"Not
everything that counts can
be counted, and not everything
that can be counted counts.“
-Albert Einstein
Diversity of Women; Diversity of Needs,
Unmet Need for Contraception
§ Unmet need
for FP of 215
million women in
developing countries
translates annually to:
•  53 million unintended
pregnancies
•  25 million abortions
•  590,000 newborn deaths
•  90,000 pregnancyrelated deaths
§ South & West Asia has
largest unmet need:
•  88 million women
§ Africa has made the least
progress in family planning:
§ Large variability
Source: Singh S and Darroch JE, Adding It Up: Costs and Benefits of Contraceptive Services—Estimates for 2012. New York: Guttmacher
Institute and United Nations Population Fund (UNFPA), 2012
© The Population Council, Inc. 2013
Evidence is Well Established of the
Associations between Family Planning
and……
• 
• 
• 
• 
Fertility and population dynamics
Maternal, infant, and child health
Women’s status
Economic development and poverty
reduction
Associations with environment and
climate change emerging
© The Population Council, Inc. 2013
Addressing all Unmet Need for Modern
Family Planning Would Result in Fewer:
Unintended
pregnancies
Abortions
53
25
million
million
Deaths
Children
Unplanned among women who will lose
and newborns their mothers
births
22
390,000
million
$1.40
$1= saved
spent
680,000
$1 spent on contraception
= $1.40 saved in
maternal and newborn
health care costs
Source: Adding It Up: The costs and benefits of investing in family planning and maternal
and newborn health, presentation. New York: Guttmacher Institute & UNFPA, 2011.
© The Population Council, Inc. 2013
Constructing a Critical
Path from
Product Development
to Introduction
Brady, M., Critical Path Framework © 2011 Population Council
© The Population Council, Inc. 2013
Population Council’s
“Bench to Bedroom” Research
Biomedical
Basic
Research
Product
Development
Clinical
Trials
Health
Operations
Product
Delivery
Research
Introduction
Systems
Social Science
© The Population Council, Inc. 2013
Product Development Timeline
1960s
1970s
1980s
1990s
2000s
Copper
T-200 IUD
█
█
█ Product
development
begins
█
█ FDA approval
Norplant®
and Jadelle®
Norplant
█
█
█ First
introduced in
developing
countries
█
█
█
█
Jadelle
(dates are
approximate)
Mirena® IUS
█
█
█
© The Population Council, Inc. 2013
Family of Vaginal Rings
2 Contraceptive Rings (one
can be used during BF)
Dual Indication Ring
What we are learning:
v  Several types of are in use, mostly in developed countries
v  Duration of action and protocol for use differ by ring type
v  Does not require daily action by the user
v  Need more data on women’s experiences in a variety of settings
© The Population Council, Inc. 2013
Across Products, Geographies, and
Time, Women Want to Know…
1.  Does it work?
(and some sense of how well)
2.  Does it cause harm?
(to me, my partner, my baby if breastfeeding)
3.  Does it jeopardize my future fertility?
(will I be able to get pregnant in future if I want to?)
4.  Does it disrupt my relationship with partner?
(issues of trust, pleasure, secrecy, social cost)
© The Population Council, Inc. 2013
What we have learned...
Product Introduction Needs to
Demonstrate….
• 
Capacity of systems and providers to deliver product
with quality and safety
• 
Affordability and acceptability (to consumer,
program, funder)
• 
Access and use by “key” and diverse population
groups can be achieved
• 
Satisfactory answers to sceptics
• 
Longer-term outcomes; how X fits into overall
method mix (e.g. contraceptive method mix)
Brady, M. 2011
© The Population Council, Inc. 2013
Untidy Relationships
• 
Clinical Efficacy vs. Typical Use Effectiveness
• 
Need≠ Demand≠ Use
• 
Risk Perception, Actual Risk, Actions Taken
• 
Population-Based Probability Estimates and
Individual Risk Assessments
© The Population Council, Inc. 2013
Uptake of New Technologies:
Diffusion of Innovation
Speed of uptake
depends on how
much behavior
change is
required, type of
service delivery
approach, price,
marketing
investments
See Bass, Frank. “A New Product Growth Model for Consumer Durables.” Management Science,
1969.
© The Population Council, Inc. 2013
There are over 600 million adolescent
girls in the developing world today.
What happens to them matters.