There are many markers that define advanced civilization. Access to a steady supply of food and good health care are both critical, as is ubiquity of education and relief from the most dangerous forms of labour. Add family planning to that list. The freedom for people to have babies when they want, and not have them when they don’t want to, provides a sturdy foundation for families, and indeed societies, to thrive. In low- and middle-income countries (LMICs), family planning is increasingly seen as central to sustainable development.
The technology of birth control has come a long way. Women are starting to gain access to methods of contraception that avoid some of the more bothersome side effects of conventional hormonal drugs. Particularly appealing are ‘set and forget’ approaches, such as subcutaneous implants and intra-uterine devices, which, once in place, protect against pregnancy for years. New approaches are also emerging for men, including a hormonal gel that is the first new male contraceptive to enter efficacy testing in more than five years, as well as non-hormonal drugs that reduce the motility of sperm.
Ever since the first test-tube baby was born more than 40 years ago, couples who found themselves shut out of baby-making have been turning to in vitro fertilization (IVF). Access to this process has been limited by its high cost, especially in LMICs. But the latest technologies — and attitudes — aim to address these inequities.
Reproductive issues have long spawned controversy. One with life-and-death stakes surrounds the use of misoprostol, a drug that helps to prevent uterine haemorrhage but that can also be used by women to terminate their pregnancies without medical assistance — a practice forbidden in many parts of the world.
Debate also swirls around the role of religion and economics in family planning, particularly in the United States, which seems to be sliding back from the policy of former president Barack Obama’s administration to cut the cost of contraceptives.
We are pleased to acknowledge the financial support of Bayer AG, Pharmaceuticals in producing this Outlook. As always, Nature retains sole responsibility for all editorial content.
Nature 588, S161 (2020)