Who is suggesting that the pill might protect women from cancer as well as from pregnancy?
The University of Aberdeen, which has been analysing results from the Oral Contraception Study set up by the UK Royal College of General Practitioners more than 40 years ago. There have always been concerns about the mass medication of healthy women, and it has more often been the risks and harms of the pill, rather than its benefits, that have been trumpeted.
So which cancers does the pill protect women from?
The pill protects women from endometrial cancer – cancer of the womb – ovarian and bowel cancer. That had been established. But this, the longest-ever study, says that protection lasts up to 35 years after women stop taking it, and that there are no other cancers connected to it in the long-term.
But doesn’t the pill increase the risk of breast cancer?
Yes, while taking it, but women on the pill are generally young and have a low risk of breast cancer, unless they have a family history. A small increase on a small risk is not much to worry about, and the increased risk disappears within five years of coming off the pill. There is also a small increased risk of cervical cancer, but that also disappears within five years of stopping.
Did the study discover anything else?
Yes. It found that women who take the pill are no more likely to get other sorts of cancers in later life than women who don’t. So, in relation to cancer, researchers say the pill is very safe in the long term.
What have other researchers found?
Researchers at Oxford University published a major review in 2008, which showed that the pill reduced the risk of ovarian cancer by 20% for every five years that a woman took it. Those on it for 15 years cut their risk in half. That’s an attractive idea, because ovarian cancer is not easily detected at an early stage, and kills two-thirds of those who get it. The Oxford scientists published in the Lancet, which ran an editorial calling for the pill to be available over the counter, as opposed to prescription-only, thereby “removing a huge and unnecessary barrier to a potentially powerful cancer-preventing agent”.
In 2015, the same team published a further review on the protection the pill provided against endometrial cancer. Protection lasted for at least 30 years, said Prof Valerie Beral. Women in their 70s were still being protected due to taking the pill earlier in life. “It is time to start saying that not only does it prevent pregnancy, which is why people take it, but you should know you are less likely to get cancer than women who don’t take the pill,” Beral said.
Why would the pill protect from cancer?
Female hormones are implicated in a number of cancers. The pill contains a low dose of the hormone oestrogen, which is linked to breast and cervical cancer, so it raises these risks, as does HRT (hormone-replacement therapy), which is given to women dealing with menopausal symptoms. But it also contains progesterone, which is known to be protective against endometrial cancer.
Aren’t there other risks involved in taking the pill?
Yes, although the NHS says they are small and that “for most women, the benefits of the pill outweigh the risks”. There is a slight increased risk of stroke because oestrogen can cause blood to clot more readily. In the leg, that can cause deep-vein thrombosis. Clots can also form in the lung or cause a stroke or heart attack. The NHS has a list of conditions that make taking the pill more risky, and says that if women have more than one of them, they should find another form of contraception. They include being over 35, being a smoker, being very overweight and having high blood pressure.
So does this mean most women should take the pill for a while in their youth?
If women want to use the pill to prevent pregnancy, the anti-cancer effect is an added bonus, and might make it a more attractive form of contraception. But no medicine is without any side effects at all, and for a small number of people, the pill is a more risky option.
A male contraceptive gel has been found to work reliably in a trial in primates, bringing the prospect of an alternative form of birth control for humans closer.
The product, called Vasalgel, is designed to be a reversible and less invasive form of vasectomy and in the latest study was 100% effective at preventing conception. A blob of the gel is injected into the sperm-carrying tube, known as the vas deferens, and acts as a long-lasting barrier.
Previous tests in smaller animals showed the procedure could be easily reversed by breaking up the gel using ultrasound.
Catherine VandeVoort, of the California National Primate Research Centre and the study’s lead author, said: “Men’s options for contraception have not changed much in decades. There’s vasectomy, which is poorly reversible, and condoms. If they knew they could get a reliable contraceptive that could also be reversed I think it would be appealing to them.”
The Parsemus Foundation, a non-profit organisation that funded the work, said it plans to start a human trial as soon as funding is secured, based on the promising monkey results.
“One of the great things about the monkey model is that the male reproductive tract is very similar to humans and they have even more sperm than humans do,” said VandeVoort. “Chances are, it’s going to be effective in humans.”
How Vasalgel male contraceptive works
After decades of minimal progress on male contraceptives, a range of different approaches now appear to be showing promise. A World Health Organisation investigation, published last year, found that a male hormonal contraceptive jab was as effective as the female pill. However, scientists are still working to overcome unwanted side-effects including depression, acne and soaring libido that are linked to hormone-altering gels, pills and injections.
By contrast, the Vasalgel procedure does not interfere with sperm production and hormone levels in the body remain unchanged, meaning such side-effects are not an issue. As with a vasectomy, sperm continues to be produced in the testes, but rather than being ejaculated, it dissolves and is naturally absorbed by the body.
Unlike vasectomy though, in which the tube is snipped and the two ends cauterised, the Vasalgel procedure should be reversible, potentially making it an attractive option for a wider range of men.
“They wouldn’t have to worry about it on a day-to-day basis,” said VandeVoort. “This would be more akin to an IUD [the coil] in women.”
In the study, published in the journal Basic and Clinical Andrology, 16 male rhesus monkeys were given injections of the gel and then returned to their group, which included between three and nine breeding females.
The monkeys were monitored for at least one breeding season and about half the monkeys lived alongside females for two years, during which time there were no conceptions and side-effects, such as inflammation, were minimal.
Angela Colagross-Schouten, lead veterinarian on the project, said: “We were impressed that this alternative worked in every single monkey, even though this was our first time trying it.”
The same team are now hoping to confirm that the procedure is fully reversible in monkeys.
As I lie back across the thin blue paper runway, my legs open, an Anglepoise lamp shining into the abyss, my nurse (called, ironically, Comfort) warns: “This may be a little uncomfortable.” Oh how we laughed. But I was determined – I wanted a coil.
According to reports, in the first week after the US election, Planned Parenthood (which Donald Trump, vice president Mike Pence, and House speaker Paul Ryan all want to stop funding, by the way) saw a 900% increase in patients seeking IUDs. As the news that Trump was to nominate “women’s health opponent” Tom Price for secretary of health and human services fell across America like sleet, women, nurses and healthworkers took to social media advising one simple thing: get a coil.
It builds on an existing trend for American women to choose intrauterine devices. Under Barack Obama’s Affordable Care Act, insurance providers are required to cover a woman’s birth-control method of choice for free; usually this costs about $ 1,000 for insertion and follow-up visits. For the first time, the IUD was affordable, as well as reliable. And so, according to US Center for Disease Control and Prevention’s National Center for Health Statistics (NCHS), IUD use increased 83% comparing 2006–2010 with 2011–2013. In an anti-abortion, pussy-grabbing climate, American women have been backed into a corner and the IUD seems, at the moment, like their last form of defence.
Coils give us hormone-free control over our wombs and, therefore, lives
Nearly 10 years ago, I had my very own little hammerhead shark of copper wire inserted into my uterus. It would do nothing to protect against sexually transmitted infections, I knew; it might make my periods heavier, I understood; having it put in might make me wince, I’d been told. But, my god, it was better than the alternatives. Even in this new millennium I couldn’t rely on men to carry, let alone use, condoms. And while on the pill I had cried, almost continuously, for three months. Sex wasn’t just off the menu – my body felt like a bovine mass of lustless, listless despair. In that way, the contraception was working brilliantly – I was about as likely to want sex as I was to take up a laboratory position at Massachusetts Institute of Technology.
