Access to
Reproductive Health

Access to
Reproductive Health

Our commitment to providing access to reproductive health starts with our research and development, which has resulted in a diverse portfolio of contraceptive products.

Over the years, we have been responsible for the development of a wide range of contraceptive options, including a single-rod contraceptive implant, a once-monthly vaginal contraceptive ring, and progestin-only and combined oral contraceptives.

In 2016, our researchers continued to develop new women’s health products to better meet conditions in developing countries.

Beyond our research, we continue to work hard to develop sustainable business models that will help improve access to our products for the people who need them most. Our partnerships with governments, international organizations and nongovernmental organizations (NGOs) help support and implement programs and policies that improve access and promote capacity-building by helping to train health care professionals and address barriers to care.

SUSTAINABLE BUSINESS MODEL TO PROMOTE ACCESS

We are committed to making our contraceptive products available to women around the world. We take a comprehensive approach to access that includes high-quality manufacturing and supply chain management; extensive registration and World Health Organization (WHO) prequalification for a wide variety of our family-planning products; responsible commercialization that incorporates training and capacity-building; policy advocacy; and community investment.

In developing countries that have high rates of maternal mortality and low rates of contraceptive prevalence, we have created a sustainable business model to promote access to contraceptive health programs. These activities are focused primarily on sub-Saharan Africa and countries in Asia and Latin America with high unmet need. Through this model, we work closely with core global partners and their regional and local affiliates─including United Nations Population Fund (UNFPA), U.S. Agency for International Development (USAID), Department for International Development (DFID), Marie Stopes International, the International Planned Parenthood Federation, DKT International, the Clinton Health Access Initiative, the Bill & Melinda Gates Foundation, and Population Services International─to help expand access to our products.

We also work to raise awareness and improve equity in access to contraception in other parts of the world. In Europe, we are working to support efforts to launch our “Call to Action for Access to Effective Contraception” at the EU and country levels, and are liaising with stakeholders to elevate awareness and generate potential solutions for improvement.

HIGH-QUALITY MANUFACTURING & SUPPLY CHAIN MANAGEMENT

We work to ensure that we have sufficient manufacturing capacity to meet short-, medium- and long-term availability of our contraceptive products to meet customer needs globally.

We continuously examine our supply chain, seeking to reduce inefficiencies, optimize yields and lower costs of production, and have passed these savings on to our customers in the form of lower prices, particularly in lower-income markets. We also invest in new technologies to increase the efficiency of our operations and to be able to produce more affordable products at the same high quality to meet increasing demand.

REGISTRATION & PREQUALIFICATION

We seek to ensure global access to our contraceptive products by obtaining and maintaining up-to-date product registrations around the world. In addition to existing and in-process registrations, numerous registrations are planned for products in countries of various income levels.

REGISTRATION

The following metrics are for our family planning products intended for underserved segments of the world’s poorest countries (defined as Family Planning 2020 or FP2020 countries) that are supplied through the public sector and social-marketing organizations. In 2016, IMPLANON NXT® (etonogestrel implant) was approved in several FP2020 countries including, but not limited to, Egypt, Sri Lanka and Nepal.

Note: For World Bank country classifications, please click here.

IMPLANON® or IMPLANON NXT® EXLUTON® MARVELON 28®
Product is WHO-prequalified Yes Yes Yes
Number of FP2020 countries where product is registered / # pending IMPLANON NXT1 44/3 25 24
Number of FP2020 countries in which we supplied product 36 6 7
Women potentially reached in FP2020 countries2 3,801,800 417,675 188,427
1. There are additional unregulated markets where our products may be available that are not represented by these numbers.
2. Number represents potential number of women who could be reached based on number of products provided.

PREQUALIFICATION

In order to facilitate institutional purchases of family-planning products and provide quality assurance, we have secured WHO prequalification for EXLUTON (lynestrenol), IMPLANON (etonogestrel implant), IMPLANON NXT (etonogestrel implant) and MARVELON 28 (desogestrel-ethinyl estradiol).

