Innovations and challenges in global contraception and family planning

Contraception and family planning are vital aspects of sexual and reproductive health and rights. Despite major advances in modern contraception over the past 60 years, many gaps remain and the rate of unplanned pregnancies and abortions remains high. These issues have given rise to a new era in contraception research with great opportunities and many challenges.

In the second in a series of five papers in Lancet about innovations in sexual and reproductive health, researchers led by Deborah Anderson PhD, professor of medicine at Boston University Chobanian & Avedisian School of Medicine, address global trends and current contraception use, as well as barriers to use. They also focus on underserved populations such as adolescent girls and young women, men, and transgender and gender non-binary populations, and include action items intended to improve contraception choices.

Despite major advances in contraceptive technologies over more than half a century, substantial unmet needs remain. In recent years approximately 50% of pregnancies worldwide have been unintended, leading to a high rate of abortion. Providing improved contraception choices will enhance the health, economic status and well-being of women and their families and is an important step towards social justice,"

Deborah Anderson PhD, professor of medicine, Boston University Chobanian & Avedisian School of Medicine

UN survey data from 2024 revealed that 57% of reproductive-age women worldwide reported wanting to avoid pregnancy at the time they were questioned, highlighting a desire to postpone, space out or stop childbearing. Of these women, an estimated 77% reported having used a modern method of contraception to prevent pregnancy and approximately 15% did not use any contraception.

The researchers point out there are substantial differences in modern contraceptive use across the world, ranging from 40% to 83% in Africa, for example, depending on the region, and 77% to 89% in the high-income countries of Europe. Although men share responsibility for 100% of unintended pregnancies, they comprise less than one quarter of the population using contraception. Only 2% of men worldwide opt for a vasectomy and approximately 20% of couples use male condoms as their primary contraception method.

While contraceptives with hormonal mechanisms of action (pills, rings, implants, injections and hormonal intrauterine devices) are highly effective, the researchers point out that they are associated with serious side-effects and health risks making them a barrier for certain women. Other barriers for contraceptive use include infrequent sex, religious beliefs and individual or social opposition.

Anderson believes underserved populations need immediate attention when it comes to contraception. She points out that adolescent pregnancies are a universal challenge and occur in all countries, but are more likely to occur in marginalized families and communities.

"Adolescent girls and young women have unique needs and experience more barriers to accessing available reproductive health services than adults because of restrictive laws and policies, lack of education, financial hardship, stigma or lack of family or community support," says Anderson.

Men can face cultural pressure to prove their fertility, and no new male contraception methodologies have entered the market in over 100 years. Some transgender and gender non-binary individuals might engage in sexual activity that has the potential for pregnancy, particularly in individuals who have not undergone gender-affirming genital surgeries.

According to Anderson, gains in modern contraceptive use have stagnated over the past 25 years. Among the action items she and her colleagues recommend are:

• Current contraception gaps should be addressed by intensifying modern basic and clinical research including social and behavioral science. Intensification of financial support from government philanthropic and industrial entities is needed to produce novel contraceptives that address some of the current gaps within the next decade.

• Needs of underserved populations should be addressed to achieve equity and

population-level impact.

• Novel products and intensified messaging are needed to increase male contraception. Two new reversible male contraceptives are currently in clinical trials: NET/T, a hormonal method, and YCT-529, a testicular enzyme inhibitor. Both methods reversibly inhibit spermatogenesis to decrease the number of sperm in semen. Another promising drug, TDI-10229, reversibly inhibits sperm motility.

• Technological advancements are necessary but understanding user preferences

will be key to guaranteeing adoption and success.

• Providers are key actors and must be trained and supported by health systems to

inform, educate, and counsel users to achieve their sexual and reproductive goals

through informed choice.

• The best way to improve family planning and promote the health of women and their families is to offer better contraception education and more options to those who wish to avoid unplanned pregnancy.

The presentation of this paper along with the other Lancet papers of this series will take place at The Lancet Innovations in Sexual & Reproductive Health Series Launch on Oct. 31, 2025, at Fenway Health.