That the source of my sadness could be linked to the galloping horse-sized quantity of hormones running through my bloodstream didn’t occur to me for longer than I care to admit. But when it did, the solution seemed as clear as it did to that tweeting nurse in Colorado: get your IUD.
As Vicky Spratt of The Debrief has written for their new Mad About The Pill campaign, the link between the contraceptive pill and mental health problems is still just anecdotal. But by god the anecdotes are there. According to the site’s survey of 1,022 women, 46% reported that the pill had decreased their sex drive, 45% said that they believed they had experienced anxiety, 45% said they had experienced depression and 20% reported experiencing panic attacks which they attributed to their hormonal contraception. If we were in America, we’d have had to pay for the pleasure of this troublesome medicine. So no wonder so many of us are looking into alternatives.
The copper coil didn’t make me weep uncontrollably with the curtains closed, it didn’t turn my tits into bricks and I never had to panic that I’d left it at home. You do not forget about your coil and then have to seek emergency contraception; you can keep the same coil in for up to 10 years, which means you can be miles from a chemist, in another country, or simply at work and never have to worry. It will not tear while fumbling in the gloom of your parents’ spare room; it won’t get punctured by the keys in your pocket; you don’t have to pay £2 in a pub toilet for it and, in my case at least, it didn’t hurt.
Coils give us hormone-free control over our wombs and, therefore, lives. On the downside they do nothing to protect against STIs and there are, of course, women who suffer serious side-effects – heavy or irregular periods, damage to the womb, pelvic infections, ectopic pregnancies. But the coil still deserves to move away from the icky, scary reputation it had when our mothers were sleeping around.
Of course I find it exasperating, frustrating, maddening and saddening that the burden of not getting pregnant still falls almost entirely on women. Many men will still assume that she “has it covered”; many still squirm away from condoms; some seem entirely unaware of what sperm may do. It’s 2017, for Christ’s sake – and yet, I know firsthand that many women are expected to be magically infertile right up until the moment their partner wants a baby. And, should that woman want to get pregnant earlier? Well then, of course, the question of coming off contraception must be a joint one. He must have his say. If he’s not ready then you cannot push it on him. If you do, you are branded selfish and controlling.
When it comes to our bodies, we carry all the responsibility; but not quite all of the power. But, perhaps, the coil can help claim some back.
Subscribe & Review on iTunes, Soundcloud, Audioboom, Mixcloud & Acast
On June 23rd 1960, the US Food and Drug Administration approved the world’s first combined oral contraceptive pill – or COCP – known as Enovid. And whilst there have been many developments in COCPs for women in the six decades that have followed, effective counterparts for men have yet to appear on to the market. Why has it taken so long? How close are we to a male contraceptive pill?
This week, Hannah Devlin hears from the University of Edinburgh’s Professor Richard Anderson, who was part of a recent World Health Organisation funded trial into a male contraceptive jab. We also talk to Dr Diana Blythe of the NICHD’s Male Contraceptive Development Program, about the progress being made Stateside using gels instead of jabs. And finally, we hear about non-hormonal alternatives in development from Aaron Hamlin, executive director of the Male Contraceptive Initiative.
Clinics offering women contraception are closing or reducing their opening hours in the wake of heavy Whitehall cuts to local councils’ public health budgets, new research has revealed.
One and a half million women of reproductive age live in parts of England where councils have restricted contraception services or are considering doing so, according to data obtained under freedom of information by the Advisory Group on Contraception.
The findings have prompted warnings from sexual health experts that paring back such services could lead to an increase in unintended pregnancies and abortions. One in four councils have already reduced their contraception service or may do so, the new findings show.
“Councils are between a rock and a hard place when faced with cuts to public health budgets, but it’s a false economy to restrict women’s access to contraception,” said Natika Halil, the chief executive of the Family Planning Association, which is a member of the AGC.
She cited research showing that every pound spent on contraception saved £11 in averted health costs, for example from women going on to have a baby or a termination.
“Making it harder for women to choose the right contraception for them will mean more unplanned pregnancies and more abortions,” she said.
Four sites offering contraception services have closed or will close during 2016-17 in Dorset, several clinics have stopped operating in Wandsworth in south London, while a clinic operating at Leighton hospital in Crewe, Cheshire was shut down last year.
Responses from 140 of England’s 152 councils to the freedom of information requests showed that a lunchtime school drop-in service in south Gloucestershire has been ended, a sexual health worker in Wokingham in Berkshire lost their job when a condom distribution service was brought in-house by the council and a young people’s service in Bexley, south London, ceased being a standalone service but is now being provided in a local GP’s surgery.
Dr Anne Connolly, a GP in Bradford who sits on the AGC, said: “It’s hugely concerning to see that, in many parts of the country, contraceptive services are being cut, meaning that women can’t access the most reliable types of contraception. Without close scrutiny, I’m worried this trend will only continue and that women will bear the consequences.”
Among the 140 councils which responded, 20 (14%) confirmed that at least one site had shut in 2015-16 or would do so this year, while another 18 (13%) said that clinics could be closed this year. The AGC is made up of health charities such as the FPA, doctors, the Local Government Association and the Faculty of Sexual and Reproductive Healthcare, which represents specialists.
Councils in England have been obliged by law since the coalition government’s NHS shakeup in 2013 to provide open access to sexual health services, including for contraception.
NHS England commissions some contraceptive services under its contract with GPs. The AGC also found that fewer councils now have contracts with local family doctors to provide the long-acting forms of contraception that women are now often encouraged to use.
However, councils have had to reduce the public health services they offer since the Treasury cut £200m from their budgets for this year and it intends to take another £600m by 2020-21, just under 10% of the planned total.
Simon Stevens, the chief executive of NHS England, has warned several times that cuts to public health will inevitably lead to higher long-term costs for the NHS. Last year, he said he was “crystal clear that any further cuts in public health and social care would impose extra costs on the NHS over and above the minimum funding requirement [the £8bn extra by 2020-21 that then chancellor George Osborne promised last year to give the NHS]”.
The Department of Health said councils were best at deciding what public health services they provided for their residents.
“Local areas are best placed to decide how to provide the sexual health services their communities need. Good progress is being made, for example teenage pregnancy is down 30% in England since 2011, the lowest for 40 years”, a spokesman said.
“Over the next five years, we will invest more than £16bn in local government public health services, in addition to what the NHS will continue to spend on vaccinations, screening and other preventative interventions.”
