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Curbing Population Growth pp 93–127Cite as

The Search for Better Contraception

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Abstract

Prior to the watershed year of 1959, the Ford Foundation confined its population effort to support of demographic studies, carefully avoiding entanglement with birth control or contraception lest it offend Catholic sensibilities, particularly those of the chairman of the board, Henry Ford II. But assuring itself of Henry II’s nihil obstat, the foundation made a $1.4 million general support grant to the Population Council in March 1959 that explicitly included support for biomedical research. And in June 1959 we organized a meeting of the leading reproductive scientists of the day, who agreed that while most established researchers were adequately funded, the foundation might want to increase the supply of young scientists entering the field.

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Notes

  1. Roy O. Greep, Marjorie A. Koblinsky, and Frederick S. Jaffe, eds., Reproduction and Human Welfare: A Challenge to Research (Cambridge, Massachusetts: MIT Press 1976), p. 376.

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  2. Christopher Tietze, “Intra-Uterine Contraceptive Rings: History and Statistical Appraisal” in Christopher Tietze and Sarah Lewit, eds., Intra-Uterine Contraceptive Devices, Report of a Conference, April 30–May 1, 1962 (New York: Excerpta Medica Foundation, n.d.). Tietze believed that intrauterine devices lying entirely in the uterus were confused with stem pessaries and other devices inserted into the cervix, which were notoriously ineffective and were sites of infection.

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  3. Unlike the closed Graffenberg and Ota rings, these devices are open-ended, avoiding the risk of bowel strangulation by a closed ring that may migrate out of the uterus.

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  4. Ford Foundation Trustees’ Docket, March, 1960, Ford Foundation Archives #ACC 00 1005.

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  5. Robert Sheehan and Elizabeth Weil-Fisher, “The Birth Control ‘Pill,’” Fortune, April 1958.

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  6. Ford Foundation Trustees’ Docket, March, 1960.

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  7. Roy Hertz, A Quest for Better Contraception: The Ford Foundation’s Contribution to Reproductive Science and Contraceptive Development, 1959–83 (New York: Ford Foundation, 1984), p. 6.

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  8. Ibid., p. 11. In an interview with Tabitha Powledge, Edwards noted that his research opened new leads to the study of human development and to the possibility of screening embryos for genetic defects before they are placed in the womb. With respect to contraception, Edwards asserted that his measurement of the LH (luteinizing hormone) surge prior to ovulation might lead to more effective use of the rhythm method of family planning (Tabitha M. Powledge, The Ford Foundation and the Revolution in Fertility Control, 1986, p. 63, Ford Foundation Archives). Ms. Powledge’s fascinating monograph, recounting “adventures in science” by a number of foundation grantees was commissioned by the Ford Foundation but never published because the foundation no longer funded reproductive science.

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  9. Directory of Ford Foundation Fellows in Reproductive Biology, 1960–1972, compiled by Catherine A. Craig, Ford Foundation, 1973.

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  10. The 362 respondents were self-selected; it is likely that a smaller proportion of the nonrespondent group were active in reproductive research in their home countries. About five years later foundation staff attempted to update the 1973 survey, entered a mass of data on computer tapes, but (alas!) those responsible for the project left the foundation and the data were never completely analyzed nor published.

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  11. For a systematic, expert evaluation of the Ford Foundation’s support of reproductive science and contraceptive development see Hertz, A Quest for Better Contraception, pp. 23-35.

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  12. See Population Council, Proceedings of a Conference on Immuno-Reproduction, September 9–11, 1962, Population Council Archives.

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  13. The Ford Foundation supported the work of Roger Guillemin, first at Baylor University and then at the Salk Institute. Guillemin’s work on the hypothalamic factor controlling pituitary hormones that activate the gonads won the Nobel prize in 1972, but has not yet resulted in a practical method of contraception.

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  14. A major exception to the free distribution of contraceptives through family planning clinics is the use of “social marketing” schemes in many developing countries under which contraceptives provided at no cost by USAID are packaged and sold for a modest price through indigenous marketing networks.

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  15. New York Times, October 30, 1992.

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  16. As of this writing, only two brands of IUD are sold in the United States: the Copper-T 380A, developed by the Population Council and licensed to Gynopharma; and the Progestasert, a progesterone-releasing IUD developed by the Alza Corporation, based on a prototype invented by Antonio Scogmegna under a Ford Foundation grant.

