While the quest to develop new contraceptive methods — and improve existing ones — continues, increasing access by making better use of available techniques is a central goal of many public-health initiatives, including those run by the Stanford Program for International Reproductive Education and Services (SPIRES). As Dr. Paul Blumenthal, professor of obstetrics and gynecology at Stanford and director of SPIRES, puts it, "Our job is to take what hardware we're given and make sure that there's user-friendly software that goes with it."
One example of how he and colleagues are making the most of existing "hardware" is by giving women options for contraception right after they give birth. In many developing countries, and particularly in rural areas, lack of facilities and pharmacies means medical care is hard to come by. So, it makes sense to present options for contraception when women are visiting the doctor for other reasons — such as giving birth. "One-stop shopping," Blumenthal says.
For many women, having an IUD implanted just after giving birth could be a unique opportunity to access a long-lasting form of contraception. What's more, inserting an IUD right after having a baby may reduce the likelihood that a woman could accidentally get pregnant while breastfeeding. (Many new mothers rely on the fact that women don't ovulate while breastfeeding to avoid a subsequent pregnancy, but the method is far from foolproof.) Rejection rates of IUDs inserted just after a woman has given birth are somewhat higher, but implantation by properly trained professionals can narrow this gap, Blumenthal says. To that end, SPIRES now has training initiatives for postpartum IUD implantation underway at locations in Zambia, Uganda and India.
From a public-health standpoint, programs like these may also increase maternal safety during childbirth, Blumenthal says. Women who give birth with a skilled medical attendant present are less likely to die from complications such as severe bleeding or infection — in fact, giving all women that opportunity is one important component of achieving the United Nations Millennium Development goal of reducing maternal mortality. If the prospect of an IUD implant helps a woman decide to have her baby at a medical center, that could be a broader public-health boon. "Wouldn't it be interesting if one of the reasons she went to the hospital was that she could leave with a method that would last her up to ten years?" Blumenthal asks.
Perhaps at no other point in history has the role of contraception in society been so thoroughly explored, analyzed and debated.
On its 50th anniversary, the birth control pill has been portrayed both as a driving force of female empowerment and a means for women to put their fertility on hold, only to later “wake up” and realize they’ve pressed the pause button for too long. As the U.S. government continues to creak through the machinations of implementing the health-care overhaul, whether or not birth control pills will be labeled preventive medicine is still up for debate — though insurers have long covered Viagra. And though conservative religious organizations are still wary of promoting contraceptive use, the Pope himself ceded a tiny bit of ground in November by suggesting that condoms were appropriate in some circumstances to prevent the spread of HIV — remarks that many see as a step toward the middle ground. (More on TIME.com: Are Doctors’ Exams a Barrier to Birth Control?)
Cultivating that middle ground — namely, reducing unwanted pregnancies that end in abortion — is central to public-health efforts to promote contraceptive use. And while researchers, public-health officials and religious and philanthropic organizations may not share the same vision of the way forward, advocates for contraception as a tool for public health have two clear goals: greater access and more choice.
The keys to access are simple, if elusive: lower cost, and more emphasis on de-medicalization, which means more options that women can use themselves and buy over the counter, rather than requiring monthly visits to the pharmacist or regular access to a physician. (More on TIME.com: Do We Need Vitamin-Supplemented Birth Control Pills?)
As for choice, inventing new methods — and improving on old ones — is critical to providing greater access and efficacy. Spurred in new directions in part by grants from organizations such as the Bill & Melinda Gates and the David & Lucile Packard foundations, several promising new techniques that last longer, have fewer side effects, and are easier to use are making their way from lab bench to bedside table. A look at how innovation is enhancing contraceptive choice, both now and in the more distant future.