Perhaps you expect us to know that “French painter Vigée le Brun” is Louise Élisabeth Vigée le Brun (Rare appearance for portrait of Emma Hamilton, 24 October). The artist’s gender is crucial to this painting’s many observational subtleties and thematic ironies, not least because here a celebrated woman artist (uncommon, to put it mildly, in 1790), in depicting a woman who famously made a career out of presenting herself in “attitudes” for the male gaze (here “Lady Hamilton as Ariadne”), shows us – wittily but not bitchily – how this sitter also confronts the gifted appraising eye of another woman. John MacInerney London
• One of my grandchildren went to the Globe with school, no doubt to enjoy “the conditions within which Shakespeare and his contemporaries worked” (Letters, 27 October). Her mother asked what she thought of the performance. “It rained,” said the child. “Well…?” from her parent. “No fucking roof,” was the reply. Christine Hawkes Cambridge
• Side effects: acne, depression and increased libido (Male contraceptive jab effective in trials, 28 October). Have they finally stumbled on the elixir of eternal youth? Jean Glasberg Cambridge
• Katy Guest (The Week in Books, Review, 29 October) reports that David Cameron has sold his memoirs for book publication, but is still in need of a title. Could I suggest Laugh Out Loud? John Pawsey Milton Keynes
• Could I suggest Making a Pig’s Ear out of a Silk Purse. Dave Crook Birmingham
• My GPs’ surgery now refuses to accept magazines on the grounds of “health and safety” (Letters, 28 October). I have managed to sneak a few in, though. Rosalind Clayton York
• Join the debate – email guardian.letters@theguardian.com
Gregory Pincus, the maverick scientist who co-invented the female contraceptive pill, first tried to come up with a male equivalent in the 1950s. Nearly six decades on we are still waiting.
Friday’s news that male contraceptive jabs are almost as effective as the female pill, is remarkable as much for the lack of progress it highlights as for the impressive result the trial delivered.
There are genuine scientific reasons why creating a male pill is tricky. But today’s results, together with a separate advance earlier in the week , make it a good time to ask whether the main obstacles are technical or a lack of will to develop the drug.
A central scientific challenge in developing a male pill is achieving the right balance of hormones that provides reliable and reversible contraception without inducing unacceptable side-effects.
Getting this right is a tightrope walk and the research fell just on the wrong side of the line. The World Health Organisation decided to stop enrolling men on its trial earlier than planned after being alerted to side effects, including low mood, acne and higher than usual libido (today some coverage interpreted this as a bonus of the drugs, although there is no suggestion that this is how the men or their partners saw it).
Participant safety must always be the first consideration when running clinical trials. It is worth noting, though, that three-quarters of the 300 men who took part in the trial, said they would continue to use this method if they had the choice – and the decision to halt the trial was not unanimous.
Richard Anderson, a professor of clinical reproductive science at the University of Edinburgh and a co-author, says: “It was a big disappointment when the trial was stopped, as the trial monitoring committee were happy with progress and safety, but another WHO committee made the decision.”
The scientists did not attempt to quantify whether the side-effects were comparable or worse to known side-effects of the female pill, but we know that these can also be substantial.
“There are many couples for whom the female pill is not an option,” says Sarah Jones, a reader in pharmacology at the University of Wolverhampton, who is working on an alternative form of male contraceptive.
“It has terrible side-effects as well for some women. It’s not much of a choice. I’m sure there are couples that would relish this [male contraceptives].”
A second challenge, for the male contraception, is that the hormones they normally rely on are quickly metabolised by the liver, meaning that it’s difficult to package the drugs in a pill form. Again, it is worth noting that most of men on the trial said they would be happy to go forward with the injection method.
Anderson and colleagues are due to start another trial using a similar hormone combination delivered through a gel that men could rub onto their chest each morning.
There are also new findings suggesting that targeting the sperm directly – by using a fast-acting pill or a nasal spray that a man could take before sex, for example – rather than using hormones might work. Until now, this approach had eluded scientists, because sperm is so impenetrable – or, as Jones puts it, “you just can’t get into the little buggers”.
She published findings this month showing that designer compounds could be smuggled inside sperm cells and target proteins that are required for the sperm to swim, essentially stopping them in their tracks.
The progress convinces Anderson that a male contraceptive will be available eventually. “It’s just disappointing that it’s going so slowly,” he adds.
Focus groups run by Anderson and others convince him that there is a clear and immediate demand. “About 90% of women we saw at a family planning clinic said it was a good idea, to share the responsibility,” he says.
“They say: ‘I’ve done that [taken the pill] for 15 years and had a baby. Come on it’s someone else’s turn.’”
However, funding from pharma companies – essential to run the trials involving thousands of men that would be required to get a product licensed – is not forthcoming.
Herjan Coelingh Bennink, who was global executive vice-president at Schering’s reproductive medicine programme until 2000 when the company was bought by German rival Bayer, has offered an insider’s perspective on why this might be the case.
“At board level it was only middle-aged white males,” Bennink told Mosaic , an online science magazine produced by the Wellcome Trust, this year. “I tried to explain how important it could be, but they never got further than saying to each other, ‘Would you do it?’ ‘No, I wouldn’t do it’. It was not considered male behaviour to take responsibility for contraception.”
Anderson said that commercial factors may have also impacted the decision to shift away from developing a male pill. “I’m not convinced by that characterisation,” he says. “Though it probably does have a grain of truth,” he says.
Undoubtedly, there are still scientific hurdles to be overcome before we have a safe, reliable male contraceptive.
But science is not there to solve life’s simple problems. When someone at the European Space Agency said let’s chase down a comet 250m miles away and land a robotic probe on it, nobody said “That sounds easy – let’s do it”.
If we’re looking for reasons why we’re still so far from equality in who bears the burden of birth control, let’s not place lack of scientific ingenuity at the top of the list.
A male contraceptive jab has been shown to be almost as effective as the female pill in a trial that could pave the way for men and women being able to share equal responsibility for birth control.
In the study, 350 men were given injections of hormones that were shown to dramatically lower their sperm count by “switching off” the male reproductive system. The drugs caused some unpleasant side-effects, however, meaning that the trial had to be halted early.
The men, who were all in long-term relationships, relied on the drugs to prevent unplanned pregnancies – and the combination of hormones was found to be nearly 96% effective.
Richard Anderson, a professor of clinical reproductive science and author of the study, said: “If you’re comparing it to other reversible male methods, it’s far better than the condom and it puts it in the same ballpark as the pill.”
However, the treatment was judged to have unacceptable side-effects, including depression, acne and increased libido, which caused 20 men to drop out of the study and ultimately led to the trial be stopped earlier than planned.
The trial involved injections of two hormones. A long-acting form of progestogen was designed to act on the pituitary gland to switch off sperm production. Testosterone was added to offset a drop in the male hormone triggered by the progestogen. “You need the testosterone to feel OK,” said Anderson.
After an initial period, when couples used both the injections and other birth control methods, the men entered the study’s “efficacy phase”. This lasted up to a year and the men relied on the jabs alone, which they received every two months.
Only four pregnancies occurred among partners of the 274 men, indicating a similar level of efficacy to the female combined pill and significantly better protection than condoms, which in real-life conditions are about 82% effective.
However, scientists stopped enrolling new participants into the study in 2011 due to the rate of reported side-effects.
Of the 1,491 incidents, 39% were found to be unrelated to the treatment. This included one suicide. One man experienced an abnormally fast and irregular heartbeat when he stopped receiving the injections.
Despite the side effects, at the end of the trial, three-quarters of the men said they would be willing to continue using the contraceptive jab. The scientists said it might be possible to reduce the side-effects by changing the dose of hormones or the way they are delivered.
“The results provide us with confidence that this can be done,” said Anderson.
He added that it would be difficult to convert the treatment to a pill form because the hormones are quickly metabolised by the liver, but the scientists are planning a new trial in which the combination is delivered through a gel that the men could rub on their chest each morning.