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  17. Carl Djerassi, “Birth Control after 1984,” Science 169 (September 1970):941–951.

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  18. Carl Djerassi, The Politics of Contraception (New York: W. W. Norton), p. 74, cited in C. Wayne Bardin, “Public Sector Contraceptive Development: History, Problems, and Prospects for the Future,” Technology in Society 9, nos. 3/4 (1987):292.

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  19. Cited in P. Roy Vagelos, “Are Prescription Drug Prices High?” Science 252 (May 1991):1080.

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  20. C. Wayne Bardin, “Public Sector Contraceptive Development,” p. 291.

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  21. Djerassi, “Birth Control After 1984,” p. 944.

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  22. Ibid., p. 951.

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  23. Phyllis Piotrow, World Population Crisis: The United States Response (New York: Praeger, 1973), p. 175.

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  24. E.-E. Baulieu, “RU-486 as an Antiprogesterone Steroid,” Journal of the American Medical Association 262 (October 1989):1808-1814.

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  25. Piotrow, World Population Crisis, pp. 176-177.

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  26. IFRP subsequently enlarged its scope to cover a broad range of reproductive health topics, including AIDS prevention, and changed its name to Family Health International, under the dynamic leadership of Dr. Malcolm Potts.

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  27. Others include the International Organization for Chemical Sciences in Development (IOCD), the Contraceptive Research and Development Program (CONRAD) initiated in 1987 by USAID, and in the developing world, contraceptive development activities supported by the Indian Council for Medical Research (see Bardin, “Public Sector Contraceptive Development,” p. 295). Newer efforts include the Rockefeller Foundation’s South-to-South Network, sponsoring collaborative research by Third World investigators, spearheaded by Sheldon Segal; and contraceptive research centers established by the National Institutes of Health at the Universities of Virginia and Connecticut.

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  28. Population Council, A Chronicle of the First Twenty-Five Years, 1952–1977 (New York: Population Council, 1978), pp. 63–65.

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  29. At Population Council headquarters there is a giant photograph of Harold Nash and Irving Sivin—council staff responsible for preparing documentation for submission of clinical data on the NORPLANT contraceptive implant to the FDA—standing next to two piles of these documents. The piles of paper tower over the two scientists.

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  30. Population Council, Chronicle, pp. 94-95.

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  31. Population Council, Annual Report, 1990, p. 85

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  32. In fact, these royalties are not earmarked for ICCR but are returned to the Population Council’s general budget.

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  33. Population Council Annual Report, 1990, p. 138, and 1993, p. 130, The council spent $6.5 million on contraceptive development in 1990, $9.7 million in 1993.

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  34. Ford Foundation grants for reproductive research contain an agreement that requires nonexclusive licensing of any patents arising from the grant to all applicants; granting of an exclusive license requires approval by the foundation. In 1968 the foundation made a grant to Antonio Scogmegna of Michael Reese Hospital under which he developed an intrauterine device that emitted progesterone. In response to the Alza Corporation’s request for an exclusive license to manufacture a version of Scogmegna’s device under the brand name of Progestasert, the foundation and Alza entered into lengthy negotiations resulting in Alza’s agreement to offer Progestasert to family planning clinics at cost in bulk quantities. (Reaching agreement on a formula to calculate the “cost” of this product took more than a year of negotiations.) Planned Parenthood of America was to serve as purchasing agent for all family planning clinics in the United States, but withdrew when a few reports appeared of birth defects for babies born to mothers wearing the device. The defects may well have occurred by chance, but Planned Parenthood was unwilling to risk product liability lawsuits.

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  35. NORPLANT is covered by Medicaid in every state. But the low insertion and removal fee allowed physicians under most Medicaid programs may prevent many family planning clinics from offering NORPLANT to their clients (see Alan Guttmacher Institute, Washington Memo, April 4, 1991, pp. 1-2). As is true of medical care in general, the working poor who are ineligible for Medicaid are unlikely to afford NORPLANT.

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  36. Piotrow, World Population Crisis, pp. 201-202.

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  37. Special Programme of Research, Development and Research Training in Human Reproduction, Reproductive Health: A Key to a Brighter Future (Geneva: WHO, 1992), pp. 44–45.

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  38. This estimate was developed in collaboration with my Ford Foundation biomedical colleague, Dr. Anna Southam, for a consultants’ report on population and family planning to the U.S. Secretary of Health, Education, and Welfare in 1967.

