Predictions: The future of family planning
Predictions: The future of family planning
By Robert Hatcher, MD, MPH
Professor of Gynecology and Obstetrics
Emory University School of Medicine, Atlanta
Dan Quayle, former U.S. vice president, warned us that "predictions are particularly difficult when you are talking about the future." In spite of his remarkable advice, I’ll suggest two advances I believe will happen and make an extremely positive contribution. I also will outline one advance I believe will happen, but if it does, I doubt that it will make much difference:
1. I believe the most important advance will be the development of vaginal spermicides that also effectively kill the bacteria and viruses that cause infection. We are not near having this spermicide today. This advance is extraordinarily important because many women simply cannot count on men to cooperate in the prevention of infection and/or in the prevention of an unintended pregnancy.
2. We are very close to being able to offer women a nearly 100% effective approach to preventing pregnancy the day after intercourse. It would not surprise me if this is what women are doing 20 to 50 years from now. Each act of intercourse would trigger the response: I need to take my pill. For some women that response would occur twice a year. For others, twice a month or twice a week. Intercourse would be the reminder. We already have a medication that would do this. A woman could take 10 mg of mifepristone (RU-486), and this medication would be close to 100% effective. Moreover, a woman could be days late taking her postcoital pill, and it would still work.
3. In the future, there may be some hormonal pills or injections for men. If this happens, we will all celebrate. However, I am not nearly as convinced that those therapeutic agents will be developed. Furthermore, I question the impact improved methods for men would have.
Two excellent methods
Two developments in the late 1800s continue to serve as excellent methods for couples in the year 2000. Latex condoms followed quickly after the 1839 vulcanization of rubber by Charles Goodyear, and in 1893, Reginald Harrison did the first vasectomy. I consider those two methods, both available by the year 1900, to be the two best contraceptives available to couples in the year 2000. Neither is used today to the extent one might wish.
After several negative tests for sperm in masturbation specimens (repeated shortly after a vasectomy, one year later, and several years after that), a couple can be close to 100% certain that pregnancy will not occur. Vasectomy is therefore the most effective method we have in the year 2000, but it is underutilized.
Condoms work! Studies of populations of women using condoms perfectly — that is, correctly and consistently — demonstrate that condoms do the job. Moreover, other than abstinence and a mutually monogamous relationship between two people, both of whom have no infection, condoms today are the only serious approach to HIV and STD prevention. But condom use is pitiful worldwide and poor in the United States.
In my opinion, our best two methods in the year 2000 are both male methods. But men must use them, and they simply don’t. I doubt that pills or injections for men would be received any more positively. This leads me to my final prediction for the new millennium. Political leaders, religious leaders, and physicians — usually men — have controlled the reproductive destinies of women for all too long. This must stop! If it does not, the major reproductive problems facing the world in 25, 50, or 100 years will remain the same.
For advancements in reproductive health to take place, the status of women in the home, in various cultures and ethnic groups, in religious bodies, and in medical communities must improve. If that does not happen, today’s reproductive health problems will persist. I’m betting the status of women will improve.
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