Other scientists were less convinced that the side-effects of could be overcome, however. Sarah Jones, a reader in pharmacology at the University of Wolverhampton, said: “Most previous attempts at male contraception that have involved hormonal targets have led to severe side-effects or have been irreversible. This study does seem better than previous ones, but it still doesn’t seem very good to me.”
Jones recently published research demonstrating that certain compounds could be used to impede sperm’s ability to swim, which she argues offers a more realistic route to reversible male contraceptives in the future.
Allan Pacey, professor of andrology at the University of Sheffield, agreed that the side-effects found in the study were a “major concern”. However, he said the efficacy was impressive. “Using long-acting injectable forms of [progestogen and testosterone] the authors were able to suppress the production of sperm to a remarkable degree,” he said. “As such, this contraceptive was extremely effective and therefore certainly has promise.”
The findings are reported in the Journal of Clinical Endocrinology & Metabolism.
Chris Barratt, professor of reproductive medicine at the University of Dundee, said: “This is high quality research from a very experienced group of investigators, and as there has been no progress in male contraceptives for 40 plus years this is a very significant and welcome development. Additionally, the fact that the study reports relatively low side-effects and good ease of use are real-world developments. The study involved a reasonable number of patients so the results are likely to be robust.”
Deaths from ovarian cancer have fallen around the world, largely because of the widespread use of the contraceptive pill, according to a major new study.
Another factor is the decline in long-term use of hormone replacement therapy (HRT), according to Italian academics who carried out the study, published in leading cancer journal Annals of Oncology.
While taking the hormonal contraceptive pill for five years or so protects women from ovarian cancer when they grow older, taking hormones in middle-age to alleviate the symptoms of the menopause carries a risk. The drop in women using HRT for long periods of 10 years or more, following revelations concerning risk of both breast and ovarian cancer and heart disease in 2002, is thought to be a factor behind the fall in deaths.
Deaths from ovarian cancer dropped by 10% in the 28 countries of the EU between 2002 and 2012, according to the study. There are substantial variations in the size of the drop between countries. In the UK, the fall was 22%; in Denmark and Sweden it was 24%; but in Hungary, just 0.6%.
Death rates fell in the United States by 16% and in Canada by 8%. In Australia and New Zealand it went down by 12%.
The protective impact of taking the pill is experienced decades later. More than 40% of the over 4,000 deaths year in the UK are in women aged over 75. Women began taking the pill in the 1960s in the UK.
HRT, however, is usually given to women in their fifties to help them with severe symptoms of the menopause, including hot flushes, night sweats and difficulty sleeping.
The research into the change in death rates was led by Professor Carlo La Vecchia of the University of Milan, who said that the difference between European countries evened out somewhat as the pill became more generally available to women over the years.
“The large variations in death rates between European countries have reduced since the 1990s when there was a threefold variation across Europe from 3.6 per 100,000 in Portugal to 9.3 in Denmark,” he said. “This is likely to be due to more uniform use of oral contraceptives across the continent, as well as reproductive factors, such as how many children a woman has.
“However, there are still noticeable differences between countries such as Britain, Sweden and Denmark, where more women started to take oral contraceptives earlier – from the 1960s onwards – and countries in Eastern Europe, but also in some other Western and Southern European countries such as Spain, Italy and Greece, where oral contraceptive use started much later and was less widespread.
“This mixed pattern in Europe also helps to explain the difference in the size of the decrease in ovarian cancer deaths between the EU and the USA, as many American women also started to use oral contraceptives earlier. Japan, where deaths from ovarian cancer have traditionally been low, now has higher rates in the young than the USA or the EU – again, reflecting infrequent oral contraceptive use.”
Some of the countries where long-term use of HRT used to be high and has now declined – with women now opting to take it for just a couple of years or not at all – such as the UK, USA and Germany, are also countries that have seen marked drops in death rates.
“The problem of HRT is not the short-term use for two to three years for menopausal symptoms,” said La Vecchia. “The problem was the long-term use for 10 to 15 years or longer, which proved to be unjustified.”
A precipitous drop in the US teenage pregnancy rate to record lows was driven by improved use of contraception, a new analysis from the Guttmacher Institute found.
“There was no significant change in adolescent sexual activity during this time period,” Dr Laura Lindberg, a principal research scientist with the Guttmacher Institute and the paper’s lead author, said in a statement. “Rather, our new data suggest that recent declines in teens’ risk of pregnancy – and in their pregnancy rates – are driven by increased contraceptive use.”
Linberg and her co-authors found that while teenage girls’ sexual activity remained constant from 2007 to 2012, the percentage of sexually active teens who used at least one type of birth control the last time they had sex increased significantly, rising from 78% to 86%.
The researchers found the use of all “highly effective methods”, like the birth control pill or IUD, increased from 2007 to 2009. There was a marginal significant increase in the use of the IUD or implant from 2007 to 2009 and in use of the pill overall. There were non-significant increases in condom use and withdrawal, while use of the ring or patch declined significantly over the 2007 to 2012 period.
The changes in contraceptive use resulted in a 28% decline in pregnancy risk index from 2007 to 2012. Not only did improvements in contraceptive use drive that entire decline, but they were also responsible for neutralizing a 6% rise in risk over the same period due to increased sexual activity among teens. The pregnancy risk index is a calculation that “summarizes the risk of pregnancy among all adolescent women, estimating the influence of both changes in the level of recent sexual activity and changes in the level of contraceptive risk”, according to the study.
In April, the Guttmacher Institute reported that the national pregnancy rate declined 23%from 2008 to 2011 for women aged 15 to 19, falling from a rate of 68.2 pregnancies per 1,000 women to 52.4. That means about 5% of teens became pregnant in 2011. It was the “lowest rate observed in the last four decades”, they said, with declines across all 50 states and racial and ethnic groups, though some disparities remained. In 2011, they found a rate of 31.3 births per 1,000 teen women, down from 40.2 in 2008, and 13.5 abortions per 1,000 teen women, down from 18.1 in 2008.
The new study used data from the National Survey of Family Growth, a survey conducted by the Centers for Disease Control and Prevention, on sexual activity, contraceptive use and contraceptive failures to estimate the pregnancy risk index for the years 2007, 2009 and 2012.
The authors noted it was important to ensure teenagers’ “access to comprehensive sexuality education that provides medically accurate information about contraception”. They wrote that the percentage of adolescents “who report receiving formal instruction about birth control has declined, while the share receiving only abstinence instruction has increased”. The American Academy of Pediatricians recently urged doctors to fill in the gaps of sexual health education with their patients. They noted that abstinence-heavy education is a concern for doctors when it comes to reducing sexually transmitted infections and unintended pregnancies, as those programs can exclude information about contraceptives.
The internet, the authors suggested, can offer new opportunities for teenagers looking for information on sexual health, and recommend further research to examine that hypothesis. A separate study from last year found a correlation between decline in transmission of sexually transmitted infections and access to high-speed internet.
“Policy discussions should focus on supporting teen contraceptive use generally, including ensuring access to a full range of contraceptive education, counseling and methods,” Heather Boonstra, the Guttmacher Institute’s director of public policy, said in the release.