IMPLANON NXT is also included on the WHO Model List of Essential Medicines. The WHO List, updated every two years, serves as a guide for the development of national and institutional essential medicine lists. Medicines for inclusion are selected by WHO based on a rigorous review process by an Expert Committee of public health and clinical experts.

Product International Nonproprietary Name (IN) Date of Prequalification
MARVELON 28Ethinylestradiol + Desogestrel 21-Oct-10
IMPLANONEtonogestrel 18-Jun-10
EXLUTONLynestrenol 18-Jun-10
IMPLANON NXT Etonogestrel 23-May-13

COMMERCIALIZATION

The success of reproductive health programs in the developing world relies upon the close cooperation and coordination of many partners. Those include pharmaceutical companies like ours that discover, develop and manufacture contraceptive products; national governments that seek to support family planning through policies that increase the use of contraception and through investment in both procurement and capacity-building; international, bilateral and multilateral donors that finance the purchase of reproductive health commodities and invest in service delivery management and implementation; NGOs that support implementation of such programs; and health care professionals and health extension workers who counsel and provide care for women around the world.

As one of many partners, we take the following steps (details below) to support family planning programs and to help increase awareness of and access to a broad choice of contraceptive products:

  • Requests for quotation
  • Pricing
  • Partnering for implementation
  • Public advocacy

REQUESTS FOR QUOTATION

Our company receives and responds to “Requests for Quotation” from developing countries’ governments seeking supplies for their own programs (financed by government funds, by multilateral organizations like the World Bank, or through bilateral aid); from donor country aid agencies (e.g., USAID, DFID and KfW, a German government-owned development bank) seeking to purchase reproductive health commodities that will be donated to programs in one or more countries; from multilateral agencies, such as UNFPA, donating to one or more countries; or from nongovernmental agencies seeking supplies for programs that they manage in one or more countries.

In responding to these requests, we adhere to the specific guidelines of each proposal and act in full compliance with local and international laws and requirements.

PRICING

For contraceptive product pricing, we consider a nation’s level of economic development and other relevant factors, including the types of family planning programs implemented by the local government.

In upper-middle-income and high-income countries, we provide our products at prices that take into account the innovation and value they represent. With a commitment to making our contraceptive products available to the public sector, we also offer discounts to organizations that serve women of all income levels, like Planned Parenthood affiliates, so that the women who rely on their services have routine access to contraceptive options that include non-daily and long-acting reversible methods.

We believe that our pricing approach will help improve product availability while also allowing the company to continue to invest in research, development, production, and the training and education necessary to help ensure appropriate counseling on and use of our products.

We are extending our access pricing to targeted countries through 2023, an additional five years beyond the expiration of our 2013 agreement.

In May 2013, our company and the Bill & Melinda Gates Foundation announced an agreement to expand contraceptive access and options for millions of women in some of the world’s poorest countries. Under the agreement, we reduced the cost of IMPLANON and IMPLANON NXT, by approximately 50 percent through 2018 in the targeted poorest eligible countries of focus for the reproductive health community. Learn more.

Since 2013, we have supplied an estimated 20 million implants, bringing greater choice to millions of women in the world’s poorest regions.

In November 2015, we announced our decision to extend our access pricing to these same targeted countries through 2023, an additional five years beyond the expiration of the 2013 agreement.

PARTNERING FOR IMPLEMENTATION

For family planning programs in the developing world involving our contraceptive implants IMPLANON and IMPLANON NXT, the company requires the recipient governments and partnering NGOs to sign its Cooperation Agreement for the Receipt and Use of IMPLANON (CARUI).