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  39. Alex Kessler, the Expanded Programme’s first director, who was reluctant to acknowledge the Ford Foundation’s role in creating his program, describes this funding as follows: “Sweden pledged US $300,000, and Canada and the Ford Foundation also made contributions” (Special Programme, Reproductive Health, p. 48).

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  40. WHO as a whole tends to irritate other agencies involved in international health activities by insisting on exercising its “constitutional function... to act as the directing and coordinating authority of international health work” (Special Programme, Reproductive Health, p. 54).

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  41. The original HRP task forces dealt with regulation of implantation, ovum transport, the fertilizing ability of sperm in the male, sperm migration and survival in the female, prostaglandins in fertility regulation, sequelae and complications of induced abortion, and acceptability of fertility regulation methods (Alan Barnes, Bruce Schearer, and Sheldon J. Segal, “Contraceptive Development,” Third Bellagio Conference on Population, May 1973, Working Papers, The Rockefeller Foundation, June 1974, p. 76). As additional promising areas of research were identified, new task forces were formed and others abandoned.

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  42. Special Programme, Reproductive Health, pp. 24-25.

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  43. Special Programme of Research, Development and Research Training in Human Reproduction, Annual Technical Report, 1991 (Geneva: WHO, 1992), p. 10.

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  44. Ibid., p. 22.

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  45. For example, Linda E. Atkinson, Richard Lincoln, and Jacqueline Darroch Forrest, “The Next Contraceptive Revolution,” Family Planning Perspectives 11, no. 4 (December 1985):100-107.

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  46. Bardin, “Public Sector Contraceptive Development,” p. 305.

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  47. New York Times, May 4, 1994, and May 17, 1994.

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  48. Bardin, “Public Sector Contraceptive Development,” p. 301.

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  49. Oscar Harkavy, “Funding Contraceptive Development,” Technology in Society 9, nos. 3/4 (1987):317.

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  50. Joan Dunlop, Presentation to Board of Directors, Population Resource Center, November 17, 1992. ICCR is currently testing one-and two-year versions of NORPLANT.

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  51. In the United States some judges have advocated a coercive use of NORPLANT by requiring child abusers or drug-addicted mothers to submit to insertion of this contraceptive as an alternative to incarceration. Sheldon Segal, inventor of NORPLANT, has written and spoken widely against coercive use of this method (Population Council, Annual Report, 1991, pp. 70-72).

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  52. Ibid., p. 37.

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  53. New York Times, November 29, 1992, p. D10.

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  54. For example, in Thailand only about 1 percent of married couples use condoms for contraception (Family Health International FHI], Network 13, no. 1 (August 1992):25).

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  55. Some years ago a mock scientific article appeared heralding the invention of an “intrapenile device.” This consisted of a small umbrella inserted in the urethra that when opened might cause “some discomfort” but would prevent emission of semen and hence serve as an effective male contraceptive.

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  56. Nash Herndon, “Looking for the ‘Male Pill,’” FHI Network 13, no. 1 (August 1992):21. Sheldon Segal (personal communication) is wary about the use of an androgen to restore the testosterone level knocked out by LHRH. He notes that there is great variability in the release of hormones by implants, with the expectation that abnormally high or low levels of testosterone may be produced in some patients. Interviewed for the Network article, Segal declared: “Androgen is just another way of saying anabolic steroid. You’d be giving a man the same stuff that we kick kids off the Olympic team for using. You have to be very, very careful administering androgens to assure that you stay with the normal ranges” (pp. 22-23).

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  57. Ibid., pp. 22-23.

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  58. Population Council, Annual Report, 1991, p. 70.

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  59. Ibid., p. 25.

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  60. Special Programme, Annual Technical Report, 1991, pp. 44-45.

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  61. Royal Society and National Academy of Science, Joint Statement, “Population Growth, Resource Consumption, and a Sustainable World” February 1992, quoted in Population and Development Review 18, no. 2 (June 1992):377.

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  62. Ibid., p. 383.

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  63. United Nations Conference on Environment and Development. A/CONF.151/4 (Part I), 22 April 1992, p. 24, United Nations.

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  1. The Ford Foundation, New York, New York, USA

    Oscar Harkavy

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Harkavy, O. (1995). The Search for Better Contraception. In: Curbing Population Growth. The Springer Series on Demographic Methods and Population Analysis. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-9906-4_5

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