

Historically, manufacturers have played an important role in shaping and measuring women’s fertility intentions, starting most notably with the advent of oral contraceptive pill Since the introduction of the pill, manufacturers have been responding to women’s reproductive and contraceptive needs by developing different methods including injectable contraceptives, implants, patches and vaginal rings, many of which were supported by USAID and non-governmental organizations (NGO) research.

Increasingly, manufacturers are playing a critical role – and sometimes the leading role - in focusing more on clients vs providers, as witnessed in their direct-to-consumer outreach and education as well in drug development. Such an effort requires contraceptive manufacturers and developers to rethink language directed at clients and continuous measurement of contraceptive needs for older as well as new methods. For example, companies now using social media platforms to reach and interact with users are communicating more around users’ self-identified needs and preferences. For newer drugs, companies are changing in part due to payers like insurance companies and pharmacy benefit companies paying for performance . This is also due to digital health and IT disruptions to healthcare making healthcare companies more focused on users and their needs. For example, using fertility biomarkers to avoid pregnancy has existed for decades. Somewhat recently, app developers introduced Fertility Awareness Method IT applications (apps) to address women’s desire for both easy-to-use, non-hormonal contraceptive methods as well as for less expensive and less invasive fertility aids. This development has disrupted both the natural contraceptive movement and the fertility industry. , , The proliferation of FAM apps in both HICs and LMICs is an illustration of IT developers finding ways to address women’s fertility intentions.

Developing better metrics to improve analysis is in the manufacturers’ interest to better understand current and future use to forecast profit as accurately as possible. As innovations change to meet women’s reproductive health needs, manufacturers must adopt different metrics. Industry can use existing indicators to measure success but will need new/adapted indicators to capture client needs and desires, some of which - but not all - will correlate with the needs of government and civil society.

USAID has a long history of partnering with pharmaceutical companies to develop new contraceptive technology and products. Nonetheless, many in the FP community remain suspicious of manufacturers.
Although manufacturers and the FP community have different incentives, they have some common interests. For example, cost is a consideration for everyone. The cost of family planning programs and commodities is an important concern among national governments. A 2012 volume guarantee by donors, including USAID, then DFID, UNECE (Norway) and the Bill and Melinda Gates Foundation (BMGF) to procure implant contraceptives permitted manufacturers to reduce their price and increase implant distribution by more than 50%, saving donors hundreds of millions of dollars over several years.

Client satisfaction is another common area. Both parties want more clients to stay on their contraceptive regimen as long as they want to be on them. The FP community can work with industry to contribute to creating appropriate indicators to measure and establish appropriate measurements for programming. To be profitable, companies need highly functioning family planning programs that serve the needs of clients. There is a lot of benefit for the FP community to view contraceptive manufacturers as partners in helping them to achieve effective FP programming. Collaboration can improve the process to help both parties get the outcome they want to achieve. With the advent of FP2030 there is an opportunity to include manufacturers as partners.

Let’s include healthcare manufacturers in the call to action to make refinements to current language and measurement of contraceptive need indicators that better capture self-identified needs and preferences and develop new measures and methods that capture the perspectives of users, potential users, and non-users.