The Guttmacher Institute’s study used data up until 2012, however, more recent data from the CDC’s Youth Risk Behavior Survey “shows sharp declines in sexual activity among high school students from 2013 to 2015 – after a long plateau from 2001 to 2013”, the authors wrote. “At this point, it is unclear whether these new data represent a new trend or are the result of other factors,” the authors wrote.
Another analysis from earlier this month found that millennials are having less sex than those in previous generations.
Fatoumatah Bah is cornered. Sitting in front of a tinsel-ringed mirror in Miskaa Salon, her head is bent forward, two women at work braiding twists into her hair. She will be stuck in the chair for at least three hours.
It is a good moment to pounce. Fatoumatah Kamara, 20, an apprentice hairdresser in a matching skirt and blouse and glinting cherry earrings, sidles up to Bah. She starts to make conversation.
At first, it is the usual hairdresser chatter. What rain we’ve been having, eh? Where are you from? What are you up to this weekend? This is the 20-year-old accountancy student’s second visit to the salon in Guinea’s capital, Conakry.
Soon Kamara’s questions become more personal. Does Bah have a husband? A boyfriend? Then she goes in for the kill. Does she know there are ways of avoiding getting pregnant?
With every manicure, pedicure and hairdo at the Miskaa Salon, clients receive a free treatment: a great deal of contraceptive advice.
Related: Contraception and family planning around the world – interactive
Five salons across Conakry have been dispensing family planning advice since 2012, and they have been so successful that the project – the brainchild of Jhpiego, a health organisation associated with Johns Hopkins University in the US – is about to be extended to salons in Guinea’s seven major cities.
In Guinea, which has one of the lowest rates of modern contraceptive use in the world, women have an average of five children. According to UN figures, in 2015 only 7.5% of married or cohabiting women use some form of contraception.
A lot of effort has gone into teaching women in rural Guinea about family planning, but not so much in urban areas. A salon is an excellent place to reach them, so long as it is the right kind of salon.
“It’s better to go where they do braids because that’s what women traditionally want,” says Yolande Hyjazi, Jhpiego’s director in Guinea. “A woman who’s straightening or washing her hair has more money and more access to information.”
Across town from Miskaa, Jumelle Coiffure is trying to turn around clients as fast as possible, largely because the room is impossibly cramped. Jumelle is owned by 32-year-old twins Tata Sylla, wearing a short black and bright green wig, and her sister Mbalia, with long, heavy braids.
“There were a lot of young women getting pregnant around here when they didn’t want to, with lots of kids running after them, and I thought it would be good to teach them how to avoid that. Even my apprentices were getting pregnant,” says Mbalia, making up Aminata Kouma’s face just inside the salon door. Outside, a dozen girls huddle under the dripping overhang of the salon’s tin roof, filing fingernails and tugging at each other’s hair.
An apprentice hairdresser at the Jumelle salon in Conakry shows a client different family planning methods. Photograph: Kate Holt
Kouma, 35, says she first heard about family planning at Jumelle.
“I never knew about this before coming here – they taught me how,” she said. “I got the injection, and since then I’ve been able to control the number of children I have. I already have four and I don’t want any more. My husband can’t afford it, school fees are so high. There’s too much suffering here. I’m a housemaid, but I’m out of work.”
Each salon has an army of apprentices, some of whom have worked in them for years, to cope with the intensity of the work and the number of clients. Jhpiego deliberately chose very popular salons to reach as many people as possible, and trained some of their apprentices as community health workers, to explain how to use exclusive breastfeeding to prevent pregnancy, talk about implants, sell pills and write referrals. They earn half the sale price for any pills and condoms they sell.
The trial started in 2013, but everything had to stop for the Ebola outbreak. Like all health organisations, Jhpiego had to turn its efforts to fighting Ebola. In any case, women were not going to the salon.
It is now back in full swing, though, and tailors’ shops are the next target. “There are women that wait around all day for their dresses, trying them on,” Hyjazi said. “People are being social, hanging around. But in the tailors’ shops we also have a lot of young men. Reaching men is important.”
The idea is that clients of both establishments will talk to their friends, and word will spread.
At Miskaa, a large wedding party is getting ready.
Apprentice hairdressers cluster around each client, carefully painting on long, black eyebrows, blow-drying hair straight, and making minute adjustments to towering, shiny headwraps.
Kamara, pointing at her laminated booklet, has just finished explaining how to use a string of beads to track fertility. But it isn’t new to Bah.
“I go on Google, I go on YouTube, I find information,” she says. “But not everybody is a student like me.”
She knew about condoms and pills, but not the other methods Kamara talks about. Young people have far more access to information than previous generations, and sex is slowly becoming something that is more talked about.
Young men who have come to Miskaa Salon for cut price condoms are shown how to use them correctly by apprentice hairdresser Nene Diakité. Photograph: Kate Holt
Traditionally, a Guinean woman would space out her children by leaving her husband and going back to her mother’s house for a few years, every time she had a baby.
“Now no one is using abstinence, so everyone is using contraceptives, but no one is talking about it,” Hyjazi says. “Many people think that if a women is using contraceptives, it’s because she has another partner. There’s not a lot of open communication – even between a husband and wife using them. Many women will use the pill without telling their husbands.”
One thing is unlikely to change, though, and according to Hyjazi, it is skewing the statistics, because people doing surveys do not always do them in private. “If a woman is asked if she’s using contraceptives and her mother or mother-in-law is there, she’ll never say yes.”
The wedding party is almost ready. Kamara looks over each woman carefully before opening the door for them. In a few hours, they have become more glamorous and, thanks to Kamara, more contraceptive-savvy.
“I like making women beautiful – that’s why I work here,” says Kamara, already looking around for her next quarry.
Had there been a male contraceptive pill in 1976, I might not be here to write this. That year my mum – may she rest in peace – was told by her doctor to come off the pill, after 12 years, because of health worries. “She said to the doctor, ‘I’ll get pregnant,’” my dad recalls. “And in a very short while, she was.” He explains, much to my discomfort, that although my parents switched to condoms, I was conceived because “sometimes you feel reckless”. But if a male pill had existed, my dad says, he would definitely have used it.
So why didn’t it? It certainly wasn’t because of a lack of scientific interest. Gregory Pincus, who co-invented the female pill, first tested the same hormonal approach on men in 1957, and various hormonal and non-hormonal methods have been explored since. Although attitudes among those who might use a male pill were once considered a daunting obstacle, it’s now clear that many men want a new option.
But we’re still waiting. Developing a method that men would accept has brought decades of frustration, yet researchers are confident that they are close to overcoming the scientific barriers. But, crucially, drug makers’ commitment to contraceptives has always been tentative, particularly with products for men – and today, the whole contraceptive industry is struggling. So who is actually going to make the male pill happen?
Related: The foul reign of the biological clock | Moira Weigel
In the 1970s, when my dad might have used the pill, prospects seemed better in some ways. Male fertility control was an active research field, with governments backing various ideas to limit overcrowding on Earth. One product my dad might have been interested in – a non-hormonal drug called gossypol – was being tested on a scale unmatched since. At the UN’s 1974 World Population Conference, Elsimar Coutinho, today a famous sex and fertility doctor in Brazil, was promoting the drug, which he was testing on men at the Federal University of Bahia. However, attitudes surrounding sex and reproduction can be unpredictable, and not everyone was convinced of its worth.
