Clinical Review Science, medicine, and the future

Contraception

BMJ 1999; 319 doi: http://dx.doi.org/10.1136/bmj.319.7215.969 (Published 09 October 1999) Cite this as: BMJ 1999;319:969
  1. David T Baird, clinical research professor ([email protected])a,
  2. Anna F Glasier, director of family planning and well woman servicesb
  1. a Centre for Reproductive Biology, University of Edinburgh, Edinburgh EH3 9EW
  2. b Edinburgh Primary Care NHS Trust, Edinburgh EH4 1NL
  1. Correspondence to: D T Baird

    The prevalence of contraceptive use is increasing worldwide, and in many countries over 75% of couples use effective methods.1 However, existing methods of contraception are not perfect, and their acceptability is limited by side effects and inconvenience. Even in developed countries where contraception is freely available, many unplanned pregnancies occur. There is thus a real need for new methods of contraception to be developed that are more effective, easier to use, and safer than existing methods. This article discusses current research into new forms of contraception and predicts what methods are likely to be used in the future.

    Social influences

    Demographic forces, prevalence of disease, and social and cultural factors influence not only the use of contraceptives but also the development of new methods. The age of onset of sexual activity is falling, while childbearing is being delayed or, in many developed countries, forgone altogether. There is pressure from the public for the use of more “natural products,” which are perceived to be safer, but at the same time demand that contraceptives have almost perfect efficacy.

    Those concerned with the development of new drugs and devices take efficacy as read and are now seeking positive health benefits—methods that prevent not only pregnancy but also sexually transmitted disease and, in the long term, common diseases such as breast cancer. Heterosexual intercourse is now the main route of transmission of HIV. While barrier methods such as condoms reduce the risk of transmission, there is a pressing need for additional and complementary methods of protection in the form of topical virucidal agents, which ideally would also be spermicidal.

    Hormonal contraception for women

    Methods involving steroid hormones have dominated new developments in contraception, and in the past 40 years more than 200 million women worldwide have taken “the pill.”2 Recent data confirm its excellent safety profile, and in …

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