The cooperation agreement includes:

  • Our commitment to a comprehensive service approach that provides and/or supports capacity-building in service delivery, including pre- and post-insertion counseling and insertion/removal training
  • Distribution requirements that must be met by our company and local partners to ensure that all clinics/providers meet training and quality assurance requirements, provide sustained services over the duration of the product’s life (three years), and can access referral centers in case more specialized care related to IMPLANON is required
  • Procedures to report product complaints and adverse events
  • Provisions regarding compliance with the applicable laws of the U.S. and the recipient country, and with our ethical and business compliance policies

In the countries where our products are included in family-planning programs, we work closely with ministries of health and local implementing partners, who play a pivotal role in supporting training, counseling and other related activities. Our local implementing partners have included Jhpiego, EngenderHealth, the Clinton Health Access Initiative, Marie Stopes International (MSI), the International Planned Parenthood Federation (IPPF), Population Services International, DKT and Pathfinder International. Such collaboration ensures that countries have the expertise and support they need to achieve their reproductive health objectives.

In February 2015, we announced, as part of our commitment to health care provider training, that we would provide IMPLANON NXT placebo training applicators at no cost in FP2020 countries. During 2016, we provided approximately 78,000 placebos, and supported “training of trainers” by providing other training materials, including audiovisual materials, training kits and artificial arm models. We have also committed to providing placebos at no cost in these countries through 2017.

In 2016, we worked with more than 42 countries in sub-Saharan Africa, Asia and Central America to provide contraceptive products through numerous partnerships with governments, donors and NGOs. Some of the countries we engaged with included Madagascar, Ethiopia, Kenya, Uganda, Tanzania, Nigeria, Honduras, the Democratic Republic of Congo, Chad, Somalia, South Sudan, Cambodia, Laos and Myanmar.

In 2016, we worked with partners in innovative ways to further expand awareness and access and strengthen health systems in low- and middle-income countries.

For example:

  • In Côte d’Ivoire, our company’s Information Technology employees supported a project with the country’s ministry of health to develop an SMS-based system that will allow health center workers to use their mobile phones to order supplies from district warehouses and better manage their local inventory. The system will also help regional and national health workers to better forecast future supply needs and avoid product stock-outs.
  • In Nigeria, we provided support to the Human Network International for the development of a free, on-demand information service via mobile phones for the general public. The service provides information on health, agriculture, microfinance, family planning, and land tenure in the local language.
  • In the Democratic Republic of Congo, we are working with Tulane University to support a pilot project to train and deploy medical students to serve as community-based distributors of contraceptive methods in the nation’s capital, Kinshasa. If successful, the pilot will show that it is possible to increase access to a broad range of contraceptive options by bringing medical students into the community rather than expecting women to travel significant distances to the nearest clinic.
  • In the Philippines, our company worked with the Integrated Midwives Association of the Philippines to conduct “Train the Trainer” sessions for implant provision, and supported learning sessions for best-practice sharing in counseling, implant insertion, and referrals for removal. Through these initiatives, newly trained midwives can connect with more experienced midwives for guidance and support through a “Community of Practice” and ultimately decrease the learning curve.
  • In Puerto Rico, we are working with the CDC Foundation through the Zika Contraception Access Network to address an urgent need to improve contraception access on the island during the Zika outbreak. Through the initiative, our company is helping to enable access to our contraceptive products NEXPLANON (etonogestrel implant) and NUVARING (etonogestrel/ethinyl estradiol vaginal ring), and is providing training and education support to local health care providers.

BRINGING A NEW CONTRACEPTIVE TOOL TO WOMEN IN SOMALIA

In 2016, women in Somalia began to receive a new family-planning option—IMPLANON NXT. Somalia has one of the highest fertility rates in the world.

Our company worked with UNFPA and the ministries of health from the three autonomous regions in Somalia—Somaliland, Puntland and Mogadishu—to hold a two-and-a-half-day training session for Somali health care workers. Because of civil strife in the country, the health providers from the three autonomous regions traveled to neighboring Djibouti, where they reunited to learn clinical data, insertion and removal techniques, and effective counseling methods. They also discussed cultural barriers, misperceptions and fears that limit the use of family planning in their country, and strategies to overcome these challenges.

PUBLIC ADVOCACY

We support the ambitious─but, we believe, achievable─ goal set by the public health community in 2012 of ensuring that voluntary lifesaving family planning information, services and products reach an additional 120 million women and girls in the world’s poorest countries by 2020.