“The conference hall was full of women,” Coutinho says on the phone, his gravelly voice matching his website’s picture of a suave doctor with slicked-back grey hair. “I was going to tell them, ‘Now you don’t have to take pills if you don’t want.’” Yet, having determined their own fertility through the contraceptive pill for little more than a decade, his female audience were determined not to relinquish control. “To my surprise, I was shouted down and booed out.”
Despite such reactions, poorer countries with fast-growing populations found gossypol appealing because it could be extracted cheaply from cotton farming waste. Coutinho also worked with the Chinese government, which in 1972 ran gossypol trials with 8,806 men. Daily doses successfully reduced sperm counts enough to satisfy researchers, but side-effects were a cause for concern. One notable problem was that 66 of the men had low potassium in their blood. More importantly, sperm levels in many men didn’t return to normal when they stopped taking the drug.
Researchers continued tests for years, showing that, in rats, gossypol doesn’t just stop sperm moving, but also damages the lining of epididymis ducts, which store sperm. Eventually, an October 1986 symposium in Wuhan, China – whose sponsors included the Chinese government and the World Health Organization (WHO) – concluded that gossypol was “of little interest”.
The science is difficult but not impossible. What the field really lacks is a champion with lots of money and enthusiasm
Attempts to revive interest in Brazil after fresh trials put the potassium problem down to the Chinese diet also foundered, and in 2001 the gossypol saga came to an end. Coutinho mischievously suggests machismo in government may have been a contributing factor. “We worked on this for many years and realised men are very afraid of losing virility,” he says. “Maybe those judging our application were among them.”
But my dad would not have seen a male pill as a threat to his virility, and I too would be interested in rather than threatened by the idea – I believe it would benefit, rather than harm, the sex my partner and I have. Are we unusual?
In fact, plenty of men are interested in a male pill. A 2005 study found that more than half of 9,000 men from across the world were keen. In 2011, Susan Walker at Anglia Ruskin University in Chelmsford published a study of 54 men in an unnamed town in England. Twenty-six of them said they would take it. “They were not concerned about losing fertility – as long as they could be sure of regaining it,” Walker stresses.
The rest, split between “no” and “don’t know”, showed some gender-based reluctance. “It’s a strange idea,” one man said. “I’m so used to women taking the pill.” Those who were unsure were more concerned about side-effects, Walker notes. “They said: ‘I’ve seen what the pill does to my girlfriend’, ‘What would the long-term effects on my fertility be?’, ‘Could I be sure my fertility would return?’ – that kind of really quite sensible concern.”
The survey also included 134 women, roughly half of whom would let their partners use a male pill. However, more than half were worried that men would forget to take it; just one in six of the men had this worry. But, says Richard Anderson, a professor of reproductive science at the University of Edinburgh: “Whenever there’s a study published, a radio journalist will walk up and down the high street in their local town and ask women whether they would trust a man to take a pill, and of course they all run for the hills. But if you ask a woman if they would trust their partner – who they share children, their bank account and a bed every night with – then you’re going to get a different answer.”
A single crumpled piece of A4 paper on an almost-bare wall in Anderson’s office illustrates how hormonal male contraceptives work, reducing men to brain and balls. In the brain, it picks out the hypothalamus and pituitary gland. In the testicles it shows cells that make testosterone, and the tubules they neighbour, where sperm are made. Progestogen hormones like those used in female pills can stop the glands in a man’s brain making luteinising hormone and follicle-stimulating hormone. The absence of these hormones stops the testicles producing sperm and testosterone. Testosterone replacement is given, along with progestogens, to avoid undesirable effects such as weaker muscles and reduced sex drive.
Dutch company Organon’s prototype male contraceptive pills and testosterone replacements, from 2001. Despite promising trials, they never took off. Photograph: SSPL via Getty
The Edinburgh trials attracted a lot of media attention. “‘100% success’ for male pill trial”, trumpeted the BBC in 2000, reporting on the suppression of sperm production in 30 men – reportedly without side-effects – from a combined progestogen pill and testosterone-releasing implant. Both hormones came from the Dutch drug company Organon, which, after what Anderson calls “a lot of persuading”, began to pay attention. But a larger clinical trial with Germany’s Schering threw up “adverse events” such as acne, sweating and effects on weight, mood and sex drive. Some of these were serious and even life-threatening, including one attempted suicide.
This would prove to be the pinnacle of big pharma’s interest. Herjan Coelingh Bennink, global executive vice-president in Organon’s reproductive medicine programme until 2000, echoed Coutinho’s account of his experience with gossypol. “At board level it was only middle-aged white males,” Coelingh Bennink recalls. “I tried to explain how important it could be, but they never got further than saying to each other, ‘Would you do it?’ ‘No, I wouldn’t do it.’ It was not considered male behaviour to take responsibility for contraception.”
Since then, he and others have continued in the field, but low profit margins have kept drug companies away. According to Anderson, the biggest obstacles are not scientific. “Getting male fertility down to acceptable levels is difficult but not impossible, and there have been many years of experience of how to do that,” he says. “What the field has really lacked is a champion with lots of money and enthusiasm. Thereafter you get industrial involvement.”
Lately, one particularly striking approach has been taken by Nnaemeka Amobi from King’s College London, who is developing a non-hormonal “instant male pill”. Also known as the “dry orgasm pill”, Amobi’s contraceptive stops men releasing semen and the sperm it contains. He stresses that otherwise the normal physical processes of a man’s orgasm are unaffected.
“The movement of semen from the testes to where it stays until ejaculation happens long before climax,” Amobi says. “As soon as you’re aroused, spermatic fluid is moved towards the seminal vesicles and prostate. Our pill stops that initial movement by inactivating the tubes that propel fluid from the testes to the prostate.”
Amobi and his fellow researchers started from two existing drugs that had caused dry orgasms as an undesirable side-effect. They redesigned the drugs to remove the original intended actions and focus on this. Animal tests suggest they have succeeded. “We used rams because rats and rabbits don’t have seminal fluid like humans,” Amobi says. “We tried boars, which produce 250ml of semen. Can you imagine that? Rams have 1ml, closer to humans’ 2-5ml.”
Related: Who wants a male pill?
These tests show the method could become effective within 3-4 hours, and wear off after a day. “A woman can say, ‘Here’s the pill – let me see you take it’,” Amobi says. And as well as avoiding pregnancy, preventing semen emission should help reduce sexual transmission of semen-borne diseases, such as HIV.
One potential backer interested in the drug was the Parsemus Foundation, a small private organisation based in Berkeley, California. Ultimately, though, its founder, Elaine Lissner, faced a tough choice between funding Amobi’s research and another promising new male contraceptive technology. She chose to spend the foundation’s limited cash on the latter. Amobi isn’t bitter because, in his opinion, Lissner is the main reason people still talk about male contraception. But she still has regrets. “It’s shocking that they can’t get backing for the first new idea about HIV transmission-prevention in ages.”
Lissner dislikes hormonal approaches because of their side-effects, and also dislikes risk. She is therefore researching a “hydrogel” that can be injected into the vas deferens – the tube linking the epididymis to the penis.
Called Vasalgel, it lets through semen but not sperm, and is intended to be washed out by another injection when men want the use of their sperm back. The blocked sperm are cleared from the epididymis and eaten up by immune cells, as happens normally if a man hasn’t had an orgasm for a while. Lissner publicises Vasalgel energetically, and one glance at its thriving Facebook page should dispel any doubts that men would be interested. “People are crazy for Vasalgel, desperate for it,” she says. “We have over 32,000 people on the mailing list waiting to hear about clinical trials.”
Elaine Lissner of the Parsemus Foundation with a vial of Vasalgel, a non-hormonal contraceptive for men. Photograph: Male Contraception Information Project
One man who is keen to try it is Justin Terry, a married 30-year-old machinist who makes vehicle parts in Alabama. He and his wife don’t have children, and she is taking the contraceptive pill. “We’ve been married 10 years,” Terry says. “She doesn’t want kids and neither do I, really. She wants to get off the pill.” It gives her tender breasts, and she is concerned about adverse effects of continuing to take it. Terry has also considered vasectomy (as have I), but has hesitated because it is more invasive and not completely reversible. “Vasalgel sounds like it will be reversible and would involve much less invasive surgery,” he says.
Parsemus’s efforts have been helped by the David and Lucile Packard Foundation, also based in California, which provided $ 50,000 to help them test Vasalgel in baboons. “We expected to be out of money last year and we’re not,” Lissner says. “But the clinical trial is half a million dollars, so that’s a different scale. Beyond that, it’s multimillions.” The trial will involve about 30 men and will test Vasalgel as a vasectomy alternative, without looking at reversibility.
Knowing the field’s status, Lissner is not relying on government or the pharmaceutical industry. Instead, she is looking for backing from wealthy social investors – and potential users – and is publicising what might be possible in the field to bring interested parties together. “The difference is that we have built an infrastructure where the public is able to channel its support,” she says.
On Blithe’s suggestion, I watch a Channel 4 documentary called The Great Sperm Race, which shows the journey sperm make through a woman’s uterus to her fallopian tube. It has people dressed in white as sperm, and they die in vast numbers. From the millions of sperm ejaculated, 20-100 get close enough to the egg to try to fertilise it.
Related: Pills, thrills and polymer gels: what’s the future for male contraception?
As I watch, I imagine the white-clad actors instead represent the many possible male pills. There have been, and still are, masses of ideas – far more than I have been able to mention here. And yet, like the unsuccessful sperm, many have fallen by the wayside. I think of the contraceptive drug industry’s current status and I can’t help think we have missed its fertile period. If the perfect idea were to fight its way through development today, there is only a tiny chance that there would be a partner to meet it and eventually produce a fully formed male pill from it.
It seems obvious that if a new male contraceptive does make it to maturity, it will be thanks to the efforts of people such as Blithe and Lissner. They, as much as anyone, are trying to create environments where the right technology can take seed. But without keen interest from the traditional contraceptive industry, that will require an enormous effort. Lissner’s energetic attempts to consolidate support from men like Justin Terry, my dad and me could prove critical.
Lissner is adamant that the ideas that seem to have faltered are not dead – they’re just resting. “We keep collecting new methods, and never finish the ones we have,” she fumes. “Pick one and make something! Finish the job!”
• A longer version of this article first appeared in Mosaic and is republished here under a Creative Commons licence.
A West Australian coroner has raised considerations about the chance posed by some oral contraceptives in an inquest into the death of a 28-12 months-old lady who collapsed with a blood clot at Fremantle hospital in 2010.
The coroner Sarah Linton discovered it was likely the pill, combined with an obvious genetic predisposition to deep vein thrombosis (DVT), put Petra Zele at increased chance of having the pulmonary embolism that killed her.
Zele died on 1 June 2010, four days right after collapsing in the hospital’s emergency department. She had been taking the contraceptive pill Yasmin given that the prior November.
The doctor who attended Zele when she 1st went to the emergency department of Fremantle hospital, on 9 May, did not know she was taking the pill.
In findings handed down this month, Linton said the box on Zele’s triage type listing any medications she was taking was marked “nil”, and neither the nurses who attended Zele nor the emergency department medical doctor exclusively asked her if she was on the contraceptive pill.
“Simply taking the oral contraceptive pill elevated the deceased’s chance of building venous thrombosis,” Linton explained.
Studies linking oral contraceptive pills containing drospirenone to a higher chance of DVT prompted the Therapeutic Products Administration to situation an advisory on 6 July 2011.
The only contraceptive pills containing drospirenone offered in Australia are Yasmin and Yaz.
The inquest heard that women taking Yasmin have been six.3 times a lot more likely to create a pulmonary embolism than girls not on any kind of medicine. Contraceptives using a distinct type of progesterone improved the threat of DVT by three.6 instances.
“For the ordinary youthful girl with no chance aspects other than becoming prescribed the oral contraceptive pill, that risk is usually deemed to be quite reduced,” Linton explained.
But for females like Zele, who took the contraceptive pill and had a genetic predisposition to DVT, the threat was 30 instances better.
Linton said the emergency department also appeared to have either misplaced or failed to appropriately label the transfer of an echocardiogram taken of Zele on 9 Might.
Alternatively Zele was diagnosed with muscle discomfort and offered some ibuprofen.
The notes of Dr Susan Hinsley, the emergency department doctor who noticed Zele on that day, said “No PE risks”. Hinsley advised the inquest that meant no pulmonary embolism hazards.
Hinsley has since been taken prior to the Australian Overall health Practitioner Regulation Company and found to have provided an “unsatisfactory specialist performance” in this situation, but no disciplinary action was taken.
On 27 May possibly Zele went to her GP complaining of chest pains and shortness of breath. The subsequent day her father drove her to Fremantle hospital soon after she suffered from chest pains so extreme she struggled to breathe. She collapsed on the way to hospital and was revived soon after 58 minutes of CPR, just before becoming transferred to the intensive care unit.
On 31 Could medical doctors declared her brain dead and the up coming day her ventilator was switched off, at her family’s request.
Linton said that had the proper diagnosis been manufactured when Zele 1st went to the hospital, she would not have collapsed 3 weeks later.
She advised all GPs must advise sufferers every time they filled a new script for the contraceptive pill that they ought to declare it when asked if they were taking any medicine or asked to supply a healthcare historical past.
Fighting above the remote manage could soon end up in much more than just a channel-hopping battle, if researchers at MIT have their way. In the Bill Gates-funded quest for the up coming form of contraception, a Massachusetts startup has come up with a small remote-controlled chip, like a digital wifi edition of the pill, that will allow females to switch their fertility on and off at the touch of a button.
The chip is implanted underneath the skin and releases modest doses of the contraceptive hormone levonorgestrel on a everyday basis, with ample capability to final 16 years. About the identical dimension as a Scrabble tile, it houses a series of micro-reservoirs covered by an ultra-thin titanium and platinum seal. The hormone is launched by passing a modest electric present from an internal battery by way of the seal, which melts it temporarily, enabling a thirty microgram dose of levonorgestrel to seep out every single day. And it can be basically switched off by a wireless remote, staying away from the clinical procedures essential to deactivate other contraceptive implants.
“The capacity to flip the device on and off gives a specific ease issue for individuals who are planning their loved ones,” says MIT’s Dr Robert Farra, incorporating that “the idea of making use of a thin membrane like an electrical fuse was the most difficult and the most inventive issue we had to remedy.”
Remote birth manage … How the micro-dispensing chip works. Photograph: Microchips
But just as teenage pranksters can hack into wifi remotes to operate neighbours’ garage doors and flip their Tv channels, could a remote-controlled contraceptive open the floodgates for a new kind of ovarian hacking? May possibly Anonymous a single day flip their hand to subversive family members organizing?
“Someone across the room can not reprogramme your implant,” says Farra. “Communication with the implant has to happen at skin get in touch with-degree distance. Then we have secure encryption. That prevents someone from making an attempt to interpret or intervene in between the communications.”
The idea for micro-dispensing chips was initial produced in the 1990s by Professor Robert Langer at MIT, the founder of innumerable biotech firms and holder of far more than 800 patents, recognized in the market as “the most cited engineer in history”. His lab caught the attention of Bill Gates in 2012, in the course of his search for a revolution in birth control (which has already spawned programs for a graphene condom), and Langer subsequently leased the engineering to Microchips, a organization currently operating on a micro-dosing implant for osteoporosis.
Two years on, Microchips says that the implant could be accessible by 2018, if clinical trials launching up coming yr in the US are effective, and that the gadget will be “competitively priced”. Customers will have the choice of possessing the chip implanted in the abdomen, upper arm or buttocks – in which case just be cautious not to sit on the remote.
Currently the contraceptive implant the NHS offers lasts three many years but if a lady wishes to get rid of it just before then, she should attend a clinic.
The creators think it will be much more convenient and if it passes safety exams, it could be on the market place as early as 2018. They stated it would be “competitively priced”.
Pre-clinical testing of the implant, designed by start-up MicroCHIPS in Massachusetts, will start up coming 12 months.
The idea for the chip originated two years in the past. Throughout a go to to Massachusetts Institute of Technology’s (MIT) lab, Gates and his colleagues asked Robert Langer, professor at MIT, regardless of whether it was achievable to generate birth manage that a girl could turn off and on.
MIT explained the implant would have to be encrypted to protect wireless data movement and maintain it safe.
The chip’s dimension is 20mm x 20mm x 7mm and reservoirs of the hormone are stored on a 1.5cm-wide microchip inside of the device.
The implant’s everyday dose performs by a little electric charge melting an ultra-thin seal close to the hormone. This would then release a 30 microgram dose into the entire body.
The co-creator of the chip, Dr Robert Farra, mentioned that the manage would have to be close sufficient for skin contact.
“Someone across the room are not able to reprogram your implant,” Dr Farra, from MIT, explained.
He additional: “The capability to turn the device on and off gives a particular convenience factor for people who are organizing their household.”
However the chip would not be without having its difficulties in accordance to Simon Karger.
The head of surgical and interventional company at Cambridge Consultants informed the BBC implanted technology faced some apparent hazards and difficulties.
Mr Karger explained he could “foresee a potential in which a massive selection of problems are treated via wise implanted systems”.
Even though the U.S. Supreme Court’s ruling on the Cost-effective Care Act’s contraceptive mandate is a victory for two family-owned businesses that explained the law violated their religious freedoms, it’s unlikely to adjust what most businesses have paid for for years.
Even just before the mandate beneath the Affordable Care Act kicked in, almost 90 % of U.S. employers – large and small – covered contraception. And really number of, or 12 percent, had some kind of restrict on contraceptive coverage, according to a examine of 779 employers by rewards consultancy Mercer in March of 2011.
Contraceptives were covered by 88 percent of respondents with “little variation in prevalence by employer dimension,” Mercer mentioned.
“Only 12% of people providing coverage placed any sort of restrict on the coverage in 2010,” the Mercer report said. “None of the respondents with limits chose to drop coverage in 2011. While ten% dropped the use of coverage limits in 2011, most (90%) manufactured no alterations.”
In a five-four selection, the Supreme Court sided with Pastime Lobby, a craft shop chain, and cabinet maker Conestoga Wood Specialties, which objected to the contraceptive coverage and stated such coverage imposed a substantial burden to their religious freedom. Financial penalties come with the mandate.
Opponents of the choice said it would open the door to extra difficulties but the Mercer examine and other benefits firms say most employers have currently offered broad coverage for contraception and at tiny expense to their employees.
Mercer’s review garnered responses from 157 employers with fewer than 500 staff and 401 respondents with 500–4,999 personnel and 221 respondents with five,000 or far more workers.
Asking yourself how Obamacare will influence your wellness care? The Forbes eBook Within Obamacare: The Repair For America’s Ailing Overall health Care Method answers that query and far more. Obtainable now at Amazon and Apple.
The U.S. Supreme Court has upheld a decision whereby closely-held firms can deny the ACA coverage provision for some contraceptives due to the fact of the corporations’ founding family’s religious beliefs.
Hobby Lobby and Conestoga the two refused to offer worker converge for four of the 20 contraceptive methods approved by the FDA, exclusively these that stop uterine implantation of a fertilized egg.
The Court ruled that the companies are permitted the latitude for coverage denial underneath the Religious Freedom
Recall that these businesses are not in the enterprise of conducting religious solutions or overseas humanitarian missions as their principal enterprise. They are for-profit companies. The ruling enables the companies to refuse coverage since of the religious beliefs of person leaders.
Beyond the ruling selectively singling-out women’s reproductive care, the determination raises the question of whether or not corporate leadership elsewhere might refuse coverage of other medicines due to religious beliefs. I’ve been concerned about this stage because pharmacist organizations permit the conscientious objection of individual pharmacists who refuse to fill prescriptions for emergency contraception. Would pharmacists have the correct to workout their conscience in refusing to fill opioid prescriptions since they worry the drugs will be abused?
In the dissenting view, Justices wrote far more extensively,
“Would the exemption the Court holds RFRA demands for employers with religiously grounded objections to the use of particular contraceptives extend to employers with religiously grounded objections to blood transfusions (Jehovah’s Witnesses) antidepressants (Scientologists) medicines derived from pigs, including anesthesia, intravenous fluids, and pills coated with gelatin (sone Muslims, Jews, and Hindus) and vaccinations (Christian Scientists, between others)?”
“According to counsel for Pastime Lobby, “each one particular of these circumstances . . . would have to be evaluated on its very own . . . apply[ing] the compelling interest-least restrictive substitute check.” Not significantly assist there for the reduced courts bound by today’s decision.”
The majority view held that no this kind of instances have come ahead of the court, for that reason, this kind of issues must not be anticipated. But Justice Ginsburg wrote for the minority that religious objections to immunization applications, for illustration, are not merely hypothetical. Just this year, a Brooklyn Federal District Court Judge denied a religious challenge to New York’s “social distancing” provision of their childhood immunization school laws that calls for individuals not vaccinated for a vaccine-preventable illness to keep house in the course of declared disease outbreaks.
Ginsburg also cited this quick from Liberty Counsel
The American Public Overall health Association has previously come out decrying today’s ruling. APHA Executive Director, Georges Benjamin, M.D., wrote in a four-paragraph statement,
“The ruling contradicts broadly accepted healthcare care standards, which ensure that females are not denied entry by employers to the total assortment of crucial preventive health care services…”
“…By limiting the contraceptive coverage clause, the Supreme Court positioned the curiosity of a corporation ahead of the overall health of girls. APHA and the public well being community strongly oppose today’s